Author Topic: Sugar free drugs, why?  (Read 2081 times)

Sugar free drugs, why?
« on: December 07, 2019, 10:50:50 pm »
I got a repeat prescription and didn't check it properly.  Oro-dispersible rizatriptan for migraines. The pharmacist read it out for a colleague to get it out. Sugar free I heard. Oh dear! That's artificial sweeteners then which gives me migraines. I raise that and she showed me the box and one for the normal one I always got. Fortunately she said the two drugs where the same active ingredients so gave me my usual one with sugar.

Firstly,  can they do that? As in going against the exact details of the prescription?

Secondly,  why make a sugar free version? There cannot be enough sugar in them to be a problem to anyone?

I'm of the view that artificial sweeteners will end up being considered a health risk and end up being reduced in foods. So why bother with such tiny tablets. They're 1mm diameter at most and half a diameter thick. There cannot be much weight to them so very little sugar.

Anyone know why the sugar and sugar free drug options?

hellymedic

  • Just do it!
Re: Sugar free drugs, why?
« Reply #1 on: December 07, 2019, 11:46:51 pm »
Kids are VERY susceptible to tooth decay. (A tooth is most likely to decay in the first two years after eruption and adults over 25 build up some immunity to the bugs that cause tooth rot.)

Syrups leave the mouth sugary for ages, favouring decay.

Kids on long-term sugary medicine DO suffer more tooth trouble as a result. Kids on long-term medicines often have problems that make dental care challenging.

Effervescent substances with sugar are particularly bad for the mouth.

Most folk don't get trouble with artificial sweeteners.

10ml of 50% sugar four times per day is not insignificant, especially for a small person.

The commonest reason for a child to need elective hospital admission is for dental extraction under general anaesthetic.

Kim

  • Timelord
Re: Sugar free drugs, why?
« Reply #2 on: December 07, 2019, 11:52:06 pm »
The elephant in the room is of course "It's going to taste minging anyway, why bother making it taste sweet and minging?", but there are bound to be some people it makes a useful difference for.  Oro-dispersable is presumably a massive win for patients who are bad at swallowing, so maybe that's worth it.
Careful, Kim. Your sarcasm's showing...

fuaran

  • rothair gasta
Re: Sugar free drugs, why?
« Reply #3 on: December 08, 2019, 12:13:45 am »
Have you checked all of the ingredients? Do they actually have any artificial sweeteners?
Might just be the same ingredients, but without added sugar. So they just taste horrible.
Also could mean smaller tablets, if don't have sugar to bulk it up. So easier to swallow.

hellymedic

  • Just do it!
Re: Sugar free drugs, why?
« Reply #4 on: December 08, 2019, 12:14:48 am »
Most kids under 8-10 can't swallow tablets
Medicating smalls is not easy.
Sweetness makes it easier and sometimes CAN help cover up nastiness.

Kim

  • Timelord
Re: Sugar free drugs, why?
« Reply #5 on: December 08, 2019, 01:02:16 pm »
Most kids under 8-10 can't swallow tablets

DAHIKT
Careful, Kim. Your sarcasm's showing...

ian

  • fatuously disingenuous
    • The Suburban Survival Guide
Re: Sugar free drugs, why?
« Reply #6 on: December 08, 2019, 01:07:11 pm »
As said, a bit of sweetness makes the pill go down easier (as do capsules, and this idiot bought 2,500 ibuprofen round tablets by mistake). A lot of medicines are pretty bitter and unpleasant. Plus the tooth decay angle.

Despite what the internet may say, there aren't any known health risks with 'artificial' sweeteners (other than the occasional sensitivities which can happen with any compound).
!nataS pihsroW

T42

  • Old fool in a hurry
Re: Sugar free drugs, why?
« Reply #7 on: December 08, 2019, 01:13:02 pm »
Most kids under 8-10 can't swallow tablets
Medicating smalls is not easy.
Sweetness makes it easier and sometimes CAN help cover up nastiness.

When I was a kid I was given pills in a spoonful of jam - probably one of the factors that put me off jam for life (another being that my mum made around 50 lb of the stuff from my dad's raspberries every year).
I've dusted all those old bottles and set them up straight.

Kim

  • Timelord
Re: Sugar free drugs, why?
« Reply #8 on: December 08, 2019, 01:14:09 pm »
When I was a kid I was given pills in a spoonful of jam - probably one of the factors that put me off jam for life

I have a similar relationship with Bourbon biscuits.
Careful, Kim. Your sarcasm's showing...

Re: Sugar free drugs, why?
« Reply #9 on: December 08, 2019, 01:28:13 pm »
Artificial sweeteners do not agree with me either. 

rr

Re: Sugar free drugs, why?
« Reply #10 on: December 08, 2019, 02:39:29 pm »
Artificial sweeteners do not agree with me either.
Nor me

Sent from my moto x4 using Tapatalk


FifeingEejit

  • Not Small
Re: Sugar free drugs, why?
« Reply #11 on: December 08, 2019, 03:46:52 pm »
I got a repeat prescription and didn't check it properly.  Oro-dispersible rizatriptan for migraines. The pharmacist read it out for a colleague to get it out. Sugar free I heard. Oh dear! That's artificial sweeteners then which gives me migraines. I raise that and she showed me the box and one for the normal one I always got. Fortunately she said the two drugs where the same active ingredients so gave me my usual one with sugar.

Firstly,  can they do that? As in going against the exact details of the prescription?

Pharmacists fix all sorts of problems with prescriptions.
Don't get discharged from hospital with medications at the weekend, a pharmacist won't check them until Monday by which time...

It's one of the big drivers to get electronic prescribing systems into hospitals,
GPs have had systems that
a) Print out legible prescriptions
b) Scream at them when they do something stupid like prescribe 200g of paracetamol instead of 200mg
c) Scream contraindications at them when they try and prescribe them.
for years.
It's relatively new for hospitals to be catching such errors mistakes pharmacy get them.

Cudzoziemiec

  • Waking up now, put the kettle on!
Re: Sugar free drugs, why?
« Reply #12 on: December 08, 2019, 05:17:41 pm »
Some "artificial" sweeteners are also derived from plants, just different ones, so are as "natural" as sugar.
Days become simply the spaces between dreams, spaces between the shifting floors of time...

Re: Sugar free drugs, why?
« Reply #13 on: December 09, 2019, 01:34:40 pm »
The drugs in this case are adult only prescriptions AIUI so sugar isn't as bad for adults especially since they're tablets not a syrup. They taste horrible in sugar version anyway so I can't see there being much sugar in them. I'll check tonight.

The sugar free version had aspartame which is wholly synthetic and not plant derived afaik.

The other point is artificial sweeteners are a common migraine trigger so why put it in migraine drugs?

I believe there's sugar free versions of popular child/ infant medications available over the counter. I can understand that but it's unlikely to amount to a high proportion of child sugar supply. Have you tasted infant foods from supermarkets recently? They're not all sugar free.

If artificial sweeteners are a negative trigger for people with the condition the drug is intended for then why make a version with them in?

Also,  why would the gp who originally prescribed the rizatriptan suddenly change to sugar free. It b should be in my records about sweeteners because I raised it as a potential trigger and he agreed it was.

I'll raise it next review. Probably several years on from now or on my next repeat request with the receptionist. Just doesn't make sense aspartame in migraine drugs imho.

ian

  • fatuously disingenuous
    • The Suburban Survival Guide
Re: Sugar free drugs, why?
« Reply #14 on: December 09, 2019, 01:50:54 pm »
Aspartame is merely a simple dipeptide of methyl ester of the aspartic acid and phenylalanine, nothing unusual or unnatural, the average living creature is full of amino acids and peptides. It's only 'artificial' in its use as a sweetener. There's no real evidence that aspartame triggers migraines.

Many drugs are being reformulated to exclude sugar for the reasons mentioned. They can only include approved additives. Some will have aspartame, others sorbitol etc.
!nataS pihsroW

Re: Sugar free drugs, why?
« Reply #15 on: December 09, 2019, 01:56:27 pm »


The other point is artificial sweeteners are a common migraine trigger so why put it in migraine drugs?

If artificial sweeteners are a negative trigger for people with the condition the drug is intended for then why make a version with them in?


Perhaps because, like MSG, the reported effects are largely anecdotal and open to interpretation?  That seems to be borne out by this article.

https://migraineagain.com/which-natural-and-artificial-sweeteners-are-safest-for-migraine-sufferers/

Note that it says that all triggers are personal, so YMMV as they say.

ETA Beaten to it by Ian.
We are making a New World (Paul Nash, 1918)

Re: Sugar free drugs, why?
« Reply #16 on: December 09, 2019, 04:23:12 pm »
A migraine isn't about single triggers but a combination of triggers. That's what I got told at an event held by a British migraine research charity from one of the leading migraine researchers in the UK at the time. That's why I question a lot of research into the matter. A double blind research I assume basically entails a randomised supply of aspartame and control sweeteners to people where the patients/researchers supplying/ monitoring the responses do not know who got what. But if, as I got  told and in my experience,  you don't necessarily get migraines based on one trigger then how do they know the result isn't due to lack of other triggers?

For example, to date my main, identified triggers appear to be light/reflections, irregular food intake,  artificial sweeteners such as in diet pop/cordials/ reduced calorie foods and stress. I often have one or more of those apply every day but I don't have an attack every day. I've cut artificial sweeteners out of my diet but occasionally I have some because I didn't spot a change in ingredients to include aspartame. I don't get migraines every time. But I've had cases where a few triggers were present and aspartame was the final trigger to a migraine.

How do I know? Well light was identified early on in my life with migraines as a trigger.  I'd get a reflected flash of light and the migraine started to come on almost immediately. I've known that feeling and how close to the final trigger it is for decades now. I've had the exact same reaction with a low calorie drink where the only difference between that and the full calorie version is reduced sugar replaced by aspartame. This summer on a stressful days touring with irregular food intake,  hot sun (dehydration another trigger) and tiredness.  We stopped for a drink. I ordered a nice lemon tonic drink. That feeling came and got stronger the more of it I drunk. Fortunately water,  rizatriptan, sunglasses and a rest in shade helped me recover enough to get to b the campsite.

These are anecdotal,  lowest form of evidence,  but they chime with the experts view of multiple triggers and what I call a random effect of triggers. By this I mean the effect where one day 3 major triggers cause a migraine the next they don't.

It's simply a very complex condition that nobody knows enough about it. Imho considering how many are effected by it there's not that much known about it. Aiui the first drug designed and researched directly for migraine was only just reaching market this year. Other drugs were developed based on observed effects of drugs developed for other conditions.

I accept I sound like a crank who doesn't accept the expert's views on the topic. However,  it's not as if things once considered safe or even healthy haven't been proven to be dangerous in the past. Tobacco, opium, even current vaping products for example. The last example I read that some involved with helping people quit smoking tobacco are now advising not to start vaping. Will one day experts get us to go back to sugar in a balanced way instead of aspartame or other artificial sweeteners.

Btw the calories saved by artificial sweeteners are most likely lost by increased intake from other parts of your diet. I think there's research saying that I once read. If so then I ask why such a small amount of sugar in a tablet for adults gets replaced by aspartame and/or other sweeteners?

hellymedic

  • Just do it!
Re: Sugar free drugs, why?
« Reply #17 on: December 09, 2019, 04:46:46 pm »
I don't know about your particular medicine but all sugars are hygroscopic/deliquescent: they absorb moisture from the air and dissolve in it.

This can make sweeties in your pocket sticky and messy, even if they are wrapped. It also reduces the chemical stability of things best kept DRY.

Artificial sweeteners need relatively tiny concentrations for sweetness, compared to sugars and their formulation attracts less moisture.

ian

  • fatuously disingenuous
    • The Suburban Survival Guide
Re: Sugar free drugs, why?
« Reply #18 on: December 09, 2019, 08:31:10 pm »
As mentioned, it's not about calories. And it's a good point that sugars are hygroscopic so will affect the shelf-life of any drug, which actually might be the most important thing.

And yes, the quantities of artificial sweeteners are minuscule (aspartame is 200-times the sweetness of sugar).

Anyway, evidence, as it stands, is that artificial sweeteners are safe. That might change certainly, but for case of aspartame (which has been blamed for everything despite a near-complete paucity of evidence), it's been consumed by millions (if not billions) over several decades without issue.

Sugar is perfectly fine in balance, it's just not the best thing to include in drug formulations.
!nataS pihsroW

hellymedic

  • Just do it!
Re: Sugar free drugs, why?
« Reply #19 on: December 09, 2019, 09:04:51 pm »
Just to expand on ian's point about a dipeptide, this means something made of two amino acids.
Amino acids are the building blocks of proteins, both animal and vegetable.
Aspartic acid and phenylalanine, which make up aspartame, are found in many proteins.
Digestion breaks proteins down to their constituent amino acids.
Some amino acids can be synthesised by humans, others need to be eaten in food and are termed 'essential' to make our proteins.
Taurine, found in beef and Red Bull, can be synthesised by humans but not by cats.

ian

  • fatuously disingenuous
    • The Suburban Survival Guide
Re: Sugar free drugs, why?
« Reply #20 on: December 10, 2019, 09:19:19 am »
Yet cats are far too sensible to drink Red Bull, a concoction that smells like a dodgy nightclub floor and tastes like it's already been drunk once.

I think the main reason is the shelf-life now. Though the internet won't give me definitive proof. It's probably a mix of these things rather than evil plot.

Anyway, aspartame is 'natural' and, unless you have a metabolic disease related to the processing of those amino acids, shouldn't really cause any adverse effects, more so at the low-levels in which it is used. Plenty of people don't like the taste, of course, which is reasonable enough. It does have a colourful history of health conspiracy though.

If you want to be terrified the next time you notice a splotch of blood on your dental floss (you do floss, don't you?), read about gum disease and dementia.
!nataS pihsroW

Re: Sugar free drugs, why?
« Reply #21 on: December 10, 2019, 10:27:07 am »
Teeth and gums is something that's not a problem. Never had feelings, no gum disease and no issues with my bashers. I'm the guy who sits in his NHS dentist for an hour and a half (I'm always optimistic and get there 5 minutes early just in case) then sits in the dentist's chair for the 2 minutes it takes for three dentist to say there's nothing wrong and see you in 6 months.

Do not have a clue why I'm like that because I've never taken much effort looking after my teeth. Teeth fight to stay with me. I had to have my last milk teeth removed under general anesthetics rather late in life too. But I digress.

If anything is going to get me it'll be cancer,  probably bowel. Probably later on in life. Probably 20 years of increases in medical treatment before then. :)

hellymedic

  • Just do it!
Re: Sugar free drugs, why?
« Reply #22 on: December 10, 2019, 10:35:39 am »
Bowel cancer has mostly seen much improved control for older folk in the last few decades. So long as you get checked and screened both routinely and as soon as there's a hint of mischief, you might well escape...

Kim

  • Timelord
Re: Sugar free drugs, why?
« Reply #23 on: December 10, 2019, 01:17:02 pm »
Do not have a clue why I'm like that because I've never taken much effort looking after my teeth.

You chose the right parents.
Careful, Kim. Your sarcasm's showing...

Cudzoziemiec

  • Waking up now, put the kettle on!
Re: Sugar free drugs, why?
« Reply #24 on: December 10, 2019, 01:56:31 pm »
Do not have a clue why I'm like that because I've never taken much effort looking after my teeth.

You chose the right parents.
Which opens up all sorts of interesting possibilities regarding questions like "What is a person?"
Days become simply the spaces between dreams, spaces between the shifting floors of time...