Medication and Supplement Use in Celiac Disease

Ashley N. Johnson, PharmD, BCPS; Angela N. Skaff, BS, PharmD Candidate; Lauren Senesac, PharmD Candidate

Disclosures

US Pharmacist. 2014;39(12):44-48. 

In This Article

Factors That may Impair Drug Absorption

Gluten is a common ingredient in many commercial food products. Less commonly known, however, is that gluten may be used in the manufacture of such unsuspected products as medications, supplements, and vitamins. Although product selection can be a nuisance, it is extremely important for persons with CD to review the nutrition labels of all foods and beverages, as well as the package inserts (PI) of medications and supplements, prior to ingestion.[12]

Gluten's role in small-intestinal inflammation and damage over time results in decreased absorption of common dietary nutrients and therefore likely causes malabsorption of oral medications, as well.[13] GI complications that can also hinder nutrient and drug absorption include impaired gastric-emptying rate, abnormal permeability, pH changes, decreased epithelial surface area, and reduced metabolizing enzymes.[13] Oral administration of most medications relies on absorption through the small intestine via passive diffusion, in which drug molecule characteristics play a large role.[13] GI-tract abnormalities may shift this diffusion process into systemic circulation, ultimately resulting in increased or decreased absorption of drug molecules. Since drug molecules have varying and unique chemical properties, it is difficult to determine the exact mechanism of absorption for all drugs in patients with CD. Based on their molecular properties, drugs currently under investigation for their absorption characteristics in gluten sensitivity include acetaminophen, aspirin, indomethacin, levothyroxine, prednisolone, propranolol, and certain antibiotics.[13] Routine monitoring of serum drug levels for medications with narrow therapeutic indexes may be warranted in CD.

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