Dr Rani Khatib
Consultant Pharmacist and Associate Professor at the University of Leeds
Editorial Board member of JBIMA
Dr Rani Khatib advocates for considering all individual patients’ needs during informed, shared decision-making, including considerations of medication sources and ingredients, to improve holistic care and medicines adherence.
What factors influence treatment decision-making?
Treatment decisions are influenced by a myriad of factors including personal beliefs, religious practices and dietary restrictions including intolerances. Understanding these factors is paramount in ensuring patients receive appropriate care tailored to individual needs.
Each person should be treated individually, with their views and preferences respected and considered before treatment. Adherence to practices with dietary restrictions, such as Judaism, Buddhism, Islam and veganism, are crucial considerations.The 2011 England and Wales census shows that 4.8% of the population may have Halal dietary restrictions.
What constituents should patients be aware of?
Medicines consist of the active ingredient (the therapeutic drug) and excipients. Excipients are additional ingredients, aiding delivery and long-term stabilisation or forming capsules and tablets. For some, the active ingredient might be permissible but one of the excipients is prohibited, which would affect treatment decision-making.
For instance, common ingredients like gelatine, shellac, lactose, lanolin and magnesium stearate are not suitable for many people with dietary restrictions.
As clinicians, by engaging with patients upfront, we avoid situations where we prescribe medication and patients later discover, upon reading the leaflet, that there are ingredients they can’t consume, discouraging them from taking the medication.
How do religious beliefs impact treatment decisions?
Even within certain religious groups, individuals may have varying beliefs. For instance, some Muslims may accept medicines with non-intoxicating alcohol while some require alcohol-free options.
Medications with bovine, ethanol or pig-derived ingredients may pose issues. Some types of insulin and heparin, used for diabetes and blood clot prevention, may be unsuitable for Muslim patients, especially when alternatives are available.
Are there alternatives or clinical exceptions?
Clinicians can address patient needs by educating them and exploring alternatives. If an excipient is unsuitable, there are often alternative formulations — with the same active ingredient. If the active ingredient is not acceptable, exploring different medications is an option.
In life-threatening situations, non-halal medication, for instance, may be necessary and acceptable when no alternatives exist.
How can clinicians empower patients in treatment decisions?
Patients and clinicians should collaborate to obtain comprehensive information on medication constituents and preparation processes. This may involve consulting licensed product information, reaching out to manufacturers or utilising certification authorities such as the Halal Food Authority (HFA) for guidance on certified medications.
Clinicians can provide information about products and their excipients based on available information. However, patients remain responsible for deciding whether their treatment adheres to their beliefs and dietary needs.
NON-2024-2176 March 2024
