title: Recommendations for the proper use of nonprescription cough suppressants and expectorants in solid-organ transplant recipients.
abstract: OBJECTIVE
  To describe the pharmacology and safety of oral over-the-counter cough suppressants and expectorants and to present recommendations for the use of these agents in solid-organ transplant recipients based on the potential for adverse drug reactions or drug-disease interactions.
  
  
  METHODS
  Data from journal articles and other sources describing the pharmacology and safety of over-the-counter cough suppressants and expectorants, drug-drug interactions with immunosuppressive agents, and drug-disease state interactions are reviewed.
  
  
  RESULTS
  Potential and documented drug-drug interactions between immunosuppressive agents and over-the-counter cough medications guaifenesin, dextromethorphan, diphenhydramine, and codeine were evaluated on the basis of pharmacokinetic and pharmacodynamic principles. Interactions between these cough medications and the physiological changes in the body following transplantation also were examined.
  
  
  CONCLUSIONS
  Diphenhydramine requires additional monitoring when used to treat cough in transplant recipients owing to its anticholinergic properties and the potential for interactions with cyclosporine. Dextromethorphan can be used in most transplant recipients, although greater caution should be exercised if the patient has undergone liver transplant or has liver impairment. Guaifenesin can be used in transplant recipients but should be used with caution in patients receiving kidney or lung transplants and in patients with renal impairment. Codeine combined with guaifenesin is another option for cough and can be used in most transplant patients although those with reduced renal function should be monitored carefully for adverse events.
authors.affiliation: Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA. sgabardi@partners.org
authors.forename: Steven
authors.initials: S
authors.lastname: Gabardi
authors.forename: Danielle
authors.initials: D
authors.lastname: Carter
authors.forename: Spencer
authors.initials: S
authors.lastname: Martin
authors.forename: Keri
authors.initials: K
authors.lastname: Roberts
mesh_terms: D000996:Antitussive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D003061:Codeine / Q000009:adverse effects / Q000627:therapeutic use; D000075202:Contraindications; D003915:Dextromethorphan / Q000009:adverse effects / Q000627:therapeutic use; D004155:Diphenhydramine / Q000009:adverse effects / Q000627:therapeutic use; D004347:Drug Interactions; D016903:Drug Monitoring; D004363:Drug Utilization; D005100:Expectorants / Q000009:adverse effects* / Q000627:therapeutic use; D006140:Guaifenesin / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D004366:Nonprescription Drugs / Q000009:adverse effects* / Q000627:therapeutic use; D016377:Organ Transplantation; D012449:Safety
chemical_list: D000996:Antitussive Agents; D005100:Expectorants; D007166:Immunosuppressive Agents; D004366:Nonprescription Drugs; D006140:Guaifenesin; D003915:Dextromethorphan; D004155:Diphenhydramine; D003061:Codeine