Mill Deanna, Dawson Jessica, Johnson Jacinta Lee
University of South Australia, Adelaide, South Australia, Australia.
Flinders Medical Centre, Bedford Park, South Australia, Australia.
Ther Adv Drug Saf. 2018 May;9(5):227-235. doi: 10.1177/2042098617751498. Epub 2018 Jan 24.
Lactose intolerance is exceedingly common, reportedly affecting up to 70% of the world's population, leading to both abdominal and systemic symptoms. Current treatment focuses predominantly on restricting dietary consumption of lactose. Given lactose is one of the most commonly used excipients in the pharmaceutical industry, consideration must be given to the lactose content and therefore safety of pharmaceutical preparations prescribed for patients with lactose intolerance. This article summarizes the current literature examining the likelihood of inducing adverse effects through the administration of lactose-containing pharmaceutical preparations in patients reporting lactose intolerance, describes how to assess this risk on an individual patient basis and reviews suitable analgesic options for this population. A case study is presented detailing a patient reporting lactose intolerance who insists on treatment with the lactose-free product codeine/ibuprofen (Nurofen Plus) rather than other codeine-free analgesics. It is important to assess the likelihood of lactose as an excipient inducing symptoms in this scenario, as reluctance to cease codeine could suggest codeine dependence, an issue that is becoming increasingly common in countries such as Australia and Canada. Given codeine dependence is associated with serious sequelae including hospitalization and death, the patient must either be reassured the lactose component in their prescribed analgesics will not induce symptoms or an alternative treatment strategy must be confirmed. General recommendations applying theory from the literature to the management of acute pain in lactose-intolerant patients are discussed and specific treatment options are outlined. Although large inter-individual variability is reported, most lactose-intolerant patients can tolerate the small quantities of lactose found in pharmaceutical preparations. Cumulative lactose exposure can be assessed in patients taking multiple medications while also consuming lactose in the diet. In those sensitive to small quantities of lactose, lactase supplements can be trailed. Additionally, for the analgesic drug classes employed for the management of acute pain, lactose-free formulations, including most oral liquids and dispersible tablets and some oral tablets and capsules, are available.
乳糖不耐受极为常见，据报道全球多达70%的人口受其影响，会导致腹部和全身症状。目前的治疗主要集中在限制饮食中乳糖的摄入。鉴于乳糖是制药行业最常用的辅料之一，必须考虑乳糖含量以及因此为乳糖不耐受患者开具的药物制剂的安全性。本文总结了当前的文献，研究了在报告有乳糖不耐受的患者中通过服用含乳糖药物制剂引发不良反应的可能性，描述了如何在个体患者基础上评估这种风险，并综述了适合该人群的止痛选择。文中呈现了一个案例研究，详细介绍了一名报告有乳糖不耐受的患者，该患者坚持使用无乳糖产品可待因/布洛芬（诺洛芬加强版）而非其他不含可待因的止痛剂进行治疗。在这种情况下，评估乳糖作为辅料引发症状的可能性很重要，因为不愿停用可待因可能表明存在可待因依赖，这一问题在澳大利亚和加拿大等国家正变得越来越普遍。鉴于可待因依赖会导致包括住院和死亡在内的严重后果，必须让患者放心其处方止痛剂中的乳糖成分不会引发症状，或者必须确定替代治疗策略。讨论了将文献中的理论应用于乳糖不耐受患者急性疼痛管理的一般建议，并概述了具体的治疗选择。尽管个体间差异很大，但大多数乳糖不耐受患者能够耐受药物制剂中少量的乳糖。在服用多种药物且饮食中也摄入乳糖的患者中，可以评估乳糖的累积暴露量。对于那些对少量乳糖敏感的患者，可以试用乳糖酶补充剂。此外，对于用于管理急性疼痛的止痛药物类别，有不含乳糖的制剂可供选择，包括大多数口服液和分散片以及一些口服片剂和胶囊。
