It is easy to understand why gluten is found in many foods, such as bread, pasta, and cereals, since wheat, barley, and rye, are popular grains. But why is gluten in other products?

Gluten is used as a'filler' in medications,  often as an inactive ingredient. Unfortunately, even when you look at the package insert for the medication, it can be hard to know if the drug contains gluten, since it typically won't list gluten or wheat, but will instead list the name of some cryptic filler. The words 'starch' or 'stabilizer' in the inactive ingredients can be clues to the presence of gluten, in addition to other inactive ingredients.

Your pharmacist or the drug's manufacturer should be able to help you figure out if the drug is gluten free too.

Fortunately, many common childhood medications, including antibiotics, seem to be gluten free. Be aware that some generic medications have more than one manufacturer, so in addition to the brand name medication, you have to may have to make sure the specific generic drug your pharmacist dispenses is also gluten free.

You can find many lists of gluten free medications from celiac disease support groups, such as glutenfreedrugs.com.

Just because a medication isn't on the list, doesn't mean it isn't gluten free!  Always doublecheck, as products always are changing.

The Need for Gluten-Free Medications

Overall, when one looks at the thousands of medications available, the problem for a potential of gluten in a drug preparation is very small.  However, a person with celiac needs to be concerned about those very few prescription and over-the-counter products that do contain one or more of the offending grains and thus gluten.  For both the celiac and the dermatitis herpetiformis patient, it is prudent to have medical direction for all medications-both prescriptions and over-the-counter non-prescription choices.  And, secondarily for all "put-ons," items which will touch the skin.  This kind of planning and monitoring allows the physician to prescribe gluten-free, preservative-free, and red and yellow dye-free medications-if any of these contents should be a problem for the patient.  If the celiac patient is to be self-directed and self-managed in the handling of the medication regimen, it is critical to have good information and to know which aspects to search out and which sensitivities and malabsorption problems are considerations as toxic reactions.

Because of the propensity for confusion and error with drug names for the consumer, it may be best for the celiac patient to always present questions regarding pharmaceutical and nutritional products to a physician or pharmacist.  With the several references and services available to health professionals and the in-print product information found in the Physicians' Desk Reference (PDR) on medications and the 800-number information service to drug companies, the pharmacy can then have access to current information about drugs being considered for prescription or non-prescription over-the-counter use.

While the percentage of pharmaceutical products containing gluten is small, gluten is used as an "inert" excipient in tablets, capsules and suspensions for both oral and rectal products.  The central message is this:  Both over-the-counter and prescription medications may be toxic to patients with the conditions of celiac disease and dermatitis herpetiformis.

 Before using a hand lotion (with a grain derivative), a face powder (with wheat starch extender), a lipstick (with oat gum), a shampoo (with wheat germ oil), a mouthwash (with a grain derivative), a toothpaste (with one of several glutens); or, an array of tablets and pills with colorings based on grains, dyes based on lakes and/or other glutens such as wheat germ oil, wheat flour or barley water, the patient must know their needs related to avoidance of gluten-containing products and then check with their pharmacist or physician for information and direction. Celiacs will need to read labels for all over-the-counter and toilet items to be assured they are appropriate choices.  Some celiacs may wish to make use of selected non-allergenic items [which are available in the non-allergenic sections at most pharmacies] such as hand soaps for the shower, detergents for the laundry, and lipsticks without grain stabilizers.   

Celiac patients with lactose intolerance will need to review with pharmacists the use of powdered milk as an excipient in a variety of medications and supplements.  A common example is selected brands of calcium which may contain 90 percent+ powdered milk as an intended "inert" ingredient.  Since individual needs are unique among celiac patients, those products that represent sensitivities and allergic reactions should be kept on a file record with pharmacies and clinics that might be used on a continuing basis by the celiac patient.

An important learning for all celiacs is represented in the continued upgrade and change in formulation for medications.  This appears to be as true for over-the-counter medications as it is for prescriptions.  Thus, a double-check is always prudent and in order for refills on prescriptions and the continued purchase of the same shampoo-since some of the basic items may have changed since your previous use and purchase.  New formulations of a tablet may look the same, but in actuality now use wheat starch as the sealer.