<<Disclaimer: Verify this information before applying it to your situation.>>
Finding Gluten-Free Pharmaceuticals
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by Anne Laginess, PhD
summarized by Tom & Carolyn Sullivan
Highlights of a talk by Pharmacist Anne Laginess, given at our March
13th meeting.
Anne has spoken to our group before and educated us on how to tell if
pharmaceuticals are gluten-free (GF) and what to look for to protect
ourselves.
Pharmacists, in general, may be knowledgeable about GF products but
probably are not. What they are knowledgeable about is ingredients
and how to investigate them.
More gluten is being eliminated from pharmaceuticals each year as
various allergy reactants are removed and the formulas are changed.
Get the package insert and check the ingredients.
The second item in a package insert, right after the chemical name, is
the list of ingredients. The listing of inert ingredients or
excipients is the area to check. If the word or words STARCH,
VEGETABLE, PROTEIN, or MALT appear without any source listed, check
them out.
In the U.S. in FOOD PRODUCTS ONLY, maltodextrin is GF by FDA
regulation. We do not know if this is true for pharmaceuticals. So
maltodextrin in prescriptions may or may not be GF if it is made in
the U.S.; and if it is imported, the source is probably not known.
Check it out.
There is practically no new published data on GF pharmaceutical
products. There was a 1983 study of U.S. manufacturers; a 1985 study
of Canadian manufacturers; and a 1987 study which updated the 1983
listing of U.S. manufacturers. Since then, only the controversial
Duke University gliadin assay study has been performed and it has
never been repeated or replicated so the results remain unsupported by
other studies.
Anne indicated that there are many sources of information regarding
prescriptions and their ingredients. The package insert is the first
and is usually available from a pharmacist just for the asking. The
Physicians Desk Reference (PDR) is usually available at a medical
library and is essentially a book of package inserts where one could
look at ingredient lists. The PDR also provides the FDA-approved
usage for a drug and a list of manufacturers and their phone numbers.
(Note: There was a list of pharmaceutical manufacturers and their
phone numbers in the new member packet you received when you initially
joined TCCSSG.)
Anne also recognized the internet as a powerful reservoir of
information. However, both she and Dr. Alexander were quick to point
out that not everything you find on the internet is true or applicable
to your situation. One must be very cautious and KNOW YOUR SOURCES.
Not all internet sites are to be trusted.
Here are some of the sites that Anne has visited and what she found
available at each::
<http://www.celiac.com>--This site has many explanations, links,
recipes and references. There is also a safe ingredient list, a
safe additives list, and a forbidden list. [Note: This is a
personal site developed and maintained by Scott Adams.]
<http://www.csaceliacs.org/pharmaceuticals.html>--This site has some
advice about medications; where to find information about
ingredients in medications; a discussion about excipients; and a
six-page list of food/drug and drug/drug interactions. [Note:
This is part of the official website of CSA/USA, the national
celiac organization of which our group is a chapter.]
<http://www.idsl.net/celiac/day2day/d2dpg2.htm>--This site has a food
list with a lot of excipients listed, some of which are explained.
[Note: This is a personal site developed and maintained by a
family referred to as Clan Thompson.]
<http://www.idsl.net/celiac/day2day/d2dpg6.htm>--This site lists phone
numbers for food manufacturers and pharmaceutical and nutritional
companies. [Note: This is a personal site developed and
maintained by a family referred to as Clan Thompson.]
<http://www.idsl.net/celiac/day2day/d2dpg8.htm>--This site lists
prescription drugs that were checked during June of 1999. [Note:
This is a personal site developed and maintained by a family
referred to as Clan Thompson.]
<http://geocities.com/HotSprings/Spa/4003/gf-meds-toiletries.html>--
This site lists GF medications, toiletries, and household products
and was updated Jan. 18, 2000. [Note: This is a personal site
developed and maintained by Abigail Neuman.]
<http://www.geocities.com/gluten_rx/gluten.html>--This site has a list
of GF medicines and some which contain gluten; a list of
pharmaceutical manufacturers who claim to be GF; and a list of
pharmaceutical manufacturer phone numbers. [Note: This site has
the same information that Steve Plodgett provided at the Columbus,
Ohio conference in November 1999 and authorized our group to
reproduce for the benefit of our members.]
<http://www/stokesrx.com/celiac.html>--This is the site for Stokes
Pharmacy in New Jersey. They will answer questions via e-mail and
they have a GF medicine guide for sale. [Note: Stokes Pharmacy is
a compounding pharmacy but you can usually find comparable products
which are GF.]
<http://www.fda.gov>--This is the website for the Food & Drug
Administration.
<http://www.ncbi.nlm.nig.gov/pubmed>--This site allows Medline
searches for articles published in medical journals. It provides
references and frequently provides abstracts.
In a discussion about the GF status of products, Anne noted that
because a particular drug product is a brand name or a generic does
not determine if it is GF or not. Either one can or can not be GF and
the status of some products may not be able to be determined at all
for any number of reasons. From a practical standpoint, a patient may
have no other option than the one drug; however special drug
compounding, just to have a GF product, is probably not a necessity.
The question was raised about what to do for a diarrhetic reaction to
antibiotics. Anne suggested a change in the drug if its usage is long
term. Dr. Alexander agreed that the drug should be avoided if
possible. However, most antibiotics are for short term use and if
necessary, he recommends Citracel at bedtime or Immodium during the
day if needed.
If diarrhea occurs suddenly and is not traceable to a drug, Anne
strongly suggests scrutinizing one's diet for gluten.
As regards many health food store products and over the counter
products, Anne notes that many are considered foods and there are no
studies to verify any claims or efficacy. She recommends both
minimizing their use and checking the source of the ingredients.
Anne promotes what she describes as the "simple, common sense
approach", particularly for celiacs.
* Eliminate unnecessary items from the diet. Do you need a diet
pill, a mood pill, a memory pill, etc? Good diet and exercise are
often a much better solution.
* Seek alternatives. Would a salt water gargle do the same as a
throat lozenge? Do you need a cold tablet to handle all five flu
symptoms rather than one to handle just your runny nose?
* Never be the first, or the last, to use a product that may help
you. Side-effects and effectiveness become more evident after a
medication has been available for a year or two.
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