Magazine article Drug Topics

Can Lactose-Intolerant Patients Use Lactose-Containing Medications?

Magazine article Drug Topics

Can Lactose-Intolerant Patients Use Lactose-Containing Medications?

Article excerpt

Submitted on Nov. 19, 2007

Q Over the past several months, the International Drug Information Center of the Arnold & Marie Schwartz College of Pharmacy and Health Sciences, Long Island University, Brooklyn, N. Y, has received a number of inquiries concerning intolerabilities to certain medications inpatients who are known to be lactose intolerant. Although gastrointestinal complaints are reported with many, if not all, oral medications, we reviewed the literature to determine whether the intolerability experienced by some patients may be due to the lactose content of drug products.

Lactose, also known as milk sugar, is a disaccharide found in many food products, particularly in dairy foods. Lactose intolerance affects between 30 million and 50 million Americans and is more common in certain ethnic groups, such as American Indians, Asians, and African Americans. The elderly and patients with HIV are two subgroups that have been shown to be especially sensitive to lactose. Gender does not seem to play a role in this condition.

Upon ingestion, lactose is metabolized to glucose and galactose by lactase, an enzyme found in the small intestine. Patients who are lactose intolerant have a lactase deficiency which prevents partial or full metabolism of lactose. The undigested lactose reaches the large intestine, causes an osmotic shift of fluids and electrolytes, and becomes fermented by colonic bacteria. The shifting of fluids and the fermentation process, which results in the production of lactic acid, carbon dioxide, mediane, and hydrogen, are collectively responsible for the symptoms of abdominal discomfort associated with lactose intolerance. These symptoms, which develop within a half-hour to 12 hours following ingestion of lactose-containing products, include diarrhea, bloating, abdominal pain, and gas.

Lactose is commonly used as an inactive ingredient, primarily as a filler in the manufacture of tablets and capsules. 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. …

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