Medications contain active ingredients—the drugs or ingredients that affect your body—and inactive ingredients—everything else, such as cornstarch to give the pill a shape or flavorings to control taste. Inactive ingredients can present a challenge to those with celiac disease because they can occasionally include gluten. However, if gluten is present, it may not be labeled clearly or prominently.
This article explores how to identify gluten in medications, the current state of labeling regulations, and practical advice for patients and caregivers seeking gluten-free options. Whether newly diagnosed or a seasoned patient, understanding how to find gluten in medication can be important to maintaining your health and peace of mind.
Gluten can sometimes be found in the excipients, or inactive ingredients, used to bind medications. Many of these excipients include starches, which may be derived from gluten-containing grains such as wheat, barley, or rye. For people with celiac disease, it’s crucial to work with your doctor or pharmacist to ensure that your medications are gluten-free. You can also reach out to manufacturers for clarity about whether specific starches or other ingredients are safe for celiac patients.
Certain starch-based excipients are considered “red flags” for potential gluten content:
Getting accurate information about gluten in medications can be difficult. The most reliable sources are your doctor, pharmacist, and the drug manufacturer. While some online lists exist, it’s essential to verify any claims you find on the internet with these trusted professionals to ensure your medication is truly gluten-free.
Several important legislative efforts related to gluten in medications happened between 2017 and 2019, but progress has unfortunately slowed. Here’s an overview of those efforts:
Although progress in Congress has slowed, Beyond Celiac and other organizations remain committed to advocating for clearer medicine labeling through public awareness campaigns and partnerships with health organizations.
Few medications contain gluten, but every oral medication must be checked to make sure it is gluten-free, since current labeling regulations do not require gluten to be labeled in medications.
It is important to remember that generic and brand name products containing the same active drug may contain different inactive ingredients. The source of these ingredients can be changed at any time without notice from the manufacturer. It also should be verified that the manufacturer has taken proper steps to avoid cross-contact from gluten-containing products.
The following inactive ingredients are considered “red flags,” as they may be sourced from wheat, barley or rye. The presence of red-flag ingredients indicates that there is a need for additional investigation to determine if the drug’s ingredients were derived from gluten:
Your first step should be to call your physician to let them know that you’re experiencing symptoms. Do not stop taking prescription medicine without talking to your doctor first.
There may be reasons aside from gluten exposure that you are experiencing symptoms, such as side effects of the prescribed medication. It is important to understand that some common side effects of medicines overlap with gluten exposure. Similarly, sugar alcohols in medications can cause significant stomach discomfort that could be easily confused with symptoms of gluten exposure.
Beyond Celiac strongly recommends that you share your concerns and any symptoms with your doctor as soon as possible. Call the manufacturer to ask about the sources of their inactive ingredients as well as their production processes and any steps taken to prevent gluten exposure.
It is important to look into medications to find out if they contain gluten before taking the medication. However, if you think you are having a reaction to gluten in your medication, Beyond Celiac strongly suggests that you contact your doctor, explain your reaction, and call the manufacturer of the medication in question to alert them to the issue. Your pharmacist might also be able to help you figure out if your medication contains gluten. When talking to the manufacturer, you should also ask them:
While prescriptions and over-the-counter medications are not covered under the FDA’s gluten-free labeling rule, dietary supplements, such as vitamins and minerals, are covered, and must contain less than 20 parts per million (ppm) gluten if they are labeled gluten-free.
It is important to be as thorough and clear as possible when talking about your gluten-free needs with your pharmacist. You should tell them that you are on a gluten-free diet to treat celiac disease, a serious genetic autoimmune disease. It may be helpful to tell them that you are at risk for serious health consequences, like thyroid disease, infertility, osteoporosis and even certain cancers if you continuously ingest gluten. You should also make sure to discuss hidden sources of gluten (listed above) and highlight the risks of cross-contact. Explain cross-contact to your pharmacist to help them understand the different ways you can be exposed to gluten.
Below are some resources for identifying medications with and without gluten*:
*Note: There are a few gluten-free medication lists available online, but it’s important to remember that these lists need constant updating to be correct and lists can have mistakes. Manufacturers can change their ingredients at any time and without warning. Gluten-free medication lists make a great starting point, but it is still important to talk to the manufacturer or your pharmacist to learn more about medications. Beyond Celiac is not involved in the creation or maintenance of any of these lists and is not liable for any consequences of medication ingestion.
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