Most over-the-counter drugs come with a long list of inactive ingredients. Dyes, sweeteners and shelf-life extenders are added to many medications to make them as presentable, palatable and long-lasting as possible.
But would it be better to take a “clean” medicine that doesn’t list unrecognizable ingredients on the side of the box? What about a cold medication made with organic blueberries in lieu of high fructose corn syrup, for example?
That’s the premise behind Genexa, a brand that calls itself the “first clean medicine company.” Clean medicine is a close relative of the clean eating and clean cosmetics trends, and Genexa claims its medicines are made using “the same active ingredients people need, but without the artificial ones they don’t.”
But swapping common inactive ingredients for “clean” alternatives doesn’t come cheap. Genexa’s antacid is $9.99 for 72 tablets, compared to a chain pharmacy version with the same active ingredient that’s under $6 for 160 tablets.
Is it worth spending extra money on a “clean” medicine? The answer depends on your health history, your budget and your priorities. We talked to experts to learn about inactive ingredients in medications and whether it’s worth making the switch to clean alternatives.
Why do medications have inactive ingredients?
A majority of inactive ingredients are fillers, but they serve an important purpose.
“They bind the medication and make it what we call homogeneous, which means it’s the same amount throughout the tablet or the liquid,” says Ashley Garling, clinical assistant professor at the University of Texas at Austin College of Pharmacy. “It makes sure that the dose you receive is accurate.”
Plus, “medications are in such tiny amounts as far as the active ingredient is concerned … that creating a tablet from only the inactive ingredients is impractical,” Garling adds. There simply wouldn’t be a way to take your medicine if it didn’t include some inactive ingredients.
Other ingredients like dyes or flavorings help make a medication look or taste more appealing. Inactive ingredients can also contribute to the effectiveness of a medication, says James Wheeler, associate dean at the University of Tennessee College of Pharmacy, Knoxville campus.
“Two common ingredients are sucrose or lactose. They can help with a drug’s taste and bind ingredients together,” Wheeler says. “The addition of fatty acids can help with drug absorption.”
Stripping away active ingredients could potentially make a medication less effective, “depending on the type of medication and the absorption properties,” Wheeler says.
Are “clean” inactive ingredients better than traditional inactive ingredients?
Genexa’s products don’t completely eliminate inactive ingredients, but they do swap common ones for organic or non-GMO alternatives.
For example, in a side-by-side comparison of Genexa’s acetaminophen with drugstore brands, the company lists its own inactive ingredients (organic agave syrup, organic blueberries, citrus extract, purified water) alongside a drugstore brand’s active ingredients (FD&C Red. No. 40, high fructose corn syrup, microcrystalline cellulose, carboxymethylcellulose sodium, among others).
The message to consumers is clear: While the drugstore brand is full of confusing chemicals, the “clean” alternative uses recognizable, easy-to-pronounce ingredients.
But “people can’t correlate natural and healthy,” Garling says. “When I think of blueberry, I think well, where were they grown? What was in the soil? What else is going to be in that blueberry extract that came from other sources?”
Garling adds: “When you go down that rabbit hole of ‘what is natural?’ you have to ask yourself, is anything natural anymore? What is the risk versus benefit?”
It’s also important to review the active ingredients in Genexa’s medications, since they aren’t always identical swaps for what you’ll find at the pharmacy.
Genexa’s allergy and decongestant medicine, for example, lists a homeopathic remedy as its active ingredient. It doesn’t contain an active ingredient like loratadine (Claritin) or cetirizine (Zyrtec), two common antihistamines, and research doesn’t provide evidence in support of homeopathic solutions.
How likely am I to have a reaction to an inactive ingredient?
Most of the time, active ingredients are more likely to cause a reaction than inactive ingredients.
“The active ingredient acts at the receptor of the cell, triggering its therapeutic effects,” Wheeler says. “Inactive ingredients don’t have that mechanism and often are well tolerated by most patients. Most of the time, there’s not an issue with inactive ingredients.”
But patients with certain allergies or conditions, including lactose intolerance or Celiac disease, could be allergic to common inactive ingredients containing milk or gluten. Other possible allergens include peanut oil and chemical dyes. Keep an eye on medication labels if you know you have an allergy. Your pharmacist or doctor can also help you avoid ingredients that would trigger a reaction.
If you aren’t already aware of any allergies, it can be hard to determine if you’ve had a reaction to an inactive ingredient.
“It’s often a process of elimination,” Garling says. “A lot of these inactive ingredients are in everything from shampoos to foods.”
Tracing the clean medicine trend
The concept of “clean” products in medicine isn’t exactly new, Garling says.
“Throughout the last decade at least, various versions of ‘clean’ medicine or over the counter products have been incredibly popular” Garling says, pointing out that “clean” has historically been used to market herbal supplements and homeopathic remedies.
Brendan R. Begnoche, an informatics pharmacist for Nuvance Health in Connecticut and New York, says he’s noticed growing interest in “clean” medicine “in parallel with societal trends where people are ‘eating clean.’ ”
“People may be eating clean to avoid artificial ingredients for personal dietary reasons, but there are also people needing to avoid specific ingredients or dyes for diagnosed health reasons,” he says.
Another factor could be a general distrust of medicine and Big Pharma, Garling says.
“It may be a sense of wanting to revert back to our roots, so to speak,” she says. “Getting back to what’s considered more natural and therefore in a lot of peoples’ minds healthier.”
But “natural products are very complex groups of chemicals even though they grow in our environment.” Garling says. Plus, products labeled or marketed as “natural” can still cause reactions and irritation.
The bottom line: Should you try clean medicine?
The average person consumes inactive ingredients from medication in such small quantities and so infrequently that those ingredients will never cause an issue.
“From a medical point of view, I think that most people do not need to be concerned with inactive ingredients in medication,” Begnoche says. “I wouldn’t categorize the ‘clean’ products as any better or worse than what is on the market.”
Garling agrees: “I would not immediately see a benefit, and for the majority of my patients I would not necessarily recommend these products, just because access is always in the back of our mind,” she says, pointing out that Genexa’s medicines are considerably more expensive than their drugstore competitors.
But if you like the idea of a clean medication and you can afford it, there’s no harm in trying it, Garling and Begnoche agree. People with allergies to common inactive ingredients may also find that “clean” medicines offer a good alternative to drugstore brands.
Ultimately, if you’re concerned about the ingredients in your medications, a pharmacist at your drugstore or grocery store can answer questions and save you from falling down a Google rabbit hole.
“There’s thousands of medications on the market,” Wheeler says. “That’s really where pharmacist’s expertise comes into play. Your pharmacist has specialized training and access to drug databases.”