WebMD Ask the Pharmacist

Digestive Problems: Ask the Pharmacist

June 8, 2010. Pharmacist Heather Free, PharmD, answers questions about treatment for digestive problems.

Question:

I take Trinsicon and have a problem with GI upset. I have taken it with food and on an empty stomach, with no relief. My hemoglobin is so low, and I would hate to just stop taking it. Help!

Answer:

Trinsicon is a multivitamin used to help treat or prevent low levels of iron. It contains iron with B12, vitamin C, folic acid, and intrinsic factor. Generally, this medication is well tolerated, especially when the directions are followed, including taking this medication as directed by your physician. It may be taken with food or a meal if stomach upset occurs. Take each dose with a full glass (8 oz or 240 ml) of water, unless your doctor directs you otherwise. Swallow it whole. Do not crush or chew. Do not lie down for 30 minutes after taking this medication. It is important not to exceed the recommended dosage.

The common side effects for this mediation are constipation and stomach upset. This is largely due to the iron component and can be minimized by eating a meal when taking the tablet, and by using a stool softener for extended complications with constipation. If all the instructions have been followed and the side effects become more intense, you should consult your health care professional.

You may also consider working with your pharmacist to find an alternative medication. There are several brand names for this vitamin that you could try to see if you experience lesser side effects. Iron is also formulated as a slow-release product. Hope this helps!

Question:

I’m having upset stomach, vomiting, and diarrhea. Can diclofenac cause these symptoms?

Answer:

Common side effects for this medication include diarrhea, dizziness, drowsiness, gas, headache, indigestion, nausea, stomach pain or upset, and vomiting. Your upset stomach can be minimized by taking the enteric coated form (do not break or crush), as well as taking the medication with food. If the side effects worsen over time, consult your health care provider or pharmacist to find a medication that is right for you.

Question:

I live in Hong Kong and I have European-named prescriptions. I would like to know if I can safely take the following medicines together: omeprazole 20 mg, atenolol 100 mg, domperidone 10 mg, and alprazolam 25 mg.

Answer:

First, it is important to remember that medication from other countries can sound alike, but can vary in indication and strength. I could not tell you exactly how equivalent these medications are to the medications we use in the United States.

I am unable to tell you about the interactions of domperidone with any of the other medications. But I can tell you that there are no major drug interactions when taking omeprazole, atenolol, and alprazolam. I would advise you to check with your pharmacist in Europe or in China to see if they have an international medication book.

Question:

What over-the-counter drugs can I use for hemorrhoid relief?

Answer:

Depending on the severity of your hemorrhoid condition, there are plenty of over-the-counter products that you can purchase. The over-the-counter FDA-approved products for treatment of hemorrhoids include Preparation H products and Tucks pads. Both of these products also have generics available.

Preparation H has many different formulations, which contain different ingredients. Therefore, reading the label to look at the active ingredients is important. The wipes contain witch hazel, which is used as an astringent. The cream, gel, and ointment products have many different ingredients. Phenylephrine is used as a vasoconstrictor. Hydrocortisone is for anti-itch. And pramoxine serves as a local anesthetic.

Either Preparation H products or Tucks pads can help temporarily relieve your symptoms, until you are able to see your health care professional. Make sure you inform your health care professional about what over-the-counter medications you’ve used and for how long you used them.

Question:

If I have some Miralax that expired 12/09, would it be a bad idea to give it to anyone?

Answer:

Expiration dates are printed on the medication container for a reason. I would advise you NOT to use this medication, since the expiration date has passed. Medications can change effectiveness. And you wouldn’t know how to supplement the dose to make it accurate. Some medications can become “sour” after they expire. And you wouldn’t want to become sick from taking an expired medication.

I would dispose of expired medication with a local pharmacy, through a local drug take-back program (check with your local police department), or through proper disposal at home. To dispose of medication at home, mix drugs (crush first if in tablet form) with an undesirable substance, such as cat litter or used coffee grounds, and place in a plastic sandwich bag. Seal the bag and double bag to prevent leakage. Throw the bag in the trash, keeping it out of reach of children and animals. Do not flush medication down the toilet or pour it into a drain.

Question:

Can I take Vicodin if I have had gastric bypass surgery?

Answer:

There has been much discussion about the low absorption of medications after gastric bypass surgery. In your case, the absorption should not be affected. However, we are more concerned about side effects from medications that can hurt your system after this serious procedure.

Pain medications have been used after gastric bypass surgery, although sparingly. It is important to remember that Vicodin (hydrocodone and acetaminophen) can cause constipation. We do not want to further increase your risk of discomfort. So minimal use of pain medication, with or without a stool softener, is advised. The important key is to weigh the risks and benefits. We do not want you to be in pain, but we also don’t want to over medicate or cause too many side effects.

With proper rest and healing time, pain medications may not have to be used at all. Follow the advice and instructions you received from your surgeon.

Question:

My son vomited about 10 minutes after taking a second dose of penicillin for strep throat. He has never had any adverse reactions to penicillin before, other than feeling poorly afterward. Should he take the next dose?

Answer:

Penicillin can be harsh on the stomach. It is important to take it with food and not on an empty stomach. Your pharmacist may also be able to flavor the medication to make it easier for your son to take.

I would make sure the vomiting has subsided before giving him another dose. Since I don’t know the original diagnosis or the reason for his penicillin prescription, I wouldn’t know if the condition is causing the vomiting or the medication. Let his stomach settle a bit and try giving him something small to eat, something that will be light on his stomach. See if he can hold this down before giving him another dose of medication.

If the vomiting continues, consult your health care provider to discuss an option that may be less upsetting to his stomach.

Question:

Does Phillips' laxative contain aspirin?

Answer:

Phillips' Milk of Magnesia only contains magnesium hydroxide as the active ingredient. This product does not contain any aspirin.

Question:

Can you take Dramamine and Pepto-Bismol at the same time?

Answer:

At present, there has been no drug interactions reported between Pepto-Bismol (bismuth subsalicylate) and Dramamine (dimenhydrinate, for chewables and original formulas, meclizine for less drowsiness). It is important to check with your local pharmacist to make sure that no drug interactions are discovered between these two products.

Question:

What pain drugs can be taken while abstaining from NSAIDs after a GI bleed, due to irritation caused by vomiting?

Answer:

That's too broad of question to answer fully.
Depending on the type of pain you are treating and any other existing conditions, acetaminophen is an over-the-counter medication you might consider for pain relief. But read the directions on the label first to make sure this medication suits your needs. I’d also advise you to ask your local pharmacist about other products that can replace your NSAIDs while your stomach is healing.

Question:

I’ve been taking generic Toprol XL 50 mg for a while. I had an endoscopy last week, and I’m noticing that I’m excreting the medication still intact. I first noticed two tablets in my stool. Today, there were five. Is something wrong with the medication or could there be another cause? Has my body started holding the tablets in my intestine?

Answer:

Toprol XL is an extended-release blood pressure medication. It is not uncommon for medications that have the enteric coating or protective surroundings to be excreted in the stool. This does not mean that your body did not absorb the medication. The active ingredient has been absorbed, while the coating has passed through your digestive tract. The coating is what protects the medication so that it will last longer in the body and act over a longer period of time.

As long as your blood pressure is being controlled and there is no interference with your colon, I’d advise you to continue the therapy.

Question:

I have celiac sprue and my doctor prescribed Bystolic to treat it. My pharmacist informed me that this medication may contain wheat. I would like to know if this is true.

Answer:

According to the manufacturer, Bystolic “may contain corn starch or wheat starch.” Therefore, Bystolic is not gluten-free. If you need to maintain a totally gluten-free diet, I would be cautious when taking this medication.

I recommend that you work with your health care provider to see what is best for you. If you need more questions answered about this medication, you can contact Forest Laboratories at 800-678-1605.

Question:

This morning I had to go to the hospital for a routine blood test, a test that I take every three months. Since I have to fast overnight, I will normally take my medication when I get up in the morning. Should I take my medication before the blood test or wait until afterward?

Answer:

This is a great question! Whether or not your mediations will interfere with your blood test results depends on the type of tests that you are having done. It is important to check with your pharmacist or physician about the specifics, to make sure there are no interactions with the procedure. If there are no interactions and it is safe to take, it is important to be compliant for better a therapeutic outcome.

Question:

What is the maximum allowable daily dosage for acetaminophen? My wife had her gallbladder removed about 48 hours ago and is trying to manage the pain with acetaminophen and ibuprofen. The hydrocodone she was prescribed is not providing adequate relief and makes her nauseous and dizzy.

Answer:

The maximum daily dose in a 24-hour time period for an adult is 4,000 mg. Depending on the strength of hydrocodone and acetaminophen, she should not take more that 1-2 tablets per dose. It is important for her to follow the directions that her doctor provided on her prescription. If the medication is not adequately treating her pain, she should consult her pharmacist about the frequency with which she should be taking the hydrocodone/acetaminophen and the ibuprofen.

Without knowing the strength of both these medications, and not knowing how much your wife has been taking, it is hard to recommend an appropriate schedule. If she has reached the maximum daily dose for all three ingredients, she should consult the prescriber to seek help in finding another therapy for relief of pain. Be cautious of the side effects and that too much pain medication is not causing cramping and constipation.

Question:

Does Flagyl come in a liquid form?

Answer:

Flagyl, or metronidazole, does not have a commercially available liquid formulation. However, there are several different population groups that cannot take the pill form, including children, the elderly, and animals. Therefore, there is a compounded recipe that pharmacists can make as a liquid formulation. Check with your doctor about prescribing the compound. Understand that the compound needs to be refrigerated, is only stable for 30 days, and may have an unpleasant taste.

Question:

I'm currently taking a Z-Pak antibiotic, and it causes stomach upset and diarrhea. Is it OK to take a medicine like Pepto-Bismol while I'm taking this antibiotic?

Answer:

Z-Pak, or azithromycin, does have common side effects of stomach upset and diarrhea. Taking this medication with food may help with your upset stomach.

If your diarrhea becomes more intense, it is important to stay hydrated by taking in fluids and replenishing your electrolytes. The diarrhea should subside within a few days to a week after you have finished the medication. If the side effects are unbearable, talk to your health care provider about prescribing another antibiotic. Just remember that all antibiotics can have an effect on the normal flora of your GI tract.

Question:

I am taking metronidazole 500 mg and SMZ/TMP DS 800-160 for a flare up of diverticulitis. Can I take a pain reliever, such as Tylenol, Advil, or ibuprofen, with these medications? If yes, which is best? I have been suffering from headaches daily. Thank you!

Answer:

If you are experiencing pain or need to take an over-the-counter pain medication, I would recommend that you avoid any NSAIDs (nonsteroidal anti-inflammatory drugs), such as ibuprofen, naproxen, Advil, or Aleve. This class of medications is harsh on the stomach and can increase GI bleeding without you being aware of it. I would stick with acetaminophen (Tylenol) to aid in pain relief. Also, consult with your local pharmacist for product selection and with your health care professional about the symptoms you are experiencing and the treatments you have used for the pain.

Question:

Can I take Phillips' Milk of Magnesia while on Vicodin?

Answer:

Currently, there have been no reports on drug interactions between magnesium hydroxide (Phillips' Milk of Magnesia) and hydrocodone/acetaminophen (Vicodin). However, it is important to consult with your pharmacist or health care professional about any new reports of any drug interactions between these two medications.

Question:

I have been diagnosed with H. pylori, but I’m allergic to the antibiotics that I was prescribed for it. Are there any alternative treatments? I’ve heard about mastic gum.

Answer:

Helicobacter pylori (H. pylori) is a bacterium that causes inflammation and ulcers in the stomach. About 80% of patients with H. pylori are asymptomatic, meaning they do not feel any pain or symptoms. Treatment is very important. We must eradicate the bacteria and allow the ulcer to heal.

Typically, treatment is a combination of two antibiotics and 1-2 stomach medications. There are several different effective combinations for treating H. pylori. Depending on what your antibiotic allergy is, we can find an alternative antibiotic that will safely and effectively eradicate the infection.

Work with your pharmacist for alternatives. The mastic gum is not going to be as effective in eliminating the bacteria. Hope this helps!

Question:

Is it OK for me to take Gas-X and ibuprofen at the same time?

Answer:

Currently, there have been no reports of drug interactions between Gas-X (simethicone) and ibuprofen. However, it is important to consult your pharmacist to make sure that no new updates have been found about interactions between these two medications.

Question:

I have been experiencing bloating and upset stomach problems for about three weeks. I have been taking probiotics for one week now and I am feeling very good. Are there any problems with taking probiotics with lisinopril for high blood pressure and Levoxyl for my thyroid?

Answer:

There are several types of probiotics available over the counter. It is always important to inform your healthcare professional and your pharmacist about which types of probiotics you are taking.

However, the two medications, lisinopril and Levoxyl, currently do not interfere with any of the probiotics available on the market. It is important to check with your pharmacist about any updates concerning drug interactions between these medications.

Question:

Can I mix Phenergan, Ativan, and meclizine for my vertigo?

Answer:

If your vertigo is not being treated appropriately, I would not recommend increasing the dose of medications or taking all three of these medications at the same time without first consulting your pharmacist and health care professional. While these medications have been prescribed for your use, it is important to take these medications as directed. It is also important to work with your team of health care professionals for proper medical care.

Question:

What can I expect from taking Miralax for the first time -- quick acting or overnight "gentle relief”? I need something daily. Thanks.

Answer:

Miralax (polyethylene glycol 3350) is intended to relieve occasional constipation. A bowel movement can be expected within a few hours of the first dose for up to three days, if used correctly. Start with the minimum recommended dose to see if it is effective for you. If you experience no relief, slowly increase your dosage to the highest recommended. Be cautious in order to prevent diarrhea.

If you’re still seeking more relief, consult your health care professional about either using the over-the-counter medication more frequently, or adding a different stool softener to your regimen.


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