What’s in the medicine you take? There’s a lot more in that pill than the active ingredient.
Pills, tablets and capsules, contain excipients that include the active ingredient and several other ingredients that help bind the drug together and aid with metabolism and absorption so that the active ingredient is properly delivered to the body.
One of the most common excipients is starch, and sometimes that starch is derived from wheat. While not common, the appearance of wheat, gluten, in a drug poses a real problem for people with celiac disease or gluten intolerance.
It’s very rare for a brand name medicine to contain gluten. However, generic drugs often don’t contain the same excipients as the brand name drugs they copy. Only the active ingredient is required to be the same.
And while labels for supplements must disclose any allergens, labels for OTC and prescription medicines are not required to do so. Legislation to correct this has been submitted in Congress, but it is not yet law.
Twice I’ve received a generic that did lead to the headaches, troubled sleep, mood changes and GI symptoms I encounter when I get gluten. My pharmacy and psychiatrist both know I have celiac disease, but the manufacturer of the medicine I had long taken changed and I ran into trouble.
In both cases the pharmacy was able to replace the med with one from a manufacturer I had tolerated well, but it’s troubling that two pills with the same name could lead to such very different reactions.
It’s not always gluten that is the culprit. Some sugars used as excipients can lead to the same symptoms as gluten ingestion does. It just shouldn’t be hard to determine what’s in the medicine you take, and whether allergens are included in the ingredient list.
But it is hard.
There is a database from the National Library of Medicine and the National Institute of Health called DailyMed that does include the ingredients of all drugs, including generics, from all manufacturers marketed in the United States, and the database is searchable.
Be on the lookout for the following ingredients:
Modified starch (if source is not specified)
- Pregelatinized starch (if source is not specified)
- Pregelatinized modified starch (if source is not specified)
- Dextrates (if source is not specified)
- Dextrin (if source is not specified; the source is usually corn or potato which is acceptable)
- Dextrimaltose (when barley malt is used)
- Caramel coloring (when barley malt is used)
Unfortunately, the information on excipients are reported by the manufacturers themselves and are not always complete lists. Many generics are manufactured in plants overseas, and the National Library of Medicine relies on the honor system in compiling lists of ingredients. In fact, many foreign generic pharmaceutical plants have never been inspected by the FDA, and even the FDA relies only on the manufacturer to confirm what is actually in each pill.
It’s no surprise that US marketers often will not explicitly guarantee that the generics they sell are completely gluten-free, even when no gluten-containing excipients are listed in the database.
What’s a person with celiac or gluten intolerance to do? Take your meds. If symptoms caused by gluten do appear, don’t stop taking what your doctor prescribed. That could lead to more trouble than gluten reactions.
Check the database for allergens, and talk to your pharmacist. Most generics, including popular psych meds, are manufactured by more than one company. If you don’t tolerate one, an equivalent drug from another manufacturer can be obtained.
Our medicine should make us feel better. It shouldn’t make us sick. Be vigilant about what you take, get all the information about it that you can, and listen to your body.