Salena Yang, PharmD, MPH; Goodrich Pharmacy
Muslim patients may sometimes encounter medications that contain ingredients considered haram in Islam. Per their beliefs, they often need to avoid haram medications unless a halal alternative is lacking and there is a genuine medical need for the medication. It is important to inform Muslim patients about the ingredients of their medication because there is a difference of opinion among Islamic scholars on which ingredients are haram. The following table below reviews potential haram medication ingredients and production methods and is not a comprehensive list.
Pharmacists can play a key role to help ensure halal medication dispensing for Muslim patients. Below is a multistep process that pharmacists can take to provide high-quality patient care for Muslim patients.
Step 1: Change the Manufacturer
The first step to consider is converting between brands, generics, and biosimilars. Medications can sometimes contain alcohol as an ingredient. A simple switch to another manufacturer that doesn’t contain alcohol can make it halal. DailyMed is a good resource that provides manufacturer specific package inserts so pharmacists can substitute for an alcohol-free alternative. This first step can primarily be completed by the pharmacist without the prescriber's approval.
Step 2: Change the Dosage Form
The next step is to consider changing the dosage form of the medication. Gelatin-containing capsules can be substituted with the tablet or liquid formulation. Depending on the type of medication, the pharmacist can make a quick switch from tablets to capsules if allowed at their site. However, this step may sometimes require the prescriber’s approval.
Step 3a: Change the Method of Administration
If changing the manufacturer or dosage form is not feasible, some gelatin-containing capsules can be opened, and the contents can be mixed with a liquid or semisolid food like applesauce. This step is usually when most providers or patients reach out to the pharmacist to ask about opening medication capsules before administration.
Step 3b: Change the Medication
The last step may be to consider a change of the medication to one in the same pharmacological class.
This step sometimes can take longer than the previous ones because it may require the pharmacist to contact the prescriber and recommend a change in the medication.
The interprofessional collaboration between physicians and pharmacists is important in these situations. This can be completed with a collaborative practices agreement (CPA) between physicians and pharmacists. CPAs allow for certain patient care functions, including but not limited to modification or initiation of drug therapy that is halal. These tactics can help change haram medications without having to consult the providers since pharmacists are the most qualified to assess halal medication alternatives. It also provides efficient care for the patient who is waiting for their prescription. Lastly, it helps expand the role of pharmacists if a patient is initiated on a haram medication because there are no halal alternatives. The patient would be followed and monitored for the continued need for the medication as well as staying up to date on available alternatives.
References:
1. Lababidi H, Judge R, Khan MA. Dispensing Medication for Muslims: A Guide for Pharmacists.
Published July 25, 2024. Accessed August 14, 2024.
https://www.pharmacytimes.com/view/dispensing-medication-for-muslims-a-guide-for-
pharmacists#
2. U.S. National Library of Medicine. DailyMed. Accessed May 24,
2024. https://www.dailymed.nlm.nih.gov/dailymed/index.cfm