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Coeliac disease gluten-free query — GPhC CRA MCQ

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HardGastrointestinal TherapeuticsCoeliac disease gluten-free queryGPhC CRA

A patient with coeliac disease has tolerated one manufacturer's levothyroxine. A wholesaler substitute has the same active ingredient and strength, but the leaflet does not resolve a named excipient that previously caused symptoms. What should the pharmacist do before supply?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Check exact product information or confirm composition with the manufacturer

Bioequivalence does not mean that manufacturers use identical excipients. When a clinically relevant excipient cannot be confirmed from the available leaflet, the pharmacist should check the current product-specific SmPC or PIL and, if necessary, confirm composition with the manufacturer before selecting the preparation. Appearance, crushing and an unsupervised trial dose do not establish suitability.

Reference: NHS SPS: Understanding excipients in medicines: https://sps.nhs.uk/articles/understanding-excipients-in-medicines/