Drug manufacturers use various excipients in the production of active medical ingredients. These not only influence the effect and tolerability of a medicine, but also extend the shelf life or serve as a filling or binding agent.
Lactose is one of the most frequently used fillers, as it has a high water-binding capacity and thus contributes to the solid, transportable form of tablets and gives them a certain volume. Lactose is of particular interest to the pharmaceutical industry because it is inexpensive, has a pleasant, slightly sweet flavour and does not react chemically with the active ingredients.
How do I know if a medicine contains lactose?
Patients can find out which medicines contain lactose in the package leaflet.
This contains a list of all ingredients, including excipients such as lactose.
In many countries, there is also a labelling requirement for allergens and other potentially problematic ingredients in medicines. This information must be stated on the packaging or in the package leaflet. Medicines that are not labelled as such do not contain lactose.
There are also specialised websites and databases from pharmacies and health portals as well as the "What's in my Meds" app, which provide information on the ingredients of medicines.
Anyone who prefers personal contact or wants to be on the safe side should ask a doctor or pharmacist for help. They have access to detailed information about the composition of medicines and can tell you whether a particular medicine contains lactose and offer a lactose-free alternative if necessary.
Which medicines have lactose in their composition?
There is no clear or conclusive answer to this question, as there is a wide range of medicines on the market and lactose-free alternatives are now available for many medicines, so those affected should always read the ingredients information on the package leaflet carefully or consult their doctor or pharmacist.
Nevertheless, the following list is intended to provide an overview of the 10 most commonly prescribed medicines in the US:
-
lisinopril (Zestril): ACE-blocker
Lactose-free. -
levothyroxine (Synthroid): thyroid hormone
Contains lactose, but there are lactose-free alternatives from Levoxyl and Tirosint. -
atorvastatin (Lipitor): cholesterol reducer
Contains lactose. -
metformin (Glucophage): diabetes medication
Lactose-free. -
simvastatin (Zocor): cholesterol reducer
Contains lactose. -
omeprazole (Prilosec): gastric acid inhibitor
Contains lactose. -
amlodipine (Norvasc): blood pressure medication
Lactose-free. -
metoprolol (Lopressor): beta-blocker
Contains lactose. -
acetaminophen plus hydrocodone: pain medication
Contains lactose. -
albuterol (Ventolin): asthma spray
Lactose is found only in dry powder inhalers.
In addition, most medicines containing paracetamol, such as Dafalgan, Doliprane (in tablet form), Efferalgan etc. contain lactose, as do the antistamine Desloratadine and the antibiotic Amoxicillin. However, diosmin, a chemical compound used to stimulate blood circulation, and Trimebutin, a drug used to treat painful cramps caused by the digestive tract, also use lactose as a carrier.
But beware: this list of lactose-containing medicines is not exhaustive and each medicine should be checked for its ingredients.
What do people affected by lactose-containing medications need to consider?
While a glance at the ingredients quickly reveals whether lactose is contained in the medication, it usually remains unclear how high the lactose content of the tablets is, as the manufacturers are not obliged to provide information on the quantity of fillers. As a rule, however, lactose is only one of several excipients used. The amount of lactose is therefore comparatively small and only makes up a fraction of the total mass of a tablet.
Whether patients react to lactose in tablets depends on the severity of the intolerance as well as the lactose concentration in a medicine and the dosage. Patients usually only react with symptoms from a certain amount of lactose, so that the amounts of lactose contained in tablets are usually tolerated without any problems.
However, in the case of severe lactose intolerance, taking lactose-containing medication can lead to the typical symptoms. In this case, lactose-free alternatives should be chosen. If these are not available and taking the medication is essential, lactase tablets can help to alleviate the symptoms of lactose intolerance, as they do not impair the effect of medication.
Best regards.
Lisa from Lactojoy
References:
- P. Eadala et al., Quantifying the 'hidden' lactose in drugs used for the treatment of gastrointestinal conditions, Alimentary Pharmacology & Therapeutics 29, 2008.
- S. Jossé, Interview with Dr. rer. nat. (certified nutritionist) Stefanie Ackermann: https://www.mein-allergie-portal.com/laktoseintoleranz/699-laktose-in-medikamenten-zahncremes-co-was-muss-man-wissen.html, 2015.
- D. Mill et al., Managing acute pain in patients who report lactose intolerance: the safety of an old excipient re-examined, Ther Adv Drug Saf, 2018.
- A. V. Fuentes et al., Comprehension of Top 200 Prescribed Drugs in the US as a Resource for Pharmacy Teaching, Training and Practice, Pharmacy (Basel), 2018.
- D. Reker et al., “Inactive” ingredients in oral medications, https://www.science.org/doi/10.1126/scitranslmed.aau6753, 2019.