From the desk of Pharmacist Steve Plogsted
Over the past few months a number of drug companies have been telling people that some of the drugs that they manufacture contain gluten. When I investigated their claims it appears that the reason they are blatantly claiming that their drugs are contaminated is because they have used a sugar alcohol as an excipient.
Sugar alcohols are not truly sugars or alcohols rather they are carbohydrates that provide a source of calories. The sugar alcohols are naturally found in a number of fruits and vegetables and may be extracted from many sources including any starch, including wheat. During the manufacturing process they are completely refined leaving behind no gluten proteins similar to making table sugar. The mostly widely used sugar alcohols used in prescription drug manufacturing are mannitol and xylitol. Both of the products are used either as sweeteners in liquid drug products or as bulking agents in the solid dosage forms.
The sugar alcohols are used in many diabetic products as well as in many health foods such as nutrition bars. Any person who consumes one of the sugar alcohols in significant quantities can experience gastrointestinal disturbances and diarrhea which may mimic symptoms celiac patients may suffer after being exposed to gluten.
National celiac organizations such as the Gluten Intolerance Group of North America® consider mannitol to be safe for use in celiac patients. Additionally, if you go to the Celiac.Com website dated 11/29/07 you will find a list of items safe for the celiac patient to consume. On that list you will also find both mannitol and xylitol as well as the following sugar alcohols sorbitol, malitol, lactilol and isomalt.
What does this means for the celiac patient? If you happen to contact a drug company for information and you are told that a drug contains gluten you really need to push them to tell you which excipient in that drug product is considered the source of the gluten contamination. If it turns out to be one sugar alcohols you may wish to re-evaluate their response. While it is always up to the celiac patient to determine whether a product is safe for them, the prevailing literature continues to suggest that these sugar alcohols are safe for use.
If you have any additional questions please contact me through the glutenfreedrugs.com website.
Steven Plogsted BS, PharmD
Clinical Pharmacy Specialist
Nutrition Support Service
Nationwide Children's Hospital
700 Children's Drive
Columbus, OH 43205
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