This is the single safety anchor for current medications, supplements, and avoid-list logic. The freshest cloud-doc reconciliation is partial: on 2026-05-04 Dag still reported atorvastatin 20 mg, eczema cortisone cream for flare-ups, and no aspirin; old 2024 RPPH papers show aspirin 81 mg + atorvastatin 40 mg + omeprazole were started after a mild right-leg PAD Doppler finding, but that is historical rather than current. Daily eye drops, occasional sildenafil 25 mg, and the exact supplement stack still need product-level confirmation. Aspirin remains avoided unless a clinician reopens it with GI-risk review; non-aspirin NSAIDs, including transdermal/topical NSAID pain products unless clinician-approved, remain a hard avoid after diverticular bleeding. Paracetamol/acetaminophen is the default OTC analgesic if package limits and duplicate-product/alcohol cautions are respected.
medications · supplements · aspirin · nsaids · statin · diverticular-bleeding · lp(a) · safety
This list is only as good as the cloud-doc medication/supplement section. Update it whenever a prescription, supplement, OTC drug, eye drop, topical product, or pain patch becomes routine.
Latest reconciliation status: partial. The original medication list is dated 2025-10-11; a 2026-05-04 cloud-doc update confirms atorvastatin 20 mg, cortisone cream for eczema flare-ups, and no aspirin. Old RPPH papers from 2024-01-22 show a historical post-Doppler prescription/recommendation of aspirin 81 mg, Lipitor/atorvastatin 40 mg, and omeprazole 20 mg on the billing sheet. Eye-drop identity, sildenafil timing/frequency, and the exact current supplement stack remain unverified.
| Item | Current KB status | Safety decision |
|---|---|---|
| Atorvastatin 20 mg daily | Fresh-confirmed 2026-05-04; historical RPPH Jan 2024 papers show Lipitor/atorvastatin 40 mg was started/recommended after mild PAD Doppler | Continue unless clinician changes it; ApoB/LDL lowering is the main current Lp(a)-adjacent medication lever. Historical 40 mg dose is useful context, not proof of current dose. |
| RPPH 2024 post-Doppler regimen | Historical: aspirin 81 mg + Lipitor/atorvastatin 40 mg + omeprazole 20 mg after mild right-leg PAD finding | Preserves why aspirin/statin escalation appeared in old papers; does not override current no-aspirin status after GI bleeding. |
| Aspirin 81 mg | Historical RPPH start/recommendation in Jan 2024; stopped after Aug 2025 bleed; still “not aspirin” on 2026-05-04 | Avoid for self-directed use. Re-open only with cardiology + GI input because mild PAD/plaque raises vascular rationale but diverticular/stool-blood history raises bleeding cost. |
| Omeprazole | Historical, paired with aspirin; not routine currently | Do not restart just to make aspirin/NSAIDs feel safer; PPIs do not neutralize lower-GI/diverticular bleeding risk. |
| Daily eye drops | Carried forward from 2025-10-11, exact product unknown | Continue as prescribed, but identify the bottle. If it is a beta-blocker drop such as timolol, systemic bradycardia/bronchospasm/BP effects become relevant. |
| Topical corticosteroid / “cortison cream” | Fresh-confirmed for eczema flare-ups 2026-05-04; exact potency unknown | Use intermittent thin-layer, lowest effective potency; avoid prolonged face/genital/large-area/occluded use unless prescribed. |
| OTC topical mupirocin near Aug 2025 bleed | Historical exposure; low-plausibility GI-bleed cause | Archive ID topical-mupirocin-prebleed-2025-08. Do not self-apply mupirocin to glans/urethral/meatal/vaginal or other mucosal surfaces; use clinician/pharmacist review for genital lesions. |
| Sildenafil 25 mg occasionally | Carried forward from 2025-10-11 | Never combine with nitrates, riociguat, or poppers; disclose dose and last-use time in any chest/epigastric-pain emergency. |
| Fish oil / omega-3 | Cloud doc: high-dose trial in 2025, lowered to 2 capsules/day by late Mar 2026; exact current product/dose needs confirmation | Modest maintenance is acceptable; avoid high-dose self-escalation while stool-blood/bleeding risk is unresolved. |
| D3/K2 | Cloud doc: NOW D3/K2 resumed 2026-02-27, 2 capsules/day; current status needs confirmation | Maintenance only; not a proven Lp(a)-valve/CAC treatment. |
| Turmeric + piperine | Stopped early Apr 2026 | Keep stopped; avoid restart during bleeding/liver-signal cleanup. High-bioavailability curcumin/piperine adds hepatotoxicity and interaction noise. |
| Bioflor / S. boulardii and fermented foods | Started 2025-10-11; current status needs confirmation | Symptom-targeted only; not a bleeding or inflammation substitute. |
| B12 / B-complex / B6 | Exact product unknown | B12 is reasonable in the vegetarian/low-normal branch; avoid chronic high-dose B6 because neuropathy is the critical toxicity. |
| Oral iron | Not a casual supplement | Use only if ferritin/TSAT/stool-blood branch justifies it; separate from tea/coffee/calcium/magnesium/zinc/fiber. |
| Exposure | Current rule | Main evidence anchor |
|---|---|---|
| Aspirin | No self-directed aspirin while bleeding risk is live; the 2024 mild PAD finding only moves this to clinician risk-balancing, not DIY use. | ACC/AHA 2019 says routine primary-prevention aspirin lacks net benefit and should not be used with increased bleeding risk; USPSTF evidence review found very-low-dose aspirin increased major GI bleeding risk (OR 1.58). |
| Non-aspirin NSAIDs, including ibuprofen/naproxen/diclofenac/ketorolac and NSAID pain patches/gels | Hard avoid unless clinician explicitly accepts bleeding risk. The avoided Manila flurbiprofen patch/indomethacin gel fits this rule. | ACG lower-GI bleeding guidance says avoid NSAIDs after acute lower-GI bleeding, especially diverticulosis/angioectasia; OTC ibuprofen labels warn GI bleeding and CV risk. |
| Paracetamol / acetaminophen | Default OTC pain/fever option, not a free-for-all. Check duplicate APAP in cold/flu products; follow package ceiling; avoid use with alcohol relapse. | DailyMed APAP 500 mg label: severe liver damage risk >4 g/day, with other APAP products, or with 3+ alcoholic drinks/day; example product limit is 3 g/day. |
| Sildenafil | Safe only if nitrate/riociguat/popper boundary is respected; emergency clinicians need last-use timing. | DailyMed sildenafil label: contraindicated with nitrates and guanylate-cyclase stimulators because BP can drop quickly to unsafe levels. |
| Eye drops | Product identity matters. If beta-blocker ophthalmic drops are used, treat them as systemically relevant. | DailyMed timolol ophthalmic label: systemically absorbed; contraindications include asthma/COPD, bradycardia, AV block, cardiac failure. PubMed reviews confirm systemic cardiopulmonary effects. |
| Topical corticosteroids | Low-potency intermittent eczema use is reasonable; chronic/high-potency/large-area/occluded or face/genital use needs clinician guidance. | NHS hydrocortisone guidance and PubMed reviews: local skin thinning/atrophy is the main concern; systemic effects are more likely with potent steroids, large area, long duration, or occlusion. |
| Fish oil / omega-3 | Modest maintenance is acceptable; high-dose purified EPA or multi-gram escalation belongs to clinician-led plans. | 2024 RCT meta-analysis found no overall bleeding increase with omega-3, with signal concentrated in very-high-dose purified EPA (PMID: 38742535). |
| Turmeric/curcumin + piperine | Keep stopped unless a clinician has a specific reason; do not use as generic anti-inflammatory cover. | NCCIH: benefit evidence is not definitive and high-bioavailability curcumin may harm the liver; LiverTox 2025 now lists turmeric as a well-documented rare cause of clinically apparent liver injury. |
| Oral iron | Repletion bridge only; do not let it obscure stool-blood/iron-loss diagnosis. | AGA 2024 iron-deficiency update supports once-daily-at-most dosing and notes every-other-day can be better tolerated; hepcidin/alternate-day studies support the low-dose alternate-day option. |
| B-complex / B6 | Avoid megadose B6 as a vague “energy/nerve” add-on. | NIH ODS and EFSA 2023: peripheral neuropathy is the critical toxicity of excess B6; food-source B6 is not the issue. |
Private archive identifier: topical-mupirocin-prebleed-2025-08.
Verified from the product photo and cross-check sources:
| Field | Identification |
|---|---|
| Brand / Chinese text | 康立邦 |
| Product | 莫匹罗星软膏 = mupirocin ointment |
| Visible package | OTC, 外/external-use marker, 广东恒健制药有限公司, 5克 |
| Strength | Not visible on the photographed front panel. Cross-checked matching manufacturer/product listings show 2% × 5 g, equivalent to 20 mg/g mupirocin. |
| Context | Bought OTC without doctor visit and applied to penile/genital skin in the period before the August 2025 visible stool bleeding incident. Exact dose, frequency, duration, skin-vs-mucosal contact, and co-exposures are unknown. |
Plausibility review completed 2026-05-07:
| Question | Current answer |
|---|---|
| Intended use | Topical small-area skin infections. Standard labels say topical use only, up to about 10 days, and not intranasal/ophthalmic/mucosal use. |
| Genital/mucosal issue | The practical concern is local irritation/sensitization and wrong-route self-treatment, not lower-GI bleeding. If it touched glans/urethral/meatal mucosa or caused genital irritation, record that for clinicians. |
| Systemic absorption | Intact-skin absorption is minimal: a labeled radiolabeled lower-arm study found no measurable systemic mupirocin absorption; reviews describe systemic absorption as <1%. PEG base absorption matters mainly with large open/damaged areas or renal impairment. |
| Diarrhea / CDAD | Labels carry class warnings for antibiotic-associated diarrhea/CDAD and overgrowth; topical mupirocin makes this less likely than systemic antibiotics. Persistent significant diarrhea or abdominal cramps after any antibiotic still warrants stopping and medical review. |
| GI bleeding / hematochezia | PubMed search found no mupirocin-specific GI-bleeding/hematochezia case reports. FAERS/openFDA has nonspecific spontaneous reports with mupirocin listed, but sampled reports are heavily confounded by aspirin, anticoagulants, cancer/chemotherapy, severe illness, or concomitant drugs; this is not a usable causality signal. |
| Practical classification | Low-plausibility / temporal-only as a cause of the August 2025 visible stool bleed. Preserve the archive and disclose it if reconstructing exposures, but the main bleeding framework remains diverticula/stool-blood/iron/endoscopy quality/NSAID-aspirin-alcohol context. |
Evidence anchors: FDA Bactroban/mupirocin ointment label; DailyMed mupirocin ointment 2%; UK SmPC for mupirocin 20 mg/g ointment; StatPearls/NCBI Bookshelf 2024; PubMed searches on 2026-05-07 for mupirocin + hematochezia/GI bleeding/CDAD/systemic absorption/genital-mucosal terms; openFDA FAERS spot-check for bleeding/CDAD terms.
| Gap | Why it matters |
|---|---|
| Exact eye-drop name, strength, and schedule | Some glaucoma drops, especially beta-blockers, have systemic heart/lung/BP relevance; unknown until named. |
| Exact topical steroid name/strength/frequency and body sites | Determines whether the risk is ordinary short-course eczema care or higher-potency/large-area/face/genital/occlusion exposure. |
| Exact sildenafil use pattern | Needed for emergency nitrate timing and BP-symptom interpretation. |
| Exact current supplement brands/doses | Needed for bleeding/interactions and lab interpretation: fish oil EPA+DHA, D3/K2 form, B12/B-complex/B6 dose, magnesium, zinc, iron, probiotics, and whether turmeric remains stopped. |
| Exact mupirocin exposure details before the Aug 2025 bleed | Causality is now graded low-plausibility, but dates, frequency, amount, skin-vs-glans/urethral/meatal contact, duration, local irritation, diarrhea, fever, other antibiotics/NSAIDs/aspirin/alcohol, and symptom timing still help any clinician reconstruct the episode. |
| Whether atorvastatin is currently morning or evening | Not clinically huge for atorvastatin, but useful for adherence consistency. |
This profile needs a conservative medication safety posture: continue lipid lowering, avoid aspirin/NSAIDs unless a clinician has a strong documented indication, disclose sildenafil in emergency chest-pain contexts, identify the eye drops, keep topical steroid use intermittent and site-aware, and prevent supplements from accidentally increasing bleeding risk, liver-risk noise, neuropathy risk, or lab-confounding.