What prescription medications contain gluten?

Prescription Medications Containing Gluten: Concerns for Celiac Disease Patients

Patients with celiac disease should be cautious about certain prescription medications that may contain gluten, as these can trigger symptoms and cause intestinal damage similar to gluten-containing foods. 1

Problematic Ingredients in Medications

• Starch-based ingredients are the primary concern in medications for celiac patients:

  • Wheat starch is not gluten-free and should be avoided 1
  • Corn, potato, rice, and tapioca starches are safe alternatives 1
  • Pregelatinized starch is only safe if derived from gluten-free sources 1

• Specific problematic excipients include:

  • Sodium starch glycolate (generally not gluten-free) 1
  • Dextrimaltose (made from wheat) 1
  • Malt and malt syrup (barley-derived) 1
  • Dextrin, dextrates, and cyclodextrins (may contain gluten depending on source) 1
  • Maltodextrin (source must be verified) 1
  • Caramel color (often derived from barley) 1

Medications of Particular Concern

• Sevelamer contains sodium starch glycolate which is generally not gluten-free 1
• Prednisone formulations may contain:
  • Pregelatinized starch (gluten-free only if from corn, rice, tapioca, or potato) 1
  • Sodium starch glycolate (generally not gluten-free) 1

Clinical Implications and Best Practices

• Oral medications pose the greatest risk due to direct gastrointestinal exposure to potential gluten-containing ingredients 1

• Prescriber responsibilities:

  • Add statements such as "As ordered if gluten-free or provide a gluten-free equivalent" to prescriptions 1
  • Avoid generic substitutions when possible, as ingredient sources may change frequently 1
  • Be aware that FDA regulations for ingredients differ between medications and foods 1

• Pharmacist role:

  • Verify gluten content of medications 1, 2
  • Provide information about gluten-free pharmaceutical products 2
  • Help identify potential gluten-containing medications 2

Patient Guidance

• Patients should consult with pharmacists about the gluten content of prescribed medications 1
• Patients should inform all healthcare providers about their celiac disease diagnosis 3
• Maintaining a strict gluten-free diet, including medications, is essential for preventing complications such as lymphoma and adverse health outcomes 3

Regulatory Considerations

• Current legislation requires analysis of protein content in wheat starch used as an excipient 4
• Regulations do not specify that reference should be made to traces of gluten that are residues of the production process of active ingredients 4
• There is a need for updated legislation to ensure safe use of drugs in celiac patients 4

Future Directions

• Development of adjuvant therapies that would permit intake of small amounts of gluten could improve quality of life for celiac patients 5, 6
• Potential therapies include gluten-degrading enzymes, polymeric binders, desensitizing vaccines, and anti-inflammatory drugs 5
• Currently, strict adherence to a gluten-free diet remains the only effective treatment for celiac disease 7