Sorbitol content of selected sugar-free liquid medications

Diarrhea is commonly encountered during tube feeding and may be caused by the feeding itself or other factors, including sorbitol content of administered liquid medications. Because content of excipients is not routinely included in product labeling, manufacturers were asked to provide sorbitol content of selected sugar-free medications. Several products, including preparations of cimetidine, lithium citrate, phenylephrine/chlorpheniramine, phenylephrine/brompheniramine, phenylephrine/phenylpropanolamine/chlorpheniramine/phenyltoloxamine, phenylpropanolamine/brompheniramine maleate, phenylpropanolamine/brompheniramine maleate/dextromethorphan, theophylline, and theophylline/guaifenesin supply more than 10 g per day of sorbitol when used in normal dosages. Many manufacturers denied permission to publish excipient information because of frequent reformulation. Pharmacists should be aware of the potential for diarrhea secondary to sorbitol in liquid medications. Manufacturers should be required to include excipient information in product labeling for ingredients present in potentially clinically significant amounts.