Celiac.com 05/12/2015 - The current treatment for celiac disease is the avoidance of gluten-containing foods, beverages, and other products by means of a strict gluten-free diet.

Photo: CC--Army MedicineFollowing such a diet can be challenging, but recent FDA labeling rules go a long way toward helping people with celiac disease know with pretty good certainty whether a food product contains gluten, or is gluten-free.

However, When it comes to prescription drugs, medicines, OTC products, supplements, and vitamins, people with celiac disease currently have little guidance. The FDA rules that mandate the labeling of gluten and other known allergens on food product labels does not apply beyond food. There are currently no rules mandating the labeling of gluten in drugs and medicines. That means that your average person with celiac disease might have a hard time finding out which medications, OTC products, supplements, and vitamins may contain gluten, and may experience adverse symptoms from continued gluten ingestion.

A team of researchers set out to assess the role of pharmacists in educating patients and evaluating their medication use to ensure the optimal management of celiac disease. The research team included Ashley N. Johnson, PharmD, BCPS, Angela N. Skaff, BS, PharmD Candidate, and Lauren Senesac, PharmD. They are affiliated with the Pharmacy Practice Drug Information Center, and the Lloyd L. Gregory School of Pharmacy Palm Beach Atlantic University West Palm Beach, Florida.

The team celiac disease review included Etiology and Risk Factors, Clinical Presentation and Diagnosis, Factors That May Impair Drug Absorption, Legislation, Management, and Resources. They found that pharmacists do indeed have an essential role to play in educating patients and evaluating their medication use to ensure the optimal management of celiac disease. This often can be accomplished by evaluating the ingredient list, contacting the manufacturer, or utilizing a variety of other resources.

Gluten can potentially be introduced and contaminate otherwise gluten-free products during the manufacturing process, although the likelihood is low. Key points to consider are that even if a brand product is confirmed to be gluten-free, it cannot be assumed that the generic version is also gluten-free, and that if a product has a new formulation, appearance, or manufacturer, it is prudent to reassess it and confirm that it remains gluten-free.

When evaluating the gluten content of prescription and OTC products, it should be remembered that gluten can be masked in an excipient.

Starches used as excipients in pharmaceutical products are often derived from rice, potato, or tapioca, which are gluten-free. However, if the source of the starch is not explicitly stated, the excipients may contain gluten. Sources of excipients that contain gluten include barley, farina, kamut, rye, spelt, triticale, and wheat.

Pharmacists play a pivotal role in educating patients about gluten-containing foods, medications, and supplements in order to help them adhere to a GFD and in ensuring that patients receive additional follow-up care, if needed.


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