Reviewed by Wendy Marcason, RD, LDN
For those with celiac disease or gluten-sensitivity, ingesting even the smallest amount of gluten can trigger a reaction, and it's no different when it comes to medication. Both over-the-counter and prescription drugs can be a hidden source of gluten. If you're following a gluten-free diet, that can spell trouble. "Obviously, you're taking medication because you're sick, you don't want to get sicker due to the medication being given to you," says Rachel Begun, MS, RDN, CDN, Academy of Nutrition and Dietetics Spokesperson. Follow these tips to make sure your meds are gluten-free.
Learn the Ingredients
The first step is identifying whether or not a medication contains gluten. This can be tricky. Labeling gluten-containing ingredients in medication isn't legally required, and it's often the inactive ingredients (binders or fillers) that can be potential sources of gluten. Cross-contamination can also be an issue. "It's basically the same challenges as with food," says Begun.
Just like with food, learning the ingredients and how to read the label is a must. Pay attention to the inactive ingredients—particularly anything with starch. Manufacturers don't have to identify the source of the starch, such as potato starch or tapioca starch. "If wheat starch is identified, obviously then that medication is off limits," explains Begun. But also watch for the plain word starch.
Some other words to look out for include: pregelatinized starch, sodium starch glycolate, dextrin or dextrate.
Check the back of the box on over-the-counter medications for ingredients. Prescription ingredients can be found in the package insert or on the manufacturer's website. If in doubt, ask your pharmacist to call the manufacturer or call yourself to confirm if a medication is safe.
A great shortcut, suggests Begun, is checking Gluten-Free Drugs (www.glutenfreedrugs.com), which lists many prescription and over-the-counter drugs that are gluten-free.
Consult Your Doctors
Another major step is to consult your doctors—all of them. "I think a lot of times people just rely on having that gluten-free conversation just with their celiac doctor or just with their GI doctors, but really you should let all the doctors that you see on a regular basis … know off the bat that you have celiac disease and that if medications are prescribed they have to be gluten-free," says Begun. This includes your dentist (think about what they might use to clean your teeth) and any specialists.
Begun also suggests sharing the Gluten-Free Drugs website with your health care providers as well.
Get to Know Your Pharmacist
In addition to developing a relationship with your doctors, it's also important to work with your pharmacy to address your gluten-free needs. They are, after all, the ones filling your prescriptions, and the prescribing doctor might not necessarily know which medications have gluten in them or not. Let your pharmacist know that your medication cannot contain gluten—and have him put it in your file. And always fill your prescriptions at the same pharmacy, advises Begun. This is important not just from a gluten-free perspective, but from a drug interaction perspective as well, she explains.
Investigate Brand vs. Generic
The difference between a brand-name product and generic can often lie in the inactive ingredients that are used, which is where gluten might show up. "You can't assume that just because a brand name medication is gluten-free that the generic will be too," says Begun. "Your investigation between a brand-name product and a generic have to be completely separate." Simply put: check everything.
Tell Your Insurance
Informing your insurance from the get-go that you are gluten-free could help when it comes to approving brand-name medication over generic, if the generic medication contains gluten. It's not a guarantee, but it's good to get it noted in advance, says Begun. "I can't say whether an insurance company is going to be willing to do this, but if they know ahead of time—instead of you asking after the fact—they may make an exception and approve a brand name because it is gluten-free."