Gluten in medications

Although gluten is not used as a medical treatment as of itself, it can be present in medicines in the form of an excipient. Excipients are substances used in medicines that bind together other ingredients and add to the stability of the product to lengthen its shelf life, among other functions.  

If you have coeliac disease or another form of gluten intolerance, there are several steps you should take to ensure that a medication is safe for you. First, if it is a prescription medicine, check with your doctor who is prescribing it. You should also check the ingredients as given by the pharmaceutical company, either in the package leaflet or on the manufacturer’s website. You can also consult online resources that are regularly updated with information on drugs and the presence of gluten, including Gluten Free Drugs (see below).      

When looking at information on a medication, inactive ingredients that can be considered ‘red flags’ alerting to the potential for gluten being present are the terms wheat, modified or pregelatinized starch (unless stated to be potato starch or another gluten free source), dextrates (if source is not specified), dextrin (if source is not specified), dextri-maltose (contains barley malt), and caramel colouring (could contain malt). 

Different countries have different rules and approaches to labelling for gluten in medicine. In the US, the Food and Drug Administration (FDA) has issued draft guidance to drug manufacturers to include in their labelling a gluten free statement where this is true, and to provide accurate information on whether their products contain gluten or not. But prescription medicines and over-the-counter products are still not legally required to label for gluten, while health products such as vitamin and mineral supplements must contain less than 20 parts per million (ppm) of gluten if they are labelled gluten free. Initiatives are being supported to make labelling for gluten or gluten free a requirement for all medications. 

In the UK, the advice from the association Coeliac UK is to check any medicine’s patient information leaflet for wheat starch. This will usually be accompanied by a statement that the medicine is suitable for people with coeliac disease due to the extremely low gluten content of the kind of wheat starch used, and a warning that the product should not be taken by people with wheat allergy.  

Sometimes the information that can be gleaned from the doctor prescribing a medication and the product information leaflet is not absolutely satisfactory. Ingredients that have the potential to contain gluten may be listed, but with no specific verdict on whether gluten is present and in what quantity. 

The Gluten Free Drugs website offers a wealth of information about specific medications and their suitability for a coeliac patient or a person with other intolerances. The site’s alphabetical list of medications uses a numerical system in which 1 means gluten free, 2 is for products which are almost certainly safe although the manufacturer does not guarantee them to be gluten free, and 3, 4 and 5 provide other categories for a full assessment of each product. The list also considers the presence of various starches, lactose and soy in medications. 

If you are not sure if there is gluten in your medication, you should continue to take the medicine while consulting the best sources to find out whether gluten is present or not. You should speak to your doctor or pharmacist, but you may also need to call the manufacturer to ask about the sources of the medication’s inactive ingredients, as well as their production processes and what attempts they make to prevent gluten contamination.  

Even if you are experiencing symptoms as a side effect of the medication you are taking, it is important to seek professional advice before concluding that it is a reaction to gluten. Sugar alcohols in medication can cause stomach upsets, for example. Once you have exhausted all avenues of information, you will know whether you need to seek an alternative medication or be confident in the knowledge that yours is a gluten free prescription.