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Hot Topic:
Pepcid AC® and Lactose in Medications

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There's a new variety of Pepcid AC® on the market, a "Convenient Great Tasting Chewable Tablet". Good for them: I approve of anything that makes life easier for consumers. Just one thing some of you should know: Chewable Pepcid AC® contains lactose.

You may or may not be surprised to learn that many hundreds of pills contain lactose as a filler or a coating. Why do pill manufacturers do this? Four main reasons:

  1. Lactose is almost tasteless except for a slight sweetness, making it an ideal filler.

  2. Lactose prevents caking, presumably a useful trait for a chewable-type tablet.

  3. Lactose can also be sprayed onto a pill to produce a shiny, hard coating, making other kinds of pills easier to swallow.

  4. Hardly anybody is bothered by small amounts of lactose.
And they're absolutely right all four times. Hardly anybody, and that's including the majority of those with lactose intolerance and even milk sensitivities, is bothered by tiny doses of pure, medicinal-grade lactose.

So what's the problem?

"Hardly anybody" is meaningless if one of those unfortunates is you. And in a country of 260 million people, "hardly anybody" can add up. You may be a minority, but there are still a lot of you out there.

Here are the facts. No matter what some doctors might lead you to believe, there are a number of cases – documented in medical journals – of people who have had lactose intolerance reactions just to lactose in the medications they were taking. It's even been shown that a few people can sense a 10 milligram dosage in an inhaled powder. [Citations for the Curious]

Again, those people are rare. Most pills have no more than 12.5 to 25 milligrams of lactose, and that's tiny on anyone's scale. An eight-ounce glass of milk contains 12,000 milligrams (12 grams) of lactose. The average person with lactose intolerance should never worry about the lactose in a pill.

What about the not-so-average? There are four classes of them as well.

  1. The extremely sensitive. That includes those people at the very far end of the sensitivity curve as well as those who have become intolerant through disease or surgery to their intestines (so-called Secondary Lactose Intolerance or SLI). These people often have absolutely no lactase in their systems at all.

  2. Seniors and others who must take dozens of pills a day. They often have the least lactase and the most delicate intestines. By ingesting even a full gram of lactose, they could easily feel the effects.

  3. People with milk allergies. There should be little or no milk protein remaining in medicinal-grade pure lactose, but those with the worst, life-threatening, allergies can hardly be expected to take the chance.

  4. Those who object to animal-derived products. The millions who are vegans or Orthodox Jews or others with religious or ethical aversions may need to avoid any pills containing lactose, even if they do not get specific lactose intolerance symptoms.

What to do?

First, don't panic. There are alternatives to every pill. Every type of medication has at least one lactose-free variety or manufacturer. If you're concerned, all doctors and pharmacists have the current edition of the Physicians Desk Reference (PDR) or equivalent volumes, listing all inactive ingredients in virtually all prescription medications.

(You can also check my book, Milk Is Not for Every Body: Living with Lactose Intolerance. I went through the PDR and made a list of every prescription pill, tablet, or capsule available at the time (1994) that contained lactose. I also listed alternatives of the very same drug that were lactose-free. This list, while somewhat out of date, is still the best overall treatment of the subject.)

Non-prescription (or over-the-counter [OTC]) medications are in some ways easier and in some ways tougher to deal with. There are no compendia of ingredient information for OTC drugs equivalent to the PDR. They wouldn't be of much use if they did exist: there are too many varieties that change too often. Fortunately, virtually all companies today list their inactive ingredients on the sides of their packages. Even small brands of vitamins and minerals often proclaim that they contain no lactose. You should always be able to find a lactose-free alternative that meets your needs.

And what about Pepcid AC®? Ironically, it is not even effective against the symptoms of lactose intolerance. But not everyone is aware of this. Undoubtedly some people with lactose intolerance, along with a larger group who don't know that they're LI, will take Pepcid AC® in the hopes of getting relief. Instead, they may wind up increasing their symptoms.

Déjà vu all over again. A few years ago, observant consumers noted that while one variety of Imodium AD® (an anti-diarrhea product also mistakingly used by many suffering from LI symptoms) contained no lactose, a different variety did. I, along with many others, I'm sure, complained to the manufacturers. Awhile later a "new and improved" version appeared – containing no lactose.

Moral: consumer action does work. If you are concerned about any medication, prescription or OTC, call, write, fax, or email the manufacturer. (The name should be on the side of the package for an OTC pill; ask your pharmacist for the manufacturer of a prescription medication.)

For Pepcid AC® specifically, call their comment line at 800-755-4008 and complain – firmly but politely. Tell them exactly why you would prefer to see them make their product without lactose. Remind them that they are making other varieties lactose-free. It may take time, but most consumer complaints are eventually addressed.

For more info, go to the Chewable Pepcid AC® web page. The site does not have an email address, but there is a "Feedback" page at a different location. (Here's another irony: Pepcid AC is made by Johnson & Johnson•Merck, the very people who used to own the rights to Lactaid, a lactase pill.)

You may congratulate yourselves if you succeed. You'll have done good.

Citations  (Back to where you left off)

  • American Academy of Pediatrics Committee on Drugs. "Inactive" ingredients in Pharmaceutical Products: Update (Subject Review). Pediatrics. 1997;99:268-278
  • Brandstetter RD, Conetta R, Glazer B. Lactose intolerance associated with Intal capsules. N Engl J Med. 1986;315:1613-1614
  • Higham MA, et al. Determination of the minimum dose of lactose drug carrier than can be sensed during inhalation. Br J Clin Pharmacol. 40;3:281-82 [I had an earlier citation of LI from a nasal spray, but I can't find it now. If anyone out there knows of it, please send me the complete reference. Thanks.]
  • Lieb J, Kazienko DJ. Lactose filler as a cause of "drug-induced" diarrhea. N Engl J Med. 1978;299:314
  • Malen DG. Parnate formulation change. J Clin Psychiatry. 1992;53:328-329
  • Petrini L, et al. Lactose intolerance following antithyroid drug medications. J. Endocrinol. Invest. 1997;20:569-570
  • Van Assendelft AH. Bronchospasm induced by vanillin and lactose. Eur J Respir Dis. 1984;65:468-472
  • Zeiss CR, Lockey RF. Refractory period to aspirin in a patient with aspirin-induced asthma. J Allergy Clin Immunol. 1979;72:633-636

    


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