Gluten, lactose in drugs? Study raises questions about risk

WASHINGTON (AP) — A man with celiac disease felt sicker after starting a new drug, but it was not a typical side effect. It turns out the pills were mixed with gluten the patient knew to avoid in food — but was surprised to find hiding in medicine.

A new report said pills often contain so-called “inactive” ingredients capable of causing allergic or gastrointestinal reactions in small numbers of people sensitive to specific compounds.

And it’s hard for those patients, or even their doctors, to tell if a pill contains an extra ingredient they should avoid, researchers from the Massachusetts Institute of Technology and Boston’s Brigham and Women’s Hospital said on Wednesday. When the doctor sends a prescription, the pharmacist issues whatever the person’s insurance covers — without discussion of inactive ingredients that are buried in the drug’s labelling.

Drugs contain an “active ingredient”, what you hope will help your health. Patients may not realise that inactive ingredients make up the rest of the pill, substances that are not supposed to directly affect your health. They are used to make it easier to absorb the drug, or to improve the taste or extend the shelf life.

Most people do not need to worry about inactive ingredients but the Boston researchers pointed to rare published reports of reactions in patients with allergies or intolerances to certain compounds — and called for more information about who might be at risk.

Pills can contain ingredients like gluten, lactose or allergy-triggering dyes that may cause problems for certain patients. – AP

The study analysed data on inactive ingredients from a database of over 42,000 prescription and over-the-counter medicines. An average pill contains eight inactive ingredients, but some contain 20 or more.

Consider that 39 per cent of seniors take at least five prescription medicines daily, and even a small amount can add up, the researchers reported in the journal Science Translational Medicine.

The report found:

– About 45 per cent of the analysed medications contained lactose. The amounts may be too small for some lactose-intolerant people to notice, but someone taking common drugs for high blood pressure and cholesterol could get about a gramme a day.

– A third of medications contained a food dye associated with allergic reactions.

– Over half contained at least one type of sugar that people with irritable bowel syndrome are supposed to avoid.

– In a recent survey, 18 per cent of manufacturers said their medications contain gluten, which can cause severe reactions if patients with celiac disease consume as little as 1.5 milligrammes a day. But labels may list only innocuous “starch”.

That’s what happened when a patient of Traverso’s experienced worsening celiac symptoms after using a common stomach acid-blocking drug, omeprazole. Traverso had to call the manufacturer to learn that particular formulation contained starch made from wheat.

Because refills can bring a different company’s formulation, patients should check the label each time, he added.

Patients should not be alarmed, cautioned one allergy expert not involved with the report.

Often the amount is too low to trigger a reaction, plus substances like soybean oil are refined to remove the allergy-causing protein before they’re used in medicines, she added.

Still, manufacturers of drugs made with refined peanut oil, such as some versions of the hormone progesterone, often put an allergy warning on the label.

The issue is getting some attention. A pending Food and Drug Administration proposal recommends adding gluten information to drug labels.

And the standard-setting United States Pharmacopeia has a panel studying how electronic health records could help doctors and pharmacists better identify patients who need to avoid a certain ingredient.