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One drug may contain up to 35 different inactive ingredients.
Monty Rakusen / Getty Images
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Monty Rakusen / Getty Images
One drug may contain up to 35 different inactive ingredients.
Monty Rakusen / Getty Images
If you have a bad reaction to a drug, it may not be the medicine itself, but what are called "inactive ingredients" in the pill or capsule.
An article published Wednesday in Translational medicine science examines this area and finds that potentially troublesome ingredients for some people are ubiquitous.
For example, a few years ago, Giovanni Traverso, co-author of the study, gastroenterologist at Brigham and Women's Hospital affiliated with Harvard, met a patient with severe pain. severe intolerance to gluten, known as celiac disease. The person had problems with a drug that apparently contained gluten as an inactive ingredient – which could worsen the condition rather than improve it.
Traverso, who is also a biomedical engineer and has an appointment at MIT, began exploring this topic with colleagues weighing pills in the hospital pharmacy. They concluded that on average, about 75% of a pill or capsule is composed of inactive ingredients, that is, a material. other than the chemical or chemicals that determine the therapeutic effect of a drug.
In their article, scientists say that pharmaceutical companies have more than a thousand choices among these inactive components. "In some cases, there can be up to 35 of them in a single tablet," Traverso said in an interview.
Traverso says that these inactive ingredients are essential for stabilizing medications and sometimes helping the body absorb active ingredients. "I do not want to denigrate inactive ingredients," he says. "I think inactive ingredients are very useful."
But, they can include materials such as gluten and lactose and dyes that can trigger allergies.
In general, the amounts of a given pill are not of concern. But many people take several medications and if these drugs contain the same inactive ingredients, the doses can add up.
If you are lactose intolerant and you take a tablet using lactose as an inactive ingredient, "it's probably not going to manifest as significant symptoms," he says. But like the number of pills you take [increases]so certainly you can cross that threshold. "
One of the challenges in understanding the scope of this problem is that it is often difficult to determine the amount of substance needed to trigger an allergy or other reaction.
"It's something that can vary from one person to the other," says Traverso. But for many of these ingredients, "we do not really know today."
The Food and Drug Administration regulates these pharmaceutical ingredients. Among other things, it has published draft guidelines on how companies should label gluten-containing medicines.
Dr. John Kelso, an allergist at the San Diego Scripps Clinic, examined the problem of allergens in medications. He says that reactions are actually quite rare. In fact, it's usually a false alarm.
For example, after many years of worry about traces of egg protein in influenza vaccines, health officials are now declaring that people with egg allergies are not threatened by the vaccine.
An overreaction to this worry can actually turn against you. "Often medications are denied to patients who say they are allergic to eggs or soy or anything else that might contain them," says Kelso, "but it's actually not a problem. "
Penicillin, although an active ingredient, is an excellent example of overreaction.
"We recently realized that about 95% of patients who are labeled as allergic to penicillin are not, either because they have never been, or because they had an allergy that has faded over time. " An allergist can test people to see if they are really allergic to this useful and inexpensive antibiotic.
For those who are worried about inactive ingredients, Traverso explains that it is possible to find this information. Go through the fine print of the instructions (called the leaflet) provided with your medications, "and you'll find them eventually," he says.
The National Library of Medicine also has an online database, called Pillbox, containing this information.
Different manufacturers of the same drug often use different inactive ingredients. Therefore, if a drug can be problematic, it is worth considering switching to the same product made by another manufacturer, explains Traverso.
He and his colleagues have a patent pending on an algorithm designed to facilitate this research. They plan to develop a consumer application or software to help doctors and pharmacists review all the medications they take, so they can alert their patients to potentially inactive, inactive ingredients.
You can contact NPR Scientific Correspondent, Richard Harris at the address [email protected].
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