Gluten in Medication

Frances Meredith, MD
“What? There’s gluten in my Advil?” 

Those with food sensitivities are always on the lookout to avoid exposure to foods we know cause trouble for us. As someone with food sensitivities myself, I was horrified to discover that a migraine medication I was taking contained food proteins to which I knew I was sensitive. How could that be?

Medications, both over the counter (OTC) and prescription, need to have “fillers” to hold the tablets together. These often come from corn or potato starch, but can also have ingredients that contain gluten or soy as well.

Most prescription medications now are gluten free though not all are certified as such by the manufacturer. Several blood pressure medications contain gluten. Gluten containing OTC medications include Advil Liquid Gel and Advil Liquigel Migraine Caps.    
“Red flag” Ingredients in medications that can have gluten hidden within include:- modified starch, pregelatinized starch (can be derived from potato, corn, tapioca or wheat)
-dextrate and dextrin (can be derived from potato, corn, tapioca, or wheat)
– dextrimaltose (may be derived from barley malt)
-Maltodextrin (may be derived from potato, corn, tapioca, or wheat)
– sodium starch glycolate (usually derived from potato, but may come from corn, tapioca, or wheat)
-caramel coloring (when barley malt is used).
-All of above are suspect if the source is not specified
 
Now, let’s talk more about “inactive” ingredients.  Ingredients such as corn starch or potato starch may be labelled as “inactive”, however, for some of us they can certainly trigger some very “active” immune responses.

Corn starch is a frequent filler in many OTC meds as well as prescription meds. These include multiple forms of Advil, blood pressure medications such as amlodipine, birth control pills, cholesterol medicines, such as atorvastatin, and common antibiotics such as azithromycin.

Other inactive ingredients may be important, causing immune reactions in some people. For this reason, I always advise choosing the cleanest version of a medication possible when needed. An example of this is the difference between NP Thyroid and Armour. Armour contains inactive ingredients which may be reactive for some, including sodium starch glycolate (gluten free), a food coloring, and microcrystalline cellulose.  NP Thyroid contains maltodextrin (gluten free), mineral oil, calcium stearate, and dextrose monohydrate as inactive ingredients. These tend to provoke fewer immune reactions.
 
Often the “inactive” ingredients are not evident on the label.  For over the counter medications you will need to peel back the label and look underneath. If there is no information on ingredient sources, call the 1-800 number on the label to be certain.

A most helpful resource is  www.glutenfreedrugs.com  On this website, kept up to date by a pharmacist, you can look up most drugs to find whether gluten, potato, corn, or soy are within. Another helpful resource is  www.beyondceliac.org.

Your most valuable resource is your pharmacist. Speak to them personally to get them on your team, letting them know your particular food sensitivities. They will add this to your profile and double check any medication to make sure it is absent of your food triggers. They can also be helpful checking ingredients on any over the counter product you might consider using. Though they cannot do this on the spot, they can research the ingredients and get back to you. My pharmacist at Publix has been an immense help to me. I am so grateful to have her on my “team”.
 
Your Partner in Health!
 Frances Meredith, MD

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