Lactose in Medications

Lactose is a sugar, but it's only slightly sweet. It's the least sweet common sugar of all, as a matter of fact, less than half as sweet as ordinary sucrose, or table sugar.

This is an advantage sometimes. Manufacturers like the idea of adding just a bit of sweetness to some products, without overwhelming the taste. Lactose browns like other sugars when heated - this is called caramelizing - and leaves that pretty toasty color. So breadmakers will sprinkle lactose on top of a bread to make it look better without making the bread overly sweet. And lactose is made from whey, which is considered a waste product in the manufacture of cheese, so lactose is comparatively cheap.

One other thing that lactose can do is form a crispy shell around a pill. This makes it easier to swallow pills and alleviates their bitter taste. Lactose therefore can be used either inside as a filler to bulk out a pill or outside or both. No wonder so many pharmaceutical firms use lactose in their products.

Now the amount of lactose in any one pill is probably extremely small, on the order of 25 mg. There are 12,000 mg of lactose in an 8 oz. glass of milk. Normally, I'd say that no one who is lactose intolerant should ever worry about the lactose in medicine.

Of course, that's not much help for those who react to even the tiniest amount of lactose, or those who have severe dairy protein allergies instead of lactose intolerance, or for vegans, or Orthodox Jews, or the other who have to worry about milk or animal by-products.

You'd think that there would be a list of which medicines have lactose and which don't. But there isn't.

Unfortunately, there are good reasons for that.

When I wrote Milk Is Not for Every Body: Living with Lactose Intolerance I thought I'd create just such a list for prescription medications. I contacted someone at the firm that publishes the Physicians Desk Reference (PDR), one of the standard compilations of drug information that virtually every doctor and pharmacist uses. He searched the CD that the PDR came on (1994-style high tech!) and gave me a list of every medication whose entry contained the word lactose.

Simple, right?

Simple, no.

Virtually every drug comes in more than one strength, and often in more than one format. Believe it or not, for many of the pills, one dosage would contain lactose as a filler but the next size up wouldn't. Sometimes a controlled release pill would contain lactose but not the regular pills, or vice versa. Sometimes liquid versions would have the lactose - or not.

I had to go through every single one of the several hundred listings given me and check which varieties had lactose and which didn't. It took forever. And I realized that I would have to do the same thing every single year when a new PDR was released. And there was no way to get this information for generic versions.

Now multiply that by ten and you have the problem of over-the-counter medicines. There are thousands and some of them have dozens of variations. (Check how many versions of Tylenol there are, for example.) There isn't any one central registry that I know of that lists them either, so they can't be searched for. And they change formulas, names, strengths, and varieties frequently.

Nobody has ever even tried to compile a complete list of lactose in any type of pills since my one attempt. While I hope that the future might bring about a simple way to find this info, I'm not optimistic.

The only advice I can give you is the same advice I always give for all products: check the ingredients list. Doctors and pharmacists should have access to information about the inactive ingredients in prescription medication. Virtually all manufacturers of over-the-counter (OTC) medications print the ingredients on the package. If you can't find it, try asking a pharmacist. Or call the consumer information number given. Or check the firm's website.

I wish there was an easier way. Not today, though, not yet.