Sec. 400.335 Fructose-Containing Drugs (CPG 7132b.02)
BACKGROUND:
Hereditary fructose intolerance is a metabolic error due to the deficiency of fructose
1-phosphate aldolase in the liver. It is thought to be inherited as an autosomal recessive
trait. The condition is characterized by symptomatic hypoglycemia and vomiting. Prolonged
fructose ingestion in young children results in their failure to thrive and in jaundice,
liver damage, renal impairment, and sometimes cachexia. <> There have been deaths
involving the administration of IV solutions containing "Invert Sugar" to
patients with hereditary fructose intolerance.
There are many drug products which contain fructose. In many cases, fructose has been
identified on the product label as either levulose or invert sugar. FDA has learned that
the public and many professionals are not always aware of the fact that levulose is a
synonym for fructose, or that "invert sugar" is a mixture of glucose and
fructose. Clearly identifying *the* presence of fructose in drugs which may be used by
persons with hereditary fructose intolerance would help insure that they are not
unknowingly being treated with such drugs.
POLICY:
All oral dosage form drugs and all parenteral drugs which contain fructose should
clearly identify this ingredient as "fructose" on labels and labeling. The words
"Fructose/Dextrose" should immediately follow the words "Invert Sugar"
whenever they appear. The word "Fructose" should immediately follow the word
"Levulose" whenever it appears.
*Material between asterisks is new or revised*
<> Indicates material has been deleted
Issued: 1/21/75
Revised: 10/1/80, 5/22/87