Pharmacists can help identify pharmaceuticals that could trigger symptoms in those with the autoimmune condition.
Pharmacists interact with many patients and a variety of different medical conditions every day. On any given day, they may meet individuals with celiac disease, an autoimmune condition in which a gluten-free diet is the only treatment.
There is no known cure for celiac disease, and no medications are available to patients that might otherwise provide relief from symptoms. However, a lack of prescriptions or OTC regimens specific to the condition does not mean that pharmacists cannot help these patients. And because May is Celiac Disease Awareness Month, now is a good time to be informed about the unique challenges that pharmacy patients with this condition face.
Pharmacists should pay special attention to the ingredients in prescriptions for patients with celiac disease or who have other medical conditions necessitating a gluten-free diet. Excipients found in prescription medications vary, and some drugs do contain gluten.1 According to the Celiac Disease Foundation (CDF), starch is a common excipient used in pharmaceuticals. A starch ingredient can be corn, potato, tapioca, or wheat, but a manufacturer may not specify which type is used in a medication.1 Patients with celiac disease can err on the side of caution by avoiding any medications in which the ingredients are uncertain.
Many pharmaceuticals are gluten-free, but there is still a risk for patients with celiac disease. Ingestion of gluten, however it happens, may cause these patients to present gastrointestinal (GI) symptoms, such as abdominal pain, constipation, diarrhea, nausea, and vomiting, as well as non-GI symptoms, including dermatitis herpetiformis. In patients with celiac disease, possible long-term adverse effects caused by gluten include loss of bone density and tooth enamel, infertility, thyroid disease, and various forms of cancer.2
There are no mandates that require drug manufacturers to disclose the source of medication ingredients.1 Patients or pharmacists can contact the manufacturer directly with questions, but an answer or the right answer, anyway, may still be hard to obtain. Some drug companies are more transparent than others, and any response may not take into consideration the possibility of cross contamination during the manufacturing process.1
This is where pharmacists can advocate for patients with celiac disease. They can check ingredients on medications being prescribed to these patients, offer information to allow patients opportunities to make educated decisions for themselves, and speak with drug manufacturers on patients’ behalf.
In addition to providing assistance with prescribed medications, pharmacists can make recommendations regarding vitamins and supplements. Celiac disease causes the small intestine to become damaged and unable to absorb adequate nutrients. Vitamins and mineral therapy can help patients with celiac disease recover from nutritional deficiency, according to the CDF.
Patients who were diagnosed with celiac disease recently may be deficient in calcium, fiber, folate, iron, magnesium, niacin, riboflavin, vitaminB12, vitamin D, and zinc.3 Deficiencies in copper and vitamin B6 are less common but still possible. Like prescribed medications, the ingredients used to manufacture vitamins and supplements should be taken into consideration when providing recommendations to patients with celiac disease.
1. Celiac Disease Foundation. Gluten in medication. celiac.org/live-gluten-free/glutenfreediet/gluten-medication/. Accessed April 24, 2018.
2. Celiac Disease Center at Columbia University Medical Center. Definition and clinical manifestations. celiacdiseasecenter.columbia.edu/celiac-disease/definition-and-clinical-manifestations. Accessed April 24, 2018.
3. Celiac Disease Foundation. Vitamins and supplements. celiac.org/live-gluten-free/glutenfreediet/vitamins-and-supplements/. Accessed April 24, 2018.