Prescriptions: Dairy is Found Under ‘Inactive Ingredients’

Many prescriptions/medications contain lactose, a sugar found in milk.

Let’s pretend we are at the doctor. You write down and tell the doctors and nurses your allergies (dairy), explain your problem and get a prescription. You assume the doctor prescribed you a medication you are not allergic to.  However, unfortunately, that is often not the case. I have never had a doctor check the inactive ingredients of a medication with a pharmacist or a clinical pharmacology book/tool prior to writing the prescription, without my prompting to do so. When I was younger, before we (my parents and I) knew about inactive ingredients, this resulted in many allergic reactions and prolonged illness even though we were very diligent about checking the ingredients of every medication I was prescribed.

Prescriptions containing dairy are frequently prescribed for those with true dairy allergies.

This is also true for people with gluten allergies and corn allergies which are also often found in the inactive ingredients of medications.

There are multiple reasons this still occurs.

1. Doctors often do not take dairy allergies seriously as they assume it is lactose intolerance.  For so many people, that may be the case but unfortunately, I am not one of those people.
2. Doctors are often not aware that many prescriptions contain dairy and may cause an allergic reaction.
3. Pharmacies/pharmacists/pharmaceutical software do not cross reference food allergies with the inactive ingredients of medications (none that I am aware of anyway).
4. The patient inserts that are provided when you pick up your prescription often do not list the inactive ingredients of that prescription.
5. Additionally, it is not just the doctor’s and pharmacies fault. There is no government legislation requiring that pharmacies cross-reference food allergies to the inactive ingredients lists and there is very little awareness of this problem.

If you have a dairy allergy, what should you do to avoid medications with dairy?

1. Provide an in-depth explanation to your doctor regarding your dairy allergy.  Explain that many medications have lactose (and/or casein and/or whey) in the active/inactive ingredients.
2. Ask your doctor to either check with the pharmacy or a clinical pharmacology guide before prescribing you the medication and definitely before you leave the doctor’s office.
3. Ask the pharmacy to provide you with the “package insert” in addition to the “patient insert”.  The “package insert” will always list the inactive ingredients of a medication whereas the “patient insert” rarely lists the inactive ingredients.
4. Double check the medication/ingredients with the pharmacist (the actual pharmacist, not the pharmacy tech, preferably) before leaving the pharmacy with your medication.
5. You may need to have your medications compounded if there are no medications available without dairy. This means your drug is hand-mixed especially for you. That way you can specify that the drug be made without dairy ingredients including casein, whey and lactose (this is true for gluten too).
6. Call the drug manufacturing company to see if the lactose is derived from milk (I have had limited results with this, many don’t know where the lactose was derived from-in that case, stay far away).
7. Advocate for change among your local pharmacies and doctors.  Educate them.  It will help you and others!

Here are a few common prescription medications (and their common indications) that are known to contain dairy:

• Almost all oral contraceptives (even some of the vaginal inserts and possibly even the patch, Ortho Evra, because of the adhesive; many adhesives are made with casein)
• Acetaminophen and Hydrocodone: Pain
• Azithromycin (Z-Pak and Zithromax): antibiotic
• Buspirone: panic disorder
• Clonazepam (benzodiazepine)
• Concerta: ADHD, narcolepsy
• Hydrochlorothiazide: water pill used to lower blood pressure
• Lorazepam: insomnia, sedation, agitation
• Norvasc: angina/blood pressure
• Oxycodone Hydrochloride: Pain
• OxyContin: Chronic Pain
• Prednisone: osteoarthritis; rheumatoid arthritis; asthma; hay fever; eczema
• Prilosec (Omeprazole): antacid
• Synthroid (levothyroxine sodium): synthetic thyroid hormone
• Tramadol Hydrochloride: Pain
• Xanax: depression, panic disorder
• Zocor (simvastatin): cholesterol lowering
• Zolpidem: Insomia

*Please note: There are a huge variety of formulations of medications.  Some of the medications may contain dairy and some may not.

Remember, this is also true for over the counter medications.  Many over the counter medications contain milk ingredients and many are listed as an inactive ingredient. Please check ingredients diligently and contact the manufacturer just to be sure!