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May 04, 2023

Is Gluten Hiding in Your Medications?

Nancy Ehrlich Lapid is an expert on celiac disease and serves as the

Nancy Ehrlich Lapid is an expert on celiac disease and serves as the Editor-in-Charge at Reuters Health.

Robert Burakoff, MD, MPH, is board-certified in gastroentrology. He is the vice chair for ambulatory services for the department of medicine at Weill Cornell Medical College in New York.

Unless a medication is specifically labeled as gluten-free, calling the manufacturer is the only way to confirm whether or not your medication is gluten-free. In prescription and over-the-counter medicines, fillers also called "inactive ingredients" or "excipients," are added to the active drug.

Fillers provide shape and bulk for tablets and capsules, aid in water absorption helping the tablet to disintegrate, as well as other purposes. Fillers can be derived from any starch source including corn, potatoes, tapioca, and wheat.​​​​​​

Unfortunately, very few medications are clearly labeled as gluten-free. Inactive ingredients may be listed on the box or the package insert, but it can be difficult to tell if these are derived from gluten.

In particular, any starch ingredient, including pregelatinized starch and sodium starch glycolate, not labeled specifically as coming from a gluten-free source—for example, corn, potato, tapioca—can be a cause for alarm. In addition to starch, other inactive ingredients that might come from wheat or barley include, but are not limited to, dextrates, dextrins, dextri-maltose, and maltodextrin.

Sometimes even the pharmaceutical company itself does not know for sure whether its medications are gluten-free because they do not know the gluten-free status of the raw materials they buy from outside suppliers. Cross-contamination during the manufacturing process is another potential problem.

Tell the pharmacists at your drugstore that your medications must be gluten-free. Remind them every time you have a prescription filled. Remember that although pharmacists have expert knowledge of medicines and how they work, they are not experts in celiac disease nor do they know the source of every inactive ingredient in pharmaceutical products.

When generic medications are available, your insurance company will probably not approve the brand-name drug. Generic medications, however, are not required to contain the same fillers as the brand name formulation. Just because you've confirmed that a brand-name medicine is gluten-free doesn't mean the generic form is safe. Likewise, one generic being gluten-free doesn't mean all generics are.

If you need a brand-name medicine because no safe generic alternative is available, call your insurance company to learn what they require to approve the brand name version of the drug.

If you require an unusual medicine for which no gluten-free formulation is commercially available, ask your pharmacist to put you in touch with a pharmacy that does customized compounding. Few drug companies have a policy of avoiding gluten completely. If your medicine is manufactured by a company that does use gluten in some of its products, you'll need to recheck periodically to be sure the manufacturing process hasn't changed and your medicine is still gluten-free.

When your healthcare provider is prescribing a medication for you, remind them that you are going to need to check the gluten-free status of the medication. Ask to be given a second-choice prescription in case the first-choice medicine turns out to be unsafe. If you'll be having any radiological (X-ray) procedures for which you'll need to drink some type of contrast material, call ahead to make sure the radiologists verify the gluten-free status of whatever they're going to give you.

The Celiac Foundation. Gluten in Medications, Vitamins, and Supplements.

Mollo, Katarina. National Celiac Association. Do I need to check that my medication is gluten-free?

By Nancy LapidNancy Ehrlich Lapid is an expert on celiac disease and serves as the Editor-in-Charge at Reuters Health.