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  • Jefferson Adams

    Pharmacists Play Key Role in Educating Patients about Gluten in Drugs and Medicines

    Jefferson Adams
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    Reviewed and edited by a celiac disease expert.

    Photo: CC--Army Medicine
    Caption: Photo: CC--Army Medicine

    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.

    Following 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.



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    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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    Guest Susan Williams

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    I would love to know what we as celiacs can do. I was given a medication for three years when both my doctor and pharmacist know I have celiac. I would expect people that go to school not to cause harm would know better.

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    We absolutely need to push legislatively for a ban of gluten in all medications. I have to ask that my pills be counted by hand with clean equipment, and be taken out of unopened bottles. Business as usual is to dump pills in a counting machine, then put the remainder back in the bottles. The pharmacist forgot once and I took 6 tiny 30 mg pills before they got a message to me. I got glutened pretty badly, with pyloric spasms for 6 days to start with.

    I routinely have to wait a week for new medication while the pharmacist calls the generic manufacturers and they in turn have to research the gluten-free status, then one that is found to have no gluten ingredients, and no pharmacological manufacturer guarantees any medication to be gluten-free, i.e. uncontaminated, has to be ordered. You would think that at some point the pharmacy chains would be interested in saving operations cost by petitioning the FDA to get gluten out if the meds. But no, everyone is afraid of and beholden to big bad pharma.

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    That's a joke if you expect the pharmacist to watch out for you! The local chain pharmacy wouldn't even call for me. They gave me the phone number so I could call to check for myself after I had already purchased the medication!

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  • About Me

    Jefferson Adams is Celiac.com's senior writer and Digital Content Director. He earned his B.A. and M.F.A. at Arizona State University, and has authored more than 2,500 articles on celiac disease. His coursework includes studies in science, scientific methodology, biology, anatomy, medicine, logic, and advanced research. He previously served as SF Health News Examiner for Examiner.com, and devised health and medical content for Sharecare.com. Jefferson has spoken about celiac disease to the media, including an appearance on the KQED radio show Forum, and is the editor of the book "Cereal Killers" by Scott Adams and Ron Hoggan, Ed.D.


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