Seriously Now, Is Lactose a Problem in Medications?

Yesterday I mentioned that seemingly every pill you can put in your mouth, even karaoke pills (no, not pills to cure karaoke, but pills to make you sing better for karaoke) contains lactose as a filler.

A frivolous frippery, to be sure, but a fun way to approach a serious subject. Just how much of a risk does someone with lactose intolerance face when taking pills containing lactose?

A bunch of serious-sounding doctors, Joseph P. Nathan, M.S., Pharm.D.; Sara Schilit, Pharm.D.; and Jack M. Rosenberg, Pharm.D., Ph.D. Drug Topics, of the International Drug Information Center of the Arnold & Marie Schwartz College of Pharmacy and Health Sciences, Long Island University, Brooklyn, N.Y., took a look at the medical literature on this subject.

They reported back to a physician audience on Drug Topics.

Case reports describing lactose-intolerant patients experiencing adverse reactions to the lactose content of medications have been published over the past 30 years. The symptoms experienced were ameliorated to some degree with supplemental lactase enzymes and resolved when the patients discontinued the offending medications. Notably, the majority of patients in these cases were extremely sensitive to lactose-containing products.

While it has been reported that the amount of ingested lactose necessary to produce adverse effects varies, it generally ranges between 12 and 18 gm of lactose (approximately 8 to 12 oz of milk). Considering the fact that most oral medications contain quantities of lactose that are far less than 12 to 18 gm, one would theoretically not expect such small quantities to result in gastrointestinal symptoms. Nonetheless, the cases reported in the literature suggest that certain individuals may react to very small quantities of lactose.

In summary, it appears that most patients who are lactose intolerant can probably tolerate the quantities of lactose that are incorporated into oral drug products. However, one must keep in mind that certain highly sensitive patients may present with gastrointestinal complaints even after ingesting the small quantities of lactose found in oral medications. Furthermore, patients ingesting multiple lactose-containing medications may experience symptoms of lactose intolerance due to the cumulative lactose intake from these medications. Patients who experience adverse gastrointestinal effects after ingesting lactose-containing drug products may opt to use lactase enzyme supplementation.

I feel good in that this is exactly what I've been saying on the subject.

If taking lactase with the pills doesn't alleviate the symptoms, then the choices are fewer. You can try requesting an alternate medication or form of the original medication that does not contain lactose. This isn't always possible, though. Some medications don't have good alternatives, or the alternatives might be considerably more expensive.

Or you could try finding a Compounding Pharmacy that will make up personalized versions of the medications just for you. That link will give you contact information to help you find a compounding pharmacist in a location near you.