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Dr Sarah Jarvis

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Intolerant to Povidone

I think I’m intolerant to a substance in my prescription medication. What rights do I have? Through having to take a cocktail of drugs, during treatment for breast cancer and MRSA, I have become intolerant to a substance called povidone, which can be found in a lot of over-the-counter and prescription drugs. I believe the substance, which is man-made from the petrochemical industry, is used to make drugs cheap. The pharmacist has been very helpful, but the GPs are reluctant to specify makes of the drugs, which I have to take, that do not contain povidone. Do I have any rights in this regard? The last GP I saw, was most unsympathetic.

- Mary, UK


I am sorry that you have had so many health problems and as a result have had to take so many medications. You are right to say that many medications contain povidone – however, it is not used to make drugs cheap. Most medicines contain only milligrams of the active ingredient, and would be far too small to take unless other, non-pharmacologically active compounds are added to bulk out the tablet to an acceptable size. Povidone, also known as Polyvinylpyrrolidone, or PVP, is one such agent. Povidone is widely used in tablets because in most people it simply passes straight through the body without having any effect. It has been widely tested and has a good safety record compared to many alternatives. It isn’t just used in medicines – it’s added to shampoos, toothpastes and even the glue on the back of stamps. It is also combined with iodine to be used as a disinfectant agent, widely used in surgical procedures and in soaps, laboratories and ointments.

Allergy or sensitivity to iodine is relatively common, but it is uncommon for people to develop a sensitivity to povidone itself. However, it is not unknown. You don’t make it clear whether you’ve been formally tested for povidone sensitivity; whether, if you have, you’ve been told it’s an intolerance or an allergy (with an allergy, you need to avoid absolutely all contact with the allergen forever, whereas with an intolerance, small amounts might not cause symptoms); or whether you have read the leaflets after getting side effects and assumed this is the problem. If you have been formally diagnosed with a povidone allergy, your GP should be prepared to ensure that any medication you ever have does not contain it. You will also need to avoid all contact with it forever and may need to carry an adrenaline injector pen and other precautions in case of a potentially life-threatening complication called anaphylaxis. However, this is very uncommon. Doctors are not obliged to give a particular medication because a patient requests it, but they do need to explain their reasoning. If they refuse to change a medication for a serious medical reason, this would clearly not be acceptable. But we do get a lot of patients who prefer one medication over another for a wide variety of reasons – because they’re used to the previous one, because someone they know took an alternative and liked it, because they believe they have a sensitivity when the research suggests this is not a problem etc. Unfortunately, there are huge cash restrictions in the NHS these days and one form of a drug could cost hundreds of pounds more than another which has exactly the same drug ingredients and is made to the same standard. As well as a duty to their individual patients, doctors have a duty to all the patients under their care to use these scarce resources appropriately to make sure other patients are not deprived of treatments because of lack of funds.

When I get a request like this I discuss it with our local medicines management team, a group of trained pharmacists who have access to all the research literature on the subject. They can often come up with a compromise (eg an alternative medicine which does not contain an ingredient the patient does not want) but which is not prohibitively expensive.

Dr. Sarah Jarvis
Healthcare Professional

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