Lactose intolerance and drug 'fillers'

Assume someone is lactose intolerant. Would a pill containing the inactive ingredient lactose monohydrate potentially irritate their digestive system?

Conceivably. Most of the lactose intolerance sites warn against fillers in medications.

I suspect that you would have to either have a very extreme case of lactose intolerance, or be taking a large number of medications with lactose fillers. A cup of low fat milk contains 11 grams of lactose. A person who couldn’t tolerate the filler in a pill could probably be set off by a spoonful of milk.

Hm. I’m assuming it’s not possible for the lactose to ‘build up’ if it’s in a pill taken daily?

I’m wondering about it because I’d been taking a certain allergy pill that has that as a filler. I stopped taking it on a daily basis because something had been making me violently ill. I never figured out if it was something I ate or a side effect of the pill, but I just noticed the list of inactive ingredients, and wondered if there was something to it. I’m not particularly intolerant, though (most cheese and yogurt is fine, occasionally a bowl of cereal with milk is usually okay, but not if I make regular habit of it). The mystery continues.

As yabob correctly says, the amount of lactose used as a filler is minuscule. It’s estimated to be about 25 milligrams, whereas an eight ounce glass of milk is 12,000 milligrams. (My sources say 12 not 11 grams.)

Lactose cannot build up either. It goes through the digestive process just like anything else.

It’s possible that some individuals have fantastically acute sensitivities. If you can have cheese and yogurt, even though they are low-lactose foods, this is unlikely. And some people who have to take dozens of even hundreds of pills a day might accumulate enough lactose to trigger a reaction.

I’m not sure what “violently ill” means in this context. Undigested lactose will result in diarrhea, gas, bloating, and flatulence. Other symptoms are somewhere between extremely unlikely and impossible.

Other supposedly neutral fillers have been implicated in digestive problems, especially the artificial sugars like mannitol.

NinjaChick, check with your pharmacist to see if the pills are known to create symptoms.

I was estimating a good bit more than 25 mg of filler in a pill. Obviously it’s going to vary a lot between different medications, but I had no figure handy. Even at a very liberal 0.5 g of pill filler, that’s less than a tablespoon of milk.

Half a gram of lactose would probably fill a tablespoon. Well, more like a teaspoon. Anyway, it’s a very light powder.

I have a 25 gram bottle of lactose. It’s about 1.4 inches in diameter and contains about an inch of lactose. That’s 6.16 cubic inches of lactose. Divide by 50 and a half gram is 0.12 cubic inch or an eighth of a cubic inch. That’s a cube a half inch on each side.

25 milligrams is a far more realistic number.

25 milligrams? It depends on the pill!

Your smallest pills, in the range of a birth control pill size, like Alesse, tend to have an average weight in the 90-110 mg range. Though I’m not a formulation chemist, the formulations I have seen that contained lactose tended to be in the 20-45% range, so 20-45 mg would be an expected amount for a small pill.

A larger pill, however, is going to be heavier and therefore have more filler: a pill the size of Advil might be 300 mg (I’m not 100% sure, but I can weigh one tomorrow if anyone really cares!), and I worked on one large, very compact pill that weighed in at 1.2 grams… so that might be as much as 540 mg assuming a 45% lactose formulation.

If someone is lactose intolerant, that could be a very significant amount.

I think you squared the diameter rather than the radius of the bottle. 1 * pi * 0.7^2 = a bit over 1.5 cubic inches. 4 cubic inches would be a 2x2x1 inch box that your bottle would fit inside.

They’re tiny pills - slightly smaller than a Sudefed tablet.

Probably wasn’t the pills making me ill, then.


I kept looking at the number and wondering how it could be so big, but the calculations came out the same no matter how many times I did them.

So. 1.5 cu. in. Divided by 50 is .03 cu. in. That’s 0.31 in on a side. That’s still much bigger than an ordinary pill. (I assume people will check my math.)

Isn’t the ibuprofen in Advil 200 mg? That would leave 100 mg for all the inactive ingredients.

Here’s a listing.

It’s not clear how that would break down, but it would seem unlikely to me that any one of them is much more than 25 of those 100 mg.

I’m not saying that there can’t be some horse-sized pill exception out there, but I see no evidence that any ordinary pill has close to half a gram of lactose in it.

And even if so, half a gram is 1/24 the lactose in a glass of milk. It is a truly small amount. The number of people with lactose intolerance who could be affected by that is equally small. If you’re that intolerant you’ve known about it for years: you don’t suddenly learn about it when you take a pill.

I have a true allergy to all dairy products and discovered that Advair Disc had LACTOSE in it’s formulary. It caused increased breathing difficulty and I had an allergenic reaction. I think this product should have upfront on label notices…not buried in the fine print of enclosed date sheets!! :frowning:

Since this flatulent zombie has crawled out of its crypt and is now wandering loose, terrorizing the villagers, it seems an opportune time to pose a question which has been pestering me for decades. Why is lactose used as a filler/binding/bulking agent at all, when there are a zillion other inert compounds that can be substituted for it? Obviously, only a miniscule percentage of the general population will experience discomfort from ingesting 25 milligrams of lactose, but why not eliminate the issue entirely by using mannitol, glucose, sucrose, or any one of a number of other fillers in its place? What chemical or economic properties does lactose possess that makes it desirable to use for this particular application?