The Serious Challenge of Getting Gluten Free at the Pharmacy

Gluten can hide anywhere, even in pills and syrups. Yes, gluten can contaminate the pills and the liquids we take for everything from sniffles to sinusitis, diabetes to depression, asthma to ankylosing spondylitis. I remember reading this early post-diagnosis and feeling overwhelmed. How on earth would I figure out if the manufacturer used wheat starch instead of corn starch as an excipient (bulking agent or ingredient needed to create a pill or capsule form) in yet another round of antibiotics for yet another respiratory infection?

Give thanks for pharmacists. I do. Your pharmacist can and should be your ally in the quest to keep your pharmaceutical regimen gluten free. A few weeks after I was diagnosed, I marched my little fanny over to the pharmacy, which is in a Target store, and told my pharmacist, who has been my pharmacist there for at least ten years (dispelling the myth that big box pharmacies are revolving doors for impersonal personnel) about the diagnosis. I mentioned a resource highlighted by the Gluten Intolerance Group of North America (GIG) and to my surprise, she already knew about it and used it!

It’s  www.glutenfreedrugs.com, a website maintained by a clinical pharmacist and his team of interns. You can read lists either by therapeutic category or by drug name in alphabetical order and you can download PDFs of the lists for handy reference. Lists include generic manufacturers as well as brand name manufacturers. The lists are just that, lists. You can’t keyword search them but it’s easy enough to scroll down until you find what you are looking for.

It would be great if a generic company worked to make everything gluten free because many pharmacies buy their generics from the same company. A companywide policy of gluten free would eliminate the need for the pharmacist to check every single prescription every single time you refill it with that manufacturer’s products. Checking every time a prescription is filled or refilled may seem silly but it’s a real safety precaution for those manufacturers who haven’t committed to 100% gluten free. The companies themselves say their excipients may change from time to time to control costs. The cost savings may maximize their profits but it may mean contamination for us if we aren’t careful.

We also need to exercise care because the drug itself, not the excipient, may contain wheat or gluten. That means the drug couldn’t be produced in a gluten free form; somehow, gluten or a gluten-containing ingredient is essential to create that specific drug’s chemical formula. Even if the manufacturer committed to 100% gluten free excipients, there still would be a need to check a new prescription for its gluten status.

How important is checking the list? Very important, if you take lorazepam, a generic form of Ativan, a popular and potent anti-anxiety medication. Geneva, a large manufacturer of generic drugs, uses gluten in its formulation of lorazepam. Take it and you may have a whole new kind of anxiety as you try to figure out why you suddenly have all those symptoms of being glutened. If your doctor prescribes Doryx, an antibiotic used to treat severe acne among other things, ask for something else because, surprise! This one contains wheat. Leurkeran, used to treat a variety of lymphatic leukemias, also contains gluten, as does Mebaral, an anti-seizure barbiturate. Of course, you and your doctor may weigh the risks and decide ingesting a gluten containing medication is essential to treat a life-threatening illness for which no other treatment is available or as effective. It’s just good to know what you’re up against from the outset so you can make an informed decision.

The website includes a good number of OTC (over the counter) medications, and these are the ones that can be really tricky. According to the website’s researchers, all Bufferin products are gluten free, except Bufferin regular 325 mg. tablet, which contains some gluten. Yikes!

Got a cough, cold or allergies? Don’t take Dimetapp or Dimetane tabs; they all contain gluten. They say the Dimetapp elixer doesn’t but I wonder how that can be, unless they produce it on different lines than the tabs. I’m steering clear of the whole shooting match.

The lists have limits. They don’t include the house brands of your favorite pharmacy, grocer, or big box retailer. To find out if Up and Up generic cetirizine contains gluten you have to contact Target but be prepared to provide the batch and lot numbers and get ready to do that every time you buy a bottle or tube of that product because the retailer only will guarantee the GF status for a specific run of the product, not for the product line in general. This is why I fork over the extra few bucks to get the brand name product; the brand companies can and often do guarantee GF status. Sure I pay more at the checkout but I pay less over time by reducing incidences of glutening.

That said, some retailers are moving toward complete gluten free status of all their private label or house OTC medications and some post lists of GF medications on their websites. Check your retailer’s website.

http://www.glutenfreedrugs.com also now posts news items, including calls for participants for clinical research trials and other research projects. Right now there are calls for a study of women with celiac disease who breastfed their babies and two studies of new celiac disease symptom survey instruments (one in Boston and one in Chicago).

There’s also an interesting article about why manufacturers might claim their products contain gluten when they don’t. It has to do with sugar alcohols. Eye-opening and important so check it out right on the homepage.

http://www.glutenfreedrugs.com is a must bookmark for everyone with celiac disease, gluten sensitivity, gluten intolerance, and DH. Hip your pharmacist to this super resource, too, so he or she not only can fill your prescriptions safely, he or she also can help others who must be gluten free but may not understand how gluten gets into medications. Peruse it yourself and get familiar with what does and doesn’t contain gluten.

Happy medicinal reading!