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How to Protect Yourself from Hidden Gluten in Medications

Gluten Is Often a "Filler" in Medicines

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Updated May 16, 2014

For both the consumer and the pharmacist, unless a medication is specifically labeled as gluten-free, calling the manufacturer is the only way to confirm the medication's gluten-free status.

How Is Gluten Hidden In Medications?

In prescription and over-the-counter medicines, fillers (also called "inactive ingredients" or "excipients") are added to the active drug. Fillers provide shape and bulk for tablets and capsules, aid in water absorption (helping the tablet to disintegrate), and serve other purposes as well. Fillers can be derived from any starch source, including corn, potatoes, tapioca and wheat.

Unfortunately, very few medications are labeled as gluten-free. Inactive ingredients may be listed on the box or the package insert, but it is difficult if not impossible (even for pharmacists) to tell if these are derived from gluten.

In particular, any starch ingredient (including "pregelatinized starch" and "sodium starch glycolate") not labeled specifically as coming from a gluten-free source -- for example, corn, potato, tapioca -- should be a cause for alarm. In addition to starch, other inactive ingredients that might come from wheat or barley include -- but are not limited to -- dextrates, dextrins, dextri-maltose, and maltodextrin.

Sometimes even the pharmaceutical company itself does not know for sure whether its medications are gluten-free, because they do not know the gluten-free status of the raw materials they buy from outside suppliers. Cross-contamination during the manufacturing process is another potential problem.

Several organizations have published lists of gluten-free medications and directories of pharmaceutical company contact information. Use these lists as starting points to investigate the gluten-free status of your medicines.

Steps for Protecting Yourself from Gluten in Medicines

  • Make friends with your pharmacist. Tell all the pharmacists at your drugstore that your medications must be gluten-free. Remind them every time you have a prescription filled. Remember that although pharmacists have expert knowledge of medicines and how they work, they are not experts either in celiac disease or in the source of the inactive ingredients in the various pharmaceutical products.

  • Ask your doctor for first-choice and second-choice prescriptions. When your doctor is prescribing a medication for you, remind her that you are going to need to check the gluten-free status of the medication. Ask to be given a second-choice prescription in case the first-choice medicine turns out to be unsafe.

  • Call the drug company yourself. You are ultimately responsible for your (or your child's) health. Get the drug company's phone number and call it yourself. If you're trying to confirm the gluten-free status of a generic prescription medicine, ask your pharmacist for the name and phone number of their generic brand supplier.

  • Prepare to argue with your insurance company. When generic medications are available, your insurance company will probably not approve the brand-name drug. Generic medications, however, are not required to contain the same fillers as the brand name formulation. Just because you've confirmed that a brand-name medicine is gluten-free doesn't mean the generic form is safe. If you need a brand-name medicine because no safe generic alternative is available, call your insurance company to learn what you'll need to do to get approval for the more expensive form.

  • Take a cell phone to the drugstore. If you are shopping for over-the-counter medications, either take a cell phone with you to the store so you can call the manufacturer from there (the consumer information number always appears on the outside of the packaging), or look for the phone number on the internet and call from home.

  • Give an advance call before any outpatient tests. If you'll be having any radiological (x-ray) procedures for which you'll need to drink some type of contrast material, call ahead to make sure the radiologists verify the gluten-free status of whatever they're going to give you.

  • Remember to periodically re-check the gluten-free status of your medications. Few drug companies have a policy of avoiding gluten completely. If your medicine is manufactured by a company that does use gluten in some of its products, you'll need to recheck periodically to be sure the manufacturing process hasn't changed and your medicine is still gluten-free.

  • Finally, if you require an unusual medicine for which no gluten-free formulation is commercially available, ask your pharmacist to put you in touch with a pharmacy that does customized compounding.

Source:

Plogsted S. Medications and celiac disease -- tips from a pharmacist. Practical Gastroenterology, January 2007.

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