Last updated in 2019! This article on lactose in medications was written for us by the lactose intolerance expert, Steve Carper of Planet Lactose. Please note that this is a FACT based article and does not speculate whether lactose in your medication is causing an issue for you. Every body is different. If you believe you are having any type of a reaction to a medication, you must speak with a physician.
Lactose is a sugar, a slightly-sweet sugar. It is only about one-seventh as sweet as sucrose, ordinary table sugar. Oddly enough, this is a good thing to many in industry. Lactose allows a bit of pleasant sweetness to be added to products, without overwhelming them with an overly-sweet taste. Commercial bakers can sprinkle lactose on the tops of bread and let it caramelize to a beautiful golden-brown. Food processors can add lactose (or whey, which is mostly lactose) to add taste and texture to foods without affecting the primary taste of the food.
Best of all, lactose is made from whey, and whey is a waste product in the cheese-making process, so it’s really cheap.
That’s why lactose is used so often in pill-making. The extremely tiny amount of actual working ingredient in a medication needs to be surrounded with fillers that bulk it out to be large enough to handle. A substance that is mostly tasteless but with just enough sweetness to balance out the bitter taste of many medications is great. That lactose can be formulated to break down in the stomach to release the medication makes it nearly ideal.
Lactose Set to Star in Even More Medications
Literally hundreds of branded prescription medications use lactose as a part of their formulations. If you add in generics and over-the-counter drugs, you probably have thousands of medications that include lactose.
And there will soon be more rather than fewer pills that use lactose.
Phil Taylor on DrugResearcher.com wrote Roquette wins US patent for Starlac in novel dosage form about a new and improved way to dispense medications.
French company Roquette has been awarded a US patent for a dissolve-in-the-mouth drug delivery technology that makes use of its novel Starlac excipient.
Use of the excipient could allow the creation of tablets that are hard and resistant to damage during handling, yet still disintegrate quickly in saliva after dosing.
The US patent, awarded to Roquette earlier this month, covers a solid dose form based on lactose and starch, the constituents of Starlac excipient, alongside one or more active pharmaceutical ingredients (APIs).
Xavier Duriez, senior project manager at Roquette, told in-PharmaTechnologist.com that almost all ODT products on the market use mannitol as a diluent, but that in some cases Starlac could be used as a good alternative.
“Starlac is preferred for ODT and chewable formulas where palatability is a ‘must’,” he said, adding that the excipient provides a creamy mouthfeel that mannitol doesn’t provide.
Starlac, a mixture of 85 per cent lactose and 15 per cent natural corn starch, was first introduced in 2002.”
Of course, the mere granting of a patent doesn’t mean that any products using Starlac will hit the market any time soon. But unless there is a serious bug with the project, it’s too good an idea not to come to pass.
How Much Lactose Is in Medications?
What does this mean for those who are lactose intolerant? Not as much as you might think. Only a tiny amount of lactose is present in any one pill. One study I read estimated that the average pill had 25 mg of lactose. You’d need to take 12,000 such pills to equal the lactose in an eight-ounce glass of milk at that rate. [Editor Note: By our calculations, this is actually 500 pills.]
Some people might still have symptoms from this tiny amount, especially if they have to take many such pills each day, as the elderly or those with serious illnesses must do. If you must take the medication, your doctor might suggest taking a lactase pill along with the medication to see if that helps. [Editor Note: Consult a physician if you are having any type of a reaction to a medication.]
Is it a Concern for Milk Allergies?
Those with a milk allergy also need to be somewhat concerned, but with the same caution. Medical-grade lactose is extremely pure and not likely to be contaminated with the dairy protein that causes problems. But possible contamination with milk protein is still possible. Extremely sensitive or anaphylactic people should certainly talk with their doctor before taking any pills with lactose. [Editor Note: Anyone with a milk allergy, regardless of the severity, should consult their physician before taking any medications with lactose.]
In most cases, there are alternative medications or brands without milk. Ask your doctor when they are writing the prescription and the pharmacist when they are filling it.
I can’t have lactose at all now. Any muscle relaxers without lactose?
Hi I have just had to start taking Mirtazapine anti depressants that contain lactose…my food goes right through me and my legs feel like lead and I can hardly move them and I am so tired I just can’t manage to get up out of the chair…would the small amount of lactose in them cause this..thankyou very much…
Be sure to speak with your doctor immediately to discuss if these are side effects of the actual medication. Mirtazapine has many possible side effects -> https://www.medicalnewstoday.com/articles/mirtazapine-oral-tablet#side-effects
I am being treated for IBS. And I cannot find the ingredients on the pill. Most of the time the print is so small, you cannot even read it. It is tough when you are 77 and have high BP, migraines, arthritis and anxiety.
The pharmacist has all of the ingredients. You can ask them to read them to you, or to look for concerning ingredients and allergens for you. They actually have a searchable database that includes allergen information. Speak with your pharmacist to find out your medication options for prescriptions.
You may want to be checked for C diff and dehydration.
I have just been prescribed Atorvastatin (Lipitor) to reduce my Cholesterol. Can anyone help me with a lactose free and hopefully aspartame free medication.
You can look into Lescol and speak with your physician about that medication to see if it would be suitable for your needs.
My daughter was about to start taking the birth control pill but is lactose intolerant and saw that it has lactose in it so doesn’t know what to do.
All birth control pills in the US do currently contain lactose. You’ll want to speak with her physician to find out what they recommend based on her situation and medical history.
Taytulla doesn’t have lactose
Apotex makes Atorvastatin without lactose as a binder. You can ask your Dr to specify that your prescription be filled only with this manufacturer’s product. I have been taking it for years.
I self diagnosed lactose intolerance in my reactions due to my symptoms when eating/drinking certain foods. I never liked milk even as a child. In my twenties, I discovered that I couldn’t tolerate yoghurt ( got really sick) and the amount of cheese I could consume in one meal was limited. I was,however, able to tolerate small helpings of some cheeses. Never a big fan of anything creamy.
Fast forward to current times. I have to take anticoagulants due to a minor heart issue (a fib). From the beginning, taking a certain newer one gave me really severe symptoms. I reported it to three different cardiologists and they stared at me and said they had never heard of that. One prescribed another new one and with my own research which ended up contact with Johnson and Johnson, I learned that all of the new ones are lactose based. I started myself on Lactaid and it helps but if I take it with every dose (twice a day), it causes the opposite problem of plugging me up. Consuming anything containing lactose (even a smidgen) makes me really sick. I can’t believe that there aren’t many people who react severely and yet there is nothing on the pharmaceutical handouts/information that mentions lacatose intolerance. I am in process of fighting with J and J to acknowledge that this is not published info and is in fact a common side effect and needs to be known.
In reading most of these posts, I can relate to the symptoms associated with lactose, milk, etc. It has been a journey for me over the years in discovering my intolerance and/or allergy to it. It was a slow process for me going through not tolerating milk but okay with cheese. Then not able to tolerate milk. I tried every supplement before realizing I could not tolerate steric acid or magnesium stearate acid only to learn that magnesium stearate composed the steric acid which was all contained milk or lactose of some form. I developed high blood pressure and the pills prescribed all have cow milk or lactose in them. After years of haphazardly taking them because of the side effects, I had an episode that the doctor said I now have heart failure. Every pill given to me again was intolerable and I have been searching for one without lactose or milk to no avail. Searching for a solution on the internet is impossible for high blood pressure meds without lactose. If anyone know of one prescribes of OTC, please reply to this.
I’m not aware of any, but hope someone here might be able to help.
But as a heads up to other readers, to avoid confusion, magnesium stearate (a salt) and stearic acid (which is bound with magnesium to create magnesium stearate) is not dairy derived. It is sometimes animal derived, from animal fat, so it isn’t always vegan (it often is), but it is dairy-free. If you do receive a report of a stearic acid producer that is deriving it from dairy, please let us know so that we can research it. If you are concerned, look for vegan supplements, which at this time, should be exclusively dairy-free.
Keep in mind, magnesium supplementation in excess amounts (high magnesium) can have effects on the heart.
I hope that you are able to find a solution and stay healthy Sandra.
To my knowledge, Apotex IS THE ONLY PHARMACEUTICAL COMPANY worldwide that doesn’t use lactose as a binder in most of their medications. I am currently using two of their generics, and my understanding is that they produce meds for sale in many countries. Hope this information helps!
Pam, the drug companies don’t want to acknowledge that their products can cause serious digestive problems for those of us who are lactose intolerant. Lactose is a cheap and effective binder, and they’re loath to discontinue using it. I can’t take Gabapentin pills because they’re loaded with lactose. A friend told me that she couldn’t tolerate them either.
To Charles A Potratz
I have been tying to work out what wrong with me and think this is my issue too please any other information I would greatly appreciate as in major pain burning and same issues as you.
So… if dairy is a common allergy… why would suppliers put lactose in an allergy pill LOL
This is so Interesting. I have asthma and major allergies since birth to all 8 allergens and more. In the past 6-7 years I have developed digestive issues (reflux) and I cannot figure what is the problem. I changed my diet and have been eating a majority plant based diet for 4 years, removing every trigger, but for some reason always symptomatic and having rashes. I take albuterol, they have changed my other inhaler several times because I have discovered it has egg in them, also taking acid reducers and Zyrtec. I came across your article as I started to google the names of the ingredients in some of my meds. And to my surprise milk is in my Zyrtec. WTH. Could this be why I am having the problems I am having. I say this because I notice when I take no meds at all I have no symptoms. I am getting ready to check all labels and figure this out. Thanks!
I really couldn’t advise on if this is your issue. If you are having a reaction to a medication, you should discuss these symptoms with your doctor immediately. It’s quite common to have reactions / symptoms to the medications themselves, since they are foreign substances. Zyrtec is quite powerful and does have side effects, which can be OR can be mistaken for an allergic reaction. You might discuss with your doctor to see if they recommend trying Xyzal instead. It still contains that small amount of lactose, but is next generation for Zyrtec, so less people typically have side effects to it. It might work for you, or you might need to switch to an antihistamine option that is completely dairy-free.
i came across your comment in the midst of googling for an allergy pill without lactose, so thought i’d let you know that i have been prescribed meds with lactose (unknown to me at the time) and over the course of several weeks i got pretty sick! i had NO idea what was going on, but i had constant low-grade nausea, and other digestive issues which is how lactose generally affects me (though also makes me congested and overall activates sinus issues too). i went cold turkey off the meds when i realized the pills had lactose (which i was taking daily). within a week all those symptoms were gone. So, yes, at least for me that tiny pill with the tiny amount of lactose, taken daily, was a not-tiny issue. i hope you have figured out your issues by now!
I completely agree with your experience. The tiniest amount of lactose in pills affects me. I wish pharmaceutical companies would come up with an alternative… even if it costs more… I’m prepared to pay to not get sick from medication.
Great info, but incomplete for me, and my fellow Alpha Gal positive brethren who are severely allergic to all mammalian meat and it’s byproducts. Even a tiny amount of lactose can cause reactions that range from hives to anaphylactic shock.
Why don’t medication manufacturers simply list meds with “animal byproduct” or “vegan”? It makes a huge difference for some of us—each medication I am prescribed results in a phone call to manufacturer to determine whether it is same for me to use.
Lactose, manganese oxide, and magnesium oxide should not be used as filler in any medication. Lactose causes problems for so many people who never realize it. Really, does it make sense to weaken the bodies of 30% of the population??? Or for someone to suffer for a lifetime with tinnitus caused by fillers in their meds that are “safe”. Is inositol really that expensive?? I have run into at least two meds I could not take because of significant diarrhea, one prescribed by a urologist for prostrate problems. I am leaving now to go buy some foot powder with talcum in it.
This article very helpful and uplifting for me! I have a digestive allergy to casein, but, I’ve never had lactose issues till recently. Eliquis and maybe some other meds I was taking were causing me to have what I best describe as Uncontrollable Rapid Deep Breathing Spells similar to Shortness OF Breath. Also, burning in the middle of my chest similar to heartburn, but no re-flux. Also, no gas or diarrhea. Turns out I had a fungal infection in my esophagus discovered with a limited endoscopy. The lactose, being a sugar, was reacting with and feeding the fungus! If you’ve ever been on an anti-fungal diet, you must avoid: 1) Anything that’s fermented or with yeast or other fungi including mushrooms; 2) All sweeteners natural or artificial; 3) All grains including grain like quinoa, buckwheat, …
This article is helpful although I am hoping you can update it as soon as possible since it’s more than 10 years old. If the data is current, I would love to know. Things change so often with allergens and there are a number of factors. I find I react to lactose in medications, but only new medications. Medications I have been on for a while “seem” okay. My doctors and pharmacy often try to give me new meds with lactose and offer no alternatives simply stating it’s not dairy, it’s sugar proteins ignoring that I have dairy like exposure reactions.
We have to be our own advocates as best as we can but it would help if we had somewhat clear answers on why some people with a milk allergy to supposedly “sugar proteins in lactose/medications.
The last update was actually last year. We just don’t republish with a new date every time an article is updated. If we do a full overhaul on it, then I will republish.
Alisa, thank you for bolding those parts; it did help.
I will be talking with my doctor very soon about this. I’m almost 60 and have been drinking milk/eating dairy all my life, but now thinking I probably should not have. A few years ago I gave up all gluten, and an autoimmune disease that I had simply vanished almost literally overnight. In the past, my mom has mentioned how as a baby I had projectile vomiting, but only in the last year or 2 did I wonder if it was related to the formula she had to give me. (My own daughter figured out in her 20’s she shouldn’t have milk, and that’s what started me wondering.) I’m still not sure of the difference between an allergy and an intolerance; that’s what I’ll be talking to my dr about. I’m sure ‘something’ is going on, because I just looked up the ingredients of the last antibiotic I was on, and it includes lactose monohydrate — and yes it made my stomach hurt. Will be spending a lot more time on your web site — THANKS again.
Glad I can help and I hope you get some answers with your doctor. It can be confusing. A common side effect of antibiotics is stomach cramping or pain (along with other digestive issues). They tend to be hard on the gut.
Is there a link to the study identifying 25mg on average of lactose in a pill which equals that 12,000 pills need to be consumed to equal the amount in a 8oz glass of milk? I have seen other articles reference only 1000 pills would be equal. Thank you
Hi Jacky, I need to update this post to ensure all data is still accurate. It was written by Steve Carper (an expert on LI), and he used the following sources (not sure which one applies to this specifically):
American Academy of Pediatrics Committee on Drugs. “Inactive” ingredients in Pharmaceutical Products: Update (Subject Review). Pediatrics. 1997;99:268-278
Brandstetter RD, Conetta R, Glazer B. Lactose intolerance associated with Intal capsules. N Engl J Med. 1986;315:1613-1614
Higham MA, et al. Determination of the minimum dose of lactose drug carrier than can be sensed during inhalation. Br J Clin Pharmacol. 40;3:281-82 [I had an earlier citation of LI from a nasal spray, but I can’t find it now. If anyone out there knows of it, please send me the complete reference. Thanks.]
Lieb J, Kazienko DJ. Lactose filler as a cause of “drug-induced” diarrhea. N Engl J Med. 1978;299:314
Malen DG. Parnate formulation change. J Clin Psychiatry. 1992;53:328-329
Petrini L, et al. Lactose intolerance following antithyroid drug medications. J. Endocrinol. Invest. 1997;20:569-570
Van Assendelft AH. Bronchospasm induced by vanillin and lactose. Eur J Respir Dis. 1984;65:468-472
Zeiss CR, Lockey RF. Refractory period to aspirin in a patient with aspirin-induced asthma. J Allergy Clin Immunol. 1979;72:633-636
I just looked up the lactose in milk, and calculated and it looks more like 500 pills to me based on 25mg.
Does lactose have to be stated in the ingredients list?
For medications, all ingredients must be available to the pharmacist and to you on request. Top allergens (like milk) are typically noted in their system. But medications do not fall under the same allergen labeling laws as food.
I am vegan and have discovered lactose monohydrate in the medication I was just about to start taking in an HRT tablet. Would the doctor be able to prescribe something similar without the lactose mnohydrate or does all prescription drugs contain some form of lactose in them ?
I couldn’t tell you on a specific medication but different brands of the same medication and generics often have different filler ingredients. You can call a pharmacy and ask as they should have all of the ingredients in a database.
Are there any blood thinners that do not contain the ingredient Lactose Monohydrate ? I am seriously lactose intolerant and just found out that my xarelto contains this, and explains why even on a lactose free diet I was still suffering all the time..please help !!
Speak with your pharmacist first to find out what the blood thinner options are for lactose-free – both generic and brand name. Pharmacists have quick access to all drug ingredients and are the most adept at reading them. You can then take that list to your doctor to see if any might be suitable for your condition. If not, and if it is lactose intolerance, then they might recommend taking lactase with the pill. It is a very small amount of lactose in the pill, so a lactase enzyme should have no problem in aiding the digestion. But speak with your physician about this. I cannot advise on medications directly, and do not have easy access to data on all brands and generics available for this condition.
Dabigabtran (brand name Pradax) is lactose free. My wife was prescibed this following a pacemaker being fitted in USA whilst on holiday She is severeley lactose allergic but has been absolutely fine wth pradaxa. It is v expensive for NHS so not all gps will prescribe it normally.
I have an allergy to milk. And taken any medication with milk makes me unwell, stiff sore joints and watery bowel movements. Even the smallest amount.
Is there an allergy medicine that does not have lactose in it?
Yes, brand name Allegra does not contain milk. Other allergy medications which do contain milk in the form of lactose monohydrate include but are not limited to Zyrtec, brand name and generic, Claritin, and Xzyal. I have a milk allergy and I have personally found that I cannot tolerate any medications with lactose because I develop breathing problems, although I am not anaphylactic.
Zyrtec liquid gels do not contain lactose and children’s Zyrtec liquid also seems to be dairy free
Thank you for this information. I am highly allergic to lactose, dairy, whey, etc. This explanation explains why I felt worse taking Claritin — the lactose. I switched to Allegra and do not have any side effects.
The generic allegra does have lactose, a fact I did not notice until I had a definite reaction to it. Claritin generic also has lactose. Why these drug companies put it in meds when so many are dairy allergic is beyond me. Surely there are alternatives.
Lactose is very cheap and accessible. I also hope they transition to other fillers, but it’s really hard to say with an industry like this.
I was about to begin a weekly regimen of Fosamax for osteoporosis until I read the ingredients. One of those is anhydrous lactose. I looked for a specific definition and it also led to these comments and responses. I am both lactose intolerant and have a milk protein allergy, so taking Fosamax would probably be a nightmare for me. Thank for all your help, Alisa, with GoDairyFree. It has saved me from much misery and complications.
If you know anything more specific about Fosamax or other related meds I could use and tolerate, please let me know.
I’m so glad to hear that my work is helpful for you AND that you discovered this issue with Fosamax before taking it! I don’t have any other details on it, but would speak to the pharmacist or your physician about options. They each have access to the ingredients and should be able to look up other options, including generics, that may work instead of that particular name brand medicine.
Intact Lactose entering the Blood Supply
is Highly Addictive to the Central Nervous System
and Human Body
By Paul C. Tofanelli
April 28th, 2016
Galactosemia has only been known as a Hereditary Disease. Galactosemia is a disease in which a persons body cannot process Lactose correctly. I have discovered an Adult strain that is highly addictive to the central nervous system and our bodies. This strain is caused by Intact Lactose entering the blood supply.
There has been a study on absorption of intact lactose into the blood stream of infants with damage to the small intestinal epithelial barrier that caused disease in several organs including the kidney.
I have found a new mechanisms for lactose entry into the blood stream in Adults that causes addiction and disease.
Intact Lactose is entering the blood stream by Medications in the Small Intestine byway of Stearic Acid and or Magnesium Sterate, melting point is 156F. Stomach acids do not break down Stearic Acid and or Magnesium Sterate. Lactose is protected from lactase and enters epithelial barrier into blood supply by a form of Leaky Gut Syndrome.
Intact Lactose is entering the blood stream byway of injection. 65% to 90% of a Heroin injection is Lactose.
Intact Lactose is entering the blood stream byway of the Nasal Cavity.
Intact Lactose is entering the Blood stream byway Inhaling “Drug use smoking”.
Intact Lactose in the Blood Supply is causing Addiction to the Brain and Disease in the Body. Withdrawal symptoms can be extremely severe depending on the amounts of Intact Lactose that has entered the blood supply and how long it was occurring. Withdrawal durations can be weeks, months, or years.
Paul C. Tofanelli
It’s interesting you mention this. Not being a user of any street drugs, I have no idea how milk gets into a supply of heroin; but I do know that a leaky gut allows undigested particles into the bloodstream, and this is implicated in allergies that develop. I know because I developed an allergy to a common food (soybeans) after years of antibiotics due to chronic strep throat. After I had my chronically inflamed tonsils out as an adult, I was much healthier and now very seldom get strep at all; but the damage was done, and the allergy I developed is still with me.
I guess I am one of those ”rare cases’ who are allergic to the small amount of lactose in over-the-counter and prescription medications. I recently found out that I have a milk allergy. I had no idea that the ‘small’ amount of lactose in over-the-counter and prescription medication would be of any concern. I used a generic antacid that had The same active ingredients as Pepcid. I had an allergic reaction, and after realizing that the last thing I had ingested had been the generic Pepcid I went back and read all of the Ingredients including the inactive
ones. There were two types of lactose. Anhydrous lactose and lactose monohydrat. I have also realized that I am having a reaction to other medications including those that I take at bedtime …Ironically I was diagnosed with sleep apnea because I was having trouble breathing at night. Since then I have had an allergy test performed by my ENT after being unable to find a cause for persistent ear pain a sinus problems. I found out about the milk allergy . I am trying to find more information about the ingredients and inactive ingredients in prescription medications, but I am having difficulty. Do you have any suggestions?
Hi Debbie, a medication / supplement list is something I looked into creating a few years ago. Unfortunately, drug companies are even worse about changing ingredients and disclosing allergens and processes than food companies. My first efforts were like trying to hit a moving target. It is very odd that you would react to milk sugar (lactose) with a milk protein allergy, but stranger things have happened! In general, the milk ingredient list I have here on the website and in my book should work for medications, too. It lists all of the forms of milk used in food – http://www.godairyfree.org/dairy-free-grocery-shopping-guide/dairy-ingredient-list-2
Hi Alisa — If you’ve had a tick bite, the combo of milk sugar AND milk protein allergies is not so surprising. After having Lyme disease, I’m allergic to milk and red meat, i.e., everything mammal-related. Tell me that wasn’t a hard one to figure out! Also, I have same issue with adverse reaction to OTC and prescription drugs containing lactose.
How frustrating Kris! There are so many strange things that are still being discovered medically. It’s amazing how little they really know.