Is there gluten in your medications? Do you know for sure? Now that the FDA has set an official standard for gluten-free labeling, and manufacturers must list the presence of any of the top 8 allergens, your medications should be safe, right?
Unfortunately, no. The FDA’s gluten-free standard only applies to food, and the Food Allergen Labeling Consumer Protection Act of 2004 only applies to food as well. So despite no warnings on the label, yes, your prescription medication may have gluten in it. You would think that manufacturers would move away from combining gluten and medications, but we don’t yet know if that is happening. In fact, we know many medications do still contain gluten.
Celiac disease is a serious autoimmune disorder with severe consequences and only one effective treatment: a gluten-free diet.
People with celiac disease are extremely sensitive to even the smallest traces of gluten. A recent Finnish study suggested that as little as 30 milligrams of gluten could increase antibodies and reduce the health of the small intestine’s mucosal lining.
How much is 30 milligrams? Just 1/164th of an average slice of bread. For more on this phenomenon, see my lesson: How Much Gluten Is Too Much?
Most Isn’t All
When discussing the potential of gluten in prescription medications with pharmacists or manufacturer representatives, I’ve heard the following accurate yet misinformed statement: “Most medications do not have gluten in them.”
While this is technically true and it’s something to keep in mind, what happens when someone highly sensitive to gluten happens to be prescribed one of the medications that does have gluten in it?
How many doctors or pharmacists know which medications may have gluten in them? In my experience, not many.
Why Do Medications Contain Gluten?
Gluten is used as both an effective binder and an inexpensive excipient. A binder simply helps hold all the ingredients together.
An excipient is an inactive substance that helps fill out the size and weight of a medication. This helps the manufacturer deliver an appropriate dose in a consistent and convenient size. Ever notice medications with different strengths that have the same size and shape? The excipients help make up the difference.
There are several different types of excipients, which is why most medications don’t use gluten. But some medications still use gluten as an excipient.
This isn’t a random vocabulary exercise: you need to understand excipients so you can discuss them with pharmacists and manufacturers.
What to Look For
First, try to work with your pharmacist to determine if a prescribed medication has gluten in it. Hopefully the pharmacist has more information on specific formulations — or at least more readily available contacts to help you determine specific formulations.
Next, be careful not to assume a brand name medication has the same formulation as a generic. It isn’t uncommon for the generic version of a drug to use different excipients.
Last but not least, try to investigate the sources of the following ingredients if they are present. Not all of these will derive from gluten, but all of them have the potential of originating from gluten if the source isn’t specified:
- Caramel coloring
- Modified starch
- Pregelatinizied starch
- Pregelatinized modified starch
Some of these may use barley malt. Some pharmacists or doctors may not realize it, but barley malt contains gluten, so if that is the source of the ingredient, the medication is not gluten-free.
Finding Gluten-Free Medications
If you’re looking for a list of medications containing gluten, I hope to have you covered with the following resources.
The following site, designed for senior citizens, tries to keep an up-to-date list of drug manufacturer contact information. Use this to contact a manufacturer and investigate the ingredients of your prescribed medication:
The next site may appear a little rudimentary, but they do a good job of keeping their sources up-to-date. You can find news on gluten in prescription medications and various lists of both prescription and Over-the-Counter (OTC) gluten-free drugs:
The last resource I’m providing here is the Internet Drug Index. This will help you identify medications that may cause gastrointestinal distress or symptoms that may resemble gluten sensitivity symptoms. I include this resource because when people experience these symptoms after taking their medication, they may fear that their medication has gluten in it. This isn’t always the case: sometimes you’re just experiencing an unpleasant but known side-effect of the medication.
I hope this information helps you be more attentive and knowledgeable when it comes to this insidious source of gluten in your life.