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January 14, 2008

Gluten in Pills: What to look for when Taking Medication

Most of us consider wheat to be something that we find in baked goods. But did you know that the medication you take to cure aches, pains and serious diseases could contain wheat too?

According to the American Society of Health System Pharmacists (ASHP), many prescription and over-the-counter medications contain binders to hold them together. The binders are called excipients and are generally made from wheat, corn, potato, or tapioca starch as well as other unspecified types of starch. If you have celiac disease and you get a pill that is bound with wheat, you may experience a typical celiac reaction.

Excipients are considered inactive ingredients and to date, there are no federal requirements in the United States mandating labeling of inactive substances in medicine; only active ingredients are labeled.

Common excipients include:

  • Corn
  • Modified starch
  • Potato
  • Pregelatinized starch
  • Wheat
  • Tapioca
  • Pregelatinized modified starch

Because there is no requirement for labeling inactive ingredients, finding out if medication has gluten in it can be quite a difficult process. To find out if a medication contains gluten, patients typically have to call a drug manufacturer directly to obtain the information.

The process is no easier for pharmacists or physicians in a hospital. Even the drug inserts that come with medication do not contain this information, so pharmacists are left calling the same consumer help numbers at the drug companies to obtain the information.

To highlight the importance of education on the issue, on December 3, 2007, CNN Newsroom Anchor and NFCA Spokeswoman Heidi Collins addressed an audience of 12,000 in-hospital pharmacists at the American Society of Health System Pharmacists Mid-Year Clinical Meeting. Heidi spoke about spending Christmas Eve 2006 in a hospital emergency room. Her five-year-old son, who has celiac disease, had a horrible infection and desperately needed a course of antibiotics. At 11:00pm on Christmas Eve, no one at the pharmaceutical companies was available to tell the doctors if there was gluten in the pills.

Consumer question departments are generally available Monday through Friday during business hours, making it almost impossible to find out the contents of a pill over the weekend or on holidays.

After calling the NFCA to help her locate the information, Heidi’s son received a strong dose of intravenous antibiotics and recovered quickly from his illness and was able to enjoy his Christmas gifts!

Heidi challenged each pharmacist in the room to become educated about the presence of gluten in medication to prevent other families from encountering the same frightening situation that she did.

To help educate the pharmacists, the National Foundation for Celiac Awareness and the American Society of Health System Pharmacists created two informational brochures: one for pharmacists and one for consumers. To download a copy, visit www.celiacentral.org.

Heidi was joined at the conference by world-renowned poet Maya Angelou.

To help patients and pharmacists determine gluten content, several organizations have developed guides:

GlutenFreeDrugs.com is a website maintained by Nationwide Children’s Hospital, Columbus Ohio. It provides information for medications including: analgesics, antibiotics, antidiarrheals, antihistamines, cough and cold, antifungals, asthma, enzymes, eye and ear, nasal sprays, oral contraceptives, oral hypglycemics and vitamins.

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Comments

The binders are called excipients and are generally made from wheat, corn, potato, or tapioca starch as well as other unspecified types of starch. Excipients are considered inactive ingredients and to date, there are no federal requirements in the United States mandating labeling of inactive substances in medicine.

The knowledge that pharmacists have is very random.
When my husband was first diagnosed, he went to the pharmacist to fill his prescription (for an acid reflux pill that the doctor had specifically prescribed as it was gluten free) and he was tryingto update his file to list gluten as an allergen. The first pharmacist said, and I quote "We don't need to know that, it doesn't matter".
Thank god the pharmacist in the back was listening, jumped in and stated how much they needed to know it. Even today, I'm not sure how proactive we would have been without that jump in, as newly diagnosed, we hardly knew what we were doing.

At least it was a chance for training, that pharmacist will never make the same mistake again

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