Pharmacist Recommendations
The pharmacist can provide assistance to patients with lactose intolerance. In addition to instructing them on the differences between milk allergy and lactose intolerance and the risks of osteoporosis, pharmacists can also point out the benefits of using lactose-free milk, milk substitutes, and tablets and liquids that contain lactase.[4-7]

Lactose-Free Milk: Lactose-intolerant patients can choose from several lactose-free milks. The Lactaid brand is available as three lactose-free choices: reduced-fat Lactaid, low-fat Lactaid, and nonfat Lactaid milks (45, 20, and 0 fat calories per cup, respectively). Another group is lactose-free Dairy Ease whole milk, reduced-fat 2% milk, and nonfat milk.

Milk Substitutes: Several milk substitutes offer a taste that may be acceptable. Patients should be urged to try another variety if one is not quite to their taste. Milk substitutes include soybean oil mixtures (eg, 8th Continent Soymilk), rice-based products, and mixtures of several ingredients (eg, Vitamite, containing corn syrup solids, canola oil, potassium caseinate, soy protein). Some of the products are enriched with calcium; these are preferable.

Lactase Tablets/Liquids: Patients may try lactose-free milk or milk substitutes and find them unacceptable. Further, most restaurants do not offer lactose-free foods or dairy substitutes. In these cases, ingesting lactose along with exogenous lactase tablets may prevent problems. To assess the usefulness of lactase-containing tablets, the patient can perform a test. The evening before the test, the patient should not eat anything after 10 pm. Along with a normal breakfast, the patient should drink 12 ounces of milk, keeping track of symptoms over the next six hours. On the second day, the patient should repeat the regimen, adding a lactase supplement (eg, Lactaid Ultra) with the first swallow of milk. If symptoms occur, the patient may simply increase the dose of lactase product as directed on the label until he or she is symptom-free. Since ingestion of lactase is free of adverse effects, the patient may continue to increase the dose until symptom-free. From that point, the patient should take care to ingest the same number of tablets for every 12 ounces of milk or its equivalent.

Some products (eg, Lactaid) are also available as drops. The patient may take them orally as an alternative to tablets or may use them to prepare their own lactose-free milk from regular milk. To do this, the patient purchases a cow's milk product, adds the suggested number of lactase drops, and shakes the carton. After approximately 24 hours, digestion of lactose is complete. Patients who choose this option may notice that the milk is sweeter than standard milk. They should be reassured that the enhanced sweetness results from the fact that glucose and galactose are sweeter than lactose, the parent compound. Eventually, they will become accustomed to the difference.




W. Steven Pray, PhD, DPh, Bernhardt Professor of Nonprescription Products and Devices, College of Pharmacy, Southwestern Oklahoma State University, Weatherford, Oklahoma