Lactose in drugs

[DebE13]

Ooh, uh...... Was happy to get my thyroid meds but now see there is lactose in it. Is that a deal breaker for MC issues? I was specific with my issues and a bit disappointed now.
Not sure if I should wait and ask for another? I am having improved BMs since the surgery, not sure how long it will last, but don't want a big set back. The nurse in the hospital told me the amount of lactose was so minuscule I shouldn't be worried about it. I am almost 100% sure she has never been in the bathroom 12 times in a few hours before. I'm at 3x a day with Norman's to loose stools. For me, that's amazing. I'm also reducing my calcium to a normal dose so I'm not sure if that will change anything either.

Anyone else ok with this sort of situation?

Levothyroxine Sodium (Levothyroxine Sodium) MFG: lannett
PRODUCT INFO
Product Code 0527-1345 Dosage Form TABLET
Route Of Administration ORAL DEA Schedule
INGREDIENTS
Name (Active Moiety) Type Strength
Levothyroxine Sodium (Levothyroxine) Active .100 MILLIGRAM In 1 TABLET
Colloidal Silicon Dioxide Inactive
Lactose, Magnesium Stearate Inactive
Microcrystalline Cellulose Inactive
Corn Starch Inactive
Acacia Inactive
Sodium Starch Glycolate Inactive
D&C Yellow No. 10 Aluminum Lake Inactive
FD&C Yellow No. 6 Aluminum Lake Inactive
IMPRINT INFORMATION
Characteristic Appearance Characteristic Appearance
Color yellow (YELLOW) Score 2
Shape ROUND (ROUND) Symbol false
Imprint Code 516 Coating false
Size 7mm

[Rosie]

I was a bit worried about that issue too, but my levothyroxine pill which is also from lannett hasn't seemed to bother me and I'm very sensitive to dairy. My personal take on this is that lactose behaves differently than casein for those of us intolerant to dairy. The casein gives me the battery acid D, while lactose just gives me a bit of gas, depending on how much I get. And I have found that the amount of lactose in the thyroid pill doesn't cause any noticeable problem. But of course we are all different.......

Rosie

[tex]

Deb,

Most doctors seem to have a hearing problem (or maybe it's a comprehension problem) when it comes to food sensitivities. If I were in that situation, I would insist that it be corrected ASAP, because once you regulate your dose, if you begin to react to the lactose at some point, then you might have to start over trying to determine your correct dosage rate. Thyroid supplements shouldn't contain dairy (and they shouldn't contain corn, for that matter). You don't need the dyes, either. Why would a thyroid supplement contain dyes (not just 1, but 2)? Armour (which I take) doesn't contain any of those.

Yes it's a small amount of lactose, and rice only contains a small amount of arsenic these days. But I try to minimize my intake of arsenic by rarely eating rice, and when I do, I try to select a variety which typically has a low arsenic content.

Who knows, without the lactose, you might be having 1 BM per day.

Tex

[DebE13]

That's the confirmation I needed. Big sigh. I've not taken anything yet so will call in the morning. When I mentioned it in the office he said because there are so many different ones out there and so many different manufacturers, there was no way to know until I could see which generic brand I got from the pharmacy. I didn't think to ask what would happen if I found it did and what the alternative would be. I was so happy not to have to research the radioactive iodine treatment I goofed up.

He did offer synthroid since the 50mcg doesn't have dyes. Guess he heard half my concern. I don't have any confirmed issues with dyes but I avoid them whenever possible. I could kick myself now because I knew Armour had neither because I looked it up.

I whole heartedly dislike relaying messages through the nurses because they seem to edit and condense my concerns. I will call first thing in the morning and leave the message. He did mention he was leaving on vacation next week (out of the country) and was really busy this week seeing all his patients that would have had an appointment during his absence. Maybe he will be so hurried he will just write the new script and not put up resistance. I've been fighting MC since 2007 and I've come too far to let this set me back. I hope I can convey that clearly, but they really have no idea how one slip can cause a slip that can last for months. I'm back to 3mg entocort every third day after my 23 day trial of none failed.

Synthroid Inactive Ingredients

Acacia, confectioner's sugar (contains corn starch), lactose monohydrate, magnesium stearate, povidone, and talc. The following are the color additives by tablet strength:

Strength (mcg) Color additive(s)
25 FD&C Yellow No. 6 Aluminum Lake*
50 None

Oh yeah, I bought my son some one a day vitamins and ended up tossing the whole thing when I opened the bottle and found bright blue pills inside! Really?? I know blue is for boys but did they really need to put the dyes in that?

Thanks for your thoughts. I shouldn't have been so quick to give up the discussion. I go back to work Friday and currently take about a two nap for every hour of activity. Crazy. My body is figuring out there's no thyroid there anymore. Live and learn.

[DebE13]

Rosie, I was hoping that may be the case for me but it still just doesn't sit right with me. If there's something out there that doesn't have either dyes or lactose why not start with that one first? If I don't do well on it, then try another and take the risk. It seems pretty reasonable.... My ongoing D since 2007 has been heartbreaking and this is the first time since then I've had not terribly bad bathroom runs, except for my first time on prednisone.

It's good to know that if he won't budge on his choice that other MCers have not had issues with it. Thanks!

[Gabes-Apg]

Deb

my pharmacist told me, that when they stopped using gluten based products as stabiliser, lactose became the next best option.
With Celiac Dx on the increase there is high demand for gluten free meds. pretty much 80% of the Gluten free meds have small amount of lactose.

they see it as the lessor of two evils ......

Keep in mind (try to be at peace) that the actual amount of lactose in each tablet is low, you would probably get more exposure to lactose if you are sharing a kitchen with people consuming dairy...

In the world of multiple intolerances, and so many triggers, our aim should be to minimise exposure to a manageable level. It would be near impossible to be 100% safe 100% of the time. and we could drive ourselves to madness trying to ..(does that make sense)

In Australia, not always is the list of inactive ingredients available to consumers, my Pharmacist has to look up the technical sheets. For me, i can handle small amount of gluten / lactose, soy is my worst enenmy... and the demand for soy free is not as much as gluten free.....

[Leah]

Hi Deb. Your concern is valid and you should try to get meds that give you piece of mind, but i am also one of those people who take Levothyroxine and am fine with what's in it. Actually, my B vitamins also have a tiny bit of lactose . Like Rosie said, lactose is the the sugar, not the protein from dairy and it's such a small amount.

Leah

[tex]

Deb,

Rosie is quite correct about lactose, provided that the manufacturer uses pharmaceutical grade lactose. Pharmaceutical grade lactose is supposed to be free of casein. Industrial grade lactose is not, however. Since so many of us seem to have problems with lactose in medications, it makes me wonder if some manufacturers might be cutting corners by using industrial grade lactose. I'm not suggesting that they do, but who would know the difference if they did (other than those of us who are sensitive to casein).

If you have good insurance, have your doctor specify a branded product, so that the pharmacy cannot substitute a generic form. That can solve many problems, provided that the brand specified meets your needs. And thyroid meds are relatively cheap, anyway.

In the meantime though, it shouldn't hurt you to use the ones you have. As Rosie, Gabes, and Leah have pointed out, the actual amount of lactose in those tiny pills is very small, so the dose of lactose is relatively small.

You're only taking 50 mcg per day? That's a very small dose of thyroxine.

Tex

[DebE13]

Mine is 100 mcg/day.

The 50mcg is the synthroid he offered if I had wanted one without dyes. I would have to then take two pills a day instead.

[DebE13]

I was doing a little more looking and from Lannett the following are what is in my pills:

Inactive Ingredients
Colloidal silicon dioxide, lactose, magnesium stearate, microcrystalline cellulose, corn starch, acacia and sodium starch glycolate. The following are the coloring additives per tablet strength:

The lactose obviously has me concerned. The corn starch raises an eyebrow. And the acacia now has me thinking.

Taken from About.com, and article by Mary Shomon

We don't always think about the possibility that the medications we take may actually make us feel worse, but it's actually quite common for people who have allergies and sensitivities. For thyroid patients who are taking Synthroid, two ingredients in the pills are common triggers that may be causing symptoms.
One of the ingredients of Synthroid brand levothyroxine is acacia. Acacia is a family of shrubs and trees, and it is used as an ingredient in some medications to provide form and shape to tablets. Some people who have pollen allergies and hay fever -- especially to tree and grass pollens -- may also have an allergy to acacia, including when it's an ingredient in a medication. So, for some thyroid patients with allergies, taking Synthroid can cause allergic symptoms, including mood changes, runny nose, watery eyes, and congestion, among other symptoms.

This screams Deb. Spring and Fall are my worst and I frequently get my facial rashes from something outside every year simply because I refuse to give up the outdoors. I can't say it's caused by acacia but en again I don't know. I recently had to give up a favorite BBW body spray, Juniper Breeze because I have a bad pine pollen allergy and everytime I used it I have reactions.

This sure is a tough call. I'd like to just take what I have and pray a little wont bother me but I'm really enjoying my new bathroom routine for however long it's going to last. Think I still will make the call this morning and express my concerns.

[tex]

Deb,

Thanks for the clarification.

I have to agree with you that acacia may be a problem for someone who has pollen allergies. Rationalizers can say what they want, but the facts are that antigenic ingredients in medications cause problems for many, many people, and there is absolutely no reason why such ingredients should be used. They are definitely not essential to the formulation of the products. Manufacturers use them because they are choices of convenience and economy, not because they will be beneficial to the user.

There is absolutely no logical reason (from a health standpoint) why so many medications should contain antigens and other chemicals that are known to cause health issues for many of the very people who are likely to use the products. That practice is simply inconsiderate, and ultimately, just plain stupid. And it will eventually stop, after enough users complain and switch to alternate products (to prove that they are serious about their objections). Money talks, and manufacturers listen when the message becomes strong enough to affect their bottom line.

You'll be taking a thyroxine replacement for the rest of your life. The least your doctor can do is to prescribe one that won't cause you to have to constantly wonder whether or not it might cause other health issues for you.

Good luck getting this straightened out.

Tex

[Zizzle]

FWIW, I take prednisone that contains lactose and it doesn't bother me at all. I even take it on an empty stomach sometimes.

[DebE13]

Thanks All for your different experience. Maybe I am overreacting a bit and should have started the meds this morning but I just couldn't do it without at least first trying. I called right away this morning and the nurse was on the phone. I left a message. Had an appointment with the surgeon so we hit the road because it takes an hour to get there. I called again since I didn't want the return call when I was sitting in the doctor's office. She wasn't available but I was assured the message was relayed. I told her that the full detail wasn't in the message and asked that she add my additional concerns about ALL the ingredients that were potential allergans and the specific request to go on Armour. I gave her my cell number and went off to my appointment.

It was all pretty quick. Surgeon removed the steri strips and pronounced me on my way. I stopped down to make the request to get a copy of the pathology report, and then some genius scheduled my mammogram (was me thinking why not, I'm already there). I'm pretty flat chested anyway so it's not a big deal for me but I didn't take into consideration that my boobs are to too far off from my neck. Needless to say, I was very uncomfortable and had visions of my newly released three inch incision (which is pretty small compared to other pictures I've seen) opening up and spilling the contents of my neck. It wasn't really that bad but sometimes I just way too gung-ho.

Made the drive back home and found a message on my answering machine- so much for my cell phone number. Arhh! The nurse just told me that she sent an email to the hospital pharmacy where I just was to see if they could find levothyroxine drug that didn't have lactose. She was very blunt in the fact that NONE of the doctors would issue scripts for Armour. I really don't get it. I told her that was not my complete message and asked about the dyes, corn starch, and acacia. I tried to explain the details of my MC and six plus years of D. She said she would update the email and get back to me if they could find one. I had a good cry, a mini temper tantrum, and probably made my husband want to go back to work just to get away from me.

I've been researching the different kinds so already had some saved on my computer. I pulled up Levoxyl which doesn't list anything that appears to potentially problematic. There is even no dyes in the 50 mcg dose so I could take two pills and avoid the dyes. I immediately called back the nurse and told her I found one. It took great effort to be polite but know the old vinegar/bee/honey analogy. Her attitude changed immediately and she became very friendly (playing by their rules now) and said she'd add it to the email to their pharmacy team to get confirmation and assured me they would find a plan that worked for me. I hope they get back to me today because I go back to work Friday full time and my butt is dragging.

Maybe I just put myself through some unneeded stress but I had to try. I have never been on any hormones before in my life so even if I have to wait one more day, I'd like to think it's worth the wait to start out on a better foot. It's not my first choice but I don't believe I will win that battle. If I don't see improvements then maybe I will have to try elsewhere. I am so close to managing my MC I just can't chance it. I've also been off of work so maybe the stress factor has played into the improved BM's but I don't know what's worse- my job or an invasive surgery and recovery. Ha, ha. I still feel like there is a shoelace tied very tightly around my neck. I keep reminding myself that I am very fortunate but think if anyone tries to remind me of that right now I may pull out a shoelace and let them be Deb for a while. Tried finding a choking emoticon but didn't find one. giggle, giggle.

As I ate my hamburger and cooked carrots for lunch while my husband treated himself to a Big Mac and fries I wondered if the nurse really realized how totally serious this is. I know the answer but it's a shame.

[DebE13]

The story only gets better..... I was awakened from my afternoon nap by a call from my doc's office. They can't use the brand I suggested since it is going to be recalled and not available again until 2014 That's comforting. They did find a manufacturer that will be compatible with my needs. I was directed to contact my pharmacist to confirm that they could fill the levothyroxine 50 mcg made by Mylan. I did and was questioned rather impatiently why this was necessary because it is going to cost them 4x more for this brand and they don't reimbursed for it. I was a little taken back by that and in my post nap fog explained my issues. After I convinced her of my need she said it would have to be special ordered each time I needed it and she wouldn't be able to get it until tomorrow. So I am waiting another day and will be waiting by the phone so I can get it ASAP- feeling the need for a little relief. As I sit here in a dripping hotflash, I really can't believe how difficult this process is.

I wanted to confirm what my coverage would because I was a bit confused thinking that I may now have to pay more but decided I would if necessary. I spoke to my rep who was very surprised that the reimbursement to Walgreens was even discussed with me. I learned a little more about Big Pharma that makes me want to spit. Whatever their contract is with my insurance company, they may not get enough money to want to fill the script. I laughed out loud and told my insurance lady they get plenty of money from my Entocort RX. She agreed and knew exactly how expensive it was. She offered to call Walgreens and explain what paperwork they could complete if they felt they weren't making enough money on this one. Within five minutes I received a phone call from the pharmacist who said she owed me an apology if I took offense to her comments because she needed the information to justify to her superiors why she was ordering the drug she was ordering in the best interest of the patient. I felt no need to be agreeable after the chasing I've done today. I simply said ok and reiterated the fact that I CANNOT have certain products in my drugs because they will create further medical problems for me. (Although, more GI issues = Entocort = $$$ for them). Hmmm, patient's best interest.........

I don't give a rats ass about the profit they are or aren't making off of me and I don't need to hear about them paying 4x as much for it. Not my problem, I have enough of my own. I hope she doesn't conveniently forget to place my order.

I thought about changing pharmacies but Walgreens is convenient since they're everywhere around here and up by our cabin. Sometimes convenience keeps me tied to something that might deserve a farewell.

[tex]

FWIW, I take prednisone that contains lactose and it doesn't bother me at all. I even take it on an empty stomach sometimes.

Why would you expect it to bother you? Those prednisone pills could be 90 % gluten and you shouldn't be able to tell the difference.

Tex