Gluten-Free Diarrhea, Constipation, and Heartburn Medications

Learn which over-the-counter drugs can treat your digestive problems

Stack of Antacid Tablets
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If you have celiac disease or non-celiac gluten sensitivity, you sadly may be accustomed to gastrointestinal issues such as diarrhea, constipation, or heartburn. Gluten issues frequently go hand-in-hand with gastrointestinal issues.

So where can you turn for occasional symptom relief? As it turns out, there are multiple gluten-free anti-diarrhea medications, gluten-free laxatives, and gluten-free antacids available over-the-counter that possibly may help.

Unfortunately, though, you can't just stop in at the pharmacy and pick up any brand. Many of the best-known name-brand medications for constipation, diarrhea, and heartburn are not considered gluten-free by their manufacturers. But there are good gluten-free alternatives—mainly store brands, but a few name brand medications, too—available in stores across the United States.

Here's the guide to gluten-free over-the-counter medications for common digestive issues.

Gluten-Free Anti-Diarrhea Medications

Diarrhea may be the most common celiac disease symptom, and it's also a common gluten sensitivity symptom. Plenty of people get diarrhea if they get glutened, and may want to try an anti-diarrhea medication to see if it helps their symptoms.

It's also possible that your diarrhea may be caused by something other than gluten—perhaps by the stomach flu, or by food poisoning. In those cases, an over-the-counter medication also may help.

There are two main active ingredients in over-the-counter anti-diarrhea medications: loperamide hydrochloride and bismuth subsalicylate.

Loperamide hydrochloride (found in Imodium) works by slowing down movement in your intestines, which in turn allows your body to absorb liquids from your stool. Bismuth subsalicylate (found in Pepto-Bismol, that familiar pink liquid, and in some pills) works to coat your intestinal lining and calm inflammation, and also prevents too much liquid from entering your stool.

The main over-the-counter anti-diarrheal medicines you'll find in any pharmacy will contain one of these two ingredients. Here's a rundown of popular brands, along with which ones are gluten-free.

Gluten-free anti-diarrhea medications include:

  • Target Up and Up 5 Symptom Digestive Relief liquid (30mL), 8-ounce size. This contains the same active ingredient as Pepto-Bismol and Kaopectate. Look for the "gluten-free" designation near the Drug Facts panel on the box.
  • Target Up and Up (house brand) loperamide hydrochloride (2 mg) caplets (loperamide hydrochloride is the active ingredient in Imodium). Safe boxes will have a "gluten-free" designation near the Drug Facts panel.
  • Walgreens Brand Diarrhea Relief caplets (262 mg). The active ingredient in these is bismuth subsalicylate. Look for the "gluten-free" designation on the box.
  • Walgreens Brand loperamide hydrochloride (1 mg) liquid suspension in mint flavor. This is a generic version of Imodium. Look for boxes with a "gluten-free" designation.

These brand-name over-the-counter anti-diarrhea medications are not gluten-free:

  • Imodium: Made by Johnson & Johnson, the Imodium line of products includes Imodium A-D soft gels, Imodium A-D caplets, Imodium A-D liquid, Imodium for children and Imodium Multi-Symptom Relief (also treats gas, cramps, and bloating). The products don't include gluten ingredients, but Johnson and Johnson says they're not guaranteed to be gluten-free. Therefore, choose Target Up and Up loperamide hydrochloride caplets or Walgreens Brand loperamide hydrochloride in gluten-free-labeled packages.
  • Pepto-Bismol: The familiar pink liquid, marketed by Procter & Gamble to treat diarrhea, heartburn, indigestion, nausea, gas, belching, and fullness, contains bismuth subsalicylate. Pepto-Bismol also offers chewable tablets, capsules, and children's formulations. The products don't contain gluten, according to a Procter & Gamble spokesperson, but may be subject to gluten cross-contamination at the facility where they're made. Instead of brand-name Pepto-Bismol, consider products that contain bismuth subsalicylate, such as Walgreens Brand Diarrhea Relief caplets or Target Up and Up 5 Symptom Digestive Relief liquid.
  • Kaopectate: Like Pepto-Bismol, Kaopectate's active ingredient is bismuth subsalicylate. It comes in cherry, vanilla, peppermint, and max (also peppermint) liquid varieties, along with coated caplets. According to manufacturer Chattem Inc., Kaopectate products have not been tested to determine their gluten content. Therefore, you should substitute one of the gluten-free-labeled products that contains bismuth subsalicylate.

The bottom line on gluten-free anti-diarrhea medications: The most familiar brand-name drugs—Imodium, Pepto-Bismol, and Kaopectate—are not considered gluten-free, but generic store-brand alternatives are available in Target and Walgreens.

Gluten-Free Laxatives

To ward off constipation, you should try and increase the amount of fiber you consume. You can do this by making sure to get plenty of gluten-free fiber sources in your regular diet, or to use a gluten-free fiber supplement. These can help bulk up your stool and make it easier to pass. Some people also find that probiotics seem to help keep them regular (be sure to choose only gluten-free protiobics).

However, once you're actually constipated—whether it's constipation due to celiac disease or some other cause—you have several alternatives in over-the-counter remedies.

Stool softeners, considered the most gentle laxatives, work by helping your body mix fluids into your stool, softening the stool and making it easier to pass. The drugs used as stool softeners include docusate.

Meanwhile, so-called osmotic laxatives actually help to move more fluid into your intestines and your stool, which (as with stool softeners) makes the stool easier to pass. Polyethylene glycol and magnesium hydroxide solution are two examples of osmotic laxatives.

Finally, stimulant laxatives actually make your large intestine contract to move the stool. Because these laxatives are considered harsh and can be addictive, you shouldn't use them for more than a few days at any given time. Senna and bisacodyl are two examples of stimulant laxatives.

Here's the list of laxatives that are considered gluten-free:

  • Colace: This line of laxatives and stool softeners includes three options: Colace capsules, Colace Clear soft gels, and Peri Colace tablets. Colace and Colace Clear each contain 100mg of the stool softener docusate sodium, while Peri Colace tablets contain both docusate sodium and the stimulant senna. According to the manufacturer, all three products are gluten-free, and Colace Clear is certified gluten-free by the Celiac Support Association, which requires testing of products to ensure they contain fewer than 5 parts per million of gluten.
  • Senokot: Given the name, you'd be correct in assuming that this brand makes senna-based laxatives. There are three different types of Senokot available: Senocot (active ingredient is sennosides 8.6mg), Senocot-S (contains both sennosides 8.6mg and docusate sodium 50mg), and SenocotXTRA (contains sennosides in double strength—17.2mg). All three versions of Senokot are gluten-free, according to a spokesperson for manufacturer Purdue Products L.P.
  • MiraLAX: MiraLAX is available only as a powder in a variety of different-sized bottles, and the active ingredient is polyethylene glycol (17mg), an osmotic laxative. To use MiraLAX, you mix it into water or another beverage. According to manufacturer Bayer, MiraLAX is considered gluten-free.

These brand-name laxatives are not considered gluten-free:

  • Dulcolax: This brand name, manufactured by Sanofi, offers seven different products, including pills and laxatives that treat constipation and gas. Those labeled as laxatives contain bisacodyl, while those labeled as stool softeners contain docusate sodium. According to the manufacturer: "We don't add gluten to any of our products, but we can't guarantee they're gluten-free" because they may come into contact with gluten-containing materials at some point in the manufacturing chain. Instead of Ducolax, choose another medication that contains bisacodyl or docusate sodium.
  • Ex-Lax: This laxative, which contains sennosides as the active ingredient, comes in chocolate-flavored pieces and pills. None of the three Ex-Lax versions is considered gluten-free, according to the manufacturer. Therefore, you should reach for a gluten-free senna-based laxative, such as Senokot.
  • Phillips Milk of Magnesia and other Phillips products: Phillips, a Bayer company, makes Milk of Magnesia (active ingredient: magnesium hydroxide) along with Phillips Laxative caplets (active ingredient: magnesium oxide) and Phillips Stool Softener liquid gels (active ingredient: docusate sodium). According to a Bayer customer service representative, "We do not add gluten to our products, but we cannot guarantee that they are 100 percent gluten-free because the products are produced in a facility that may contain gluten." Instead of Phillips products, try a gluten-free stool softener like Colace or a gluten-free osmotic laxative like MiraLAX.

The bottom line on gluten-free laxatives: Assuming you shop around carefully, you can find a gluten-free laxative that contains a stool softener, an osmotic drug, or a senna-based drug. However, once again you'll need to steer clear of some name-brand products.

Gluten-Free Antacids

You may be familiar with heartburn—it's not uncommon for people with celiac disease or non-celiac gluten sensitivity to suffer from that burning sensation in the upper chest. In fact, some research shows that people with celiac disease may be more likely to suffer from acid reflux or GERD (gastroesophageal reflux disease) once they've gone gluten-free.

If you have heartburn or have been diagnosed with GERD, there's a multitude of over-the-counter medications you can take. These drugs are known as antacids, since they work to reduce the amount of acid in your stomach, thereby decreasing the burning sensation.

A group of drugs called H2 blockers reduce the amount of acids your stomach actually makes. The active ingredients ranitidine and famotidine are examples of H2 blockers. The drugs called proton pump inhibitors, meanwhile, also reduce acid, but through a different mechanism in the stomach. Examples of proton pump inhibitors include the active ingredients omeprazole and lansoprazole.

Finally, calcium carbonate-based and magnesium hydroxide-based antacids neutralize the acid that's already in your stomach, helping to decrease the acid-related discomfort.

Generally speaking, when it comes to antacids, it can be difficult to find a brand name over-the-counter treatment that's labeled as gluten-free. However, there are plenty of store-brand alternatives.

Here's a rundown of the various gluten-free antacids on the market:

  • Equate (Walmart) brand antacid tablets: These contain calcium carbonate, which makes them similar to Tums. They come in a variety of different flavors and strengths. Make sure to choose one that has a "gluten-free" designation on the label.
  • Equate (Walmart) brand famotidine (20mg) tablets: This is a generic version of Pepsid AC. Look for the "gluten-free" designation below the "Drug Facts" panel on the packaging.
  • Equate (Walmart) brand rantidine (150mg) tablets: This is a generic version of Zantac. Look for the "gluten-free" designation below the "Drug Facts" panel on the packaging. Only some Equate packages are marked "gluten-free," so stick with those.
  • Target Up and Up brand antacid tablets: These calcium carbonate-based antacids are similar to Tums, and come in a variety of flavors and strengths. Look for the "gluten-free" designation on the back of the bottle.
  • Target Up and Up brand antacid soft chews: These cherry-flavored calcium carbonate antacids are certified gluten-free by the Gluten-Free Certification Organization (GFCO), which requires testing to below 10 parts per million of gluten. Look for the GFCO symbol on the back of the package.
  • Target Up and Up brand 24-hour lansoprazole (15mg) pills: This is a generic version of Prevacid. Look for the "gluten-free" designation in a colored box near the "Drug Facts" part of the packaging.
  • Target Up and Up brand ranitidine (150mg) pills: This is a generic version of Zantac. Look for the "gluten-free" designation in a colored box near the "Drug Facts" part of the packaging.
  • Tums: This is the only brand-name antacid that makes a gluten-free claim. Tums tablets, which come in a wide variety of flavors and strengths, contain the active ingredient calcium carbonate and are considered gluten-free, according to the manufacturer.
  • Walgreens Brand extra-strength antacid tablets in wild berry flavor: These tablets, with 750mg of calcium carbonate, are a generic version of Tums. They carry a gluten-free label.
  • Walgreens Brand lansoprazole (15mg) pills: This is a generic version of Prevacid. Look for the "gluten-free" designation near the "Drug Facts" on the packaging.

These brand-name antacids are not considered gluten-free:

  • Alka-Seltzer: This "pop, pop, fizz, fizz" brand name offers several different heartburn and gas relief effervescent remedies. However, a spokesperson for manufacturer Bayer says the products are made in a facility shared with gluten-containing products, and are not considered gluten-free.
  • Nexium: Known as the "purple pill," Nexium contains 22.3mg of esomeprazole, a proton pump inhibitor. Manufacturer Pfizer, Inc. does not guarantee that the product is gluten-free.
  • Pepsid: Pepsid AC contains the H2 blocker famotidine, while Pepsid Complete contains famotidine plus the acid reducers calcium carbonate and magnesium hydroxide. However, manufacturer McNeil Consumer Pharmaceuticals, Inc., does not guarantee that the products are gluten-free.
  • Prevacid: This product, made by Takeda Pharmaceuticals U.S.A., Inc., contains the proton pump inhibitor lansoprazole. Takeda does not guarantee that the product is gluten-free.
  • Prilosec: Made by Procter & Gamble, Prilosec contains the proton pump inhibitor omeprazole. Its manufacturer does not say whether or not the product is gluten-free.
  • Zantac: Zantac, manufactured by Boehringer Ingelheim, contains ranitidine, an H2 blocker. Like the other brand-name drugs in this category, Zantac is not guaranteed to be gluten-free.

The bottom line on gluten-free antacids: There's a gluten-free over-the-counter generic substitute for almost every name-brand antacid available, so if necessary you can try several to find one that works well for you.

A Word From Verywell

Whether you need an antacid, an anti-diarrheal medication, or a laxative, there are gluten-free alternatives available. Oftentimes, you'll be better off with a generic version of a brand-name drug, since they're more reliably labeled "gluten-free." You may need to shop around, though—not every drug store or national big box store will carry every medication in a gluten-free version.

Finally, when purchasing over-the-counter drugs, make certain you check every package for a "gluten-free" designation every single time. Although stores like Target and Walgreens (and to a lesser extent, Walmart) have been consistent in carrying gluten-free products, product formulations can change at any time. Always make sure what you're buying that day is safe.

Sources:

American Academy of Family Physicians. Antacids and Acid Reducers: OTC Relief for Heartburn and Acid Reflux fact sheet.

American Academy of Family Physicians. Anti-diarrheal Medicines: OTC Relief for Diarrhea fact sheet.

American Academy of Family Physicians. Laxatives: OTC Products for Constipation fact sheet.

Nachman F. et al. Gastroesophageal Reflux Symptoms in Patients With Celiac Disease and the Effects of a Gluten-Free Diet. Clinical Gastroenterology and Hepatology. 2010 Jun 30 [Epub ahead of print].

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