Medicines Q&As

What factors to consider when advising on medicines suitable for a

Halal diet?
Prepared by UK Medicines Information (UKMi) pharmacists for NHS healthcare professionals
Before using this Q&A, read the disclaimer at https://www.sps.nhs.uk/articles/about-ukmi-medicines-qas/
Date prepared: 06/12/2017

Disclaimer: The aim of this document is to increase awareness of the term ‘Halal’ in relation to
medication and to direct readers towards further sources of information. Religious concepts
presented in this document reflect information found in the reference sources cited. It is
acknowledged that some of the religious concepts are subjective to individuals’ religious belief
systems, which are known to vary considerably. In addition, the pharmaceutical components of
medications may vary from manufacturer to manufacturer and so readers are advised to consult
manufacturers directly for written confirmation of compliance with Halal manufacturing processes
and ingredients. Halal certifications of manufacturers or products are also subject to expiry.

Background
There are a wide range of religions and beliefs in the UK today (1). Some religions prohibit the
ingestion of certain foods and drink. For example, data from the 2011 England and Wales census
indicates that 4.8% of the population may have dietary restrictions pertaining to Halal (2). How these
impact on and influence attitudes to planning, giving and receiving healthcare from pre-conception
right through to dying and even after death, require NHS staff and clinicians to be aware of and
sensitive to the many perspectives that patients bring to ethical decision making (1). Consideration
should therefore be given to the patient’s religious beliefs before prescribing drugs or treatment.

It should never be assumed, however, that an individual belonging to a specific religious group will
necessarily be compliant with or completely observant of all the views and practices of that group.
Individual patients’ reactions to a particular clinical situation can be influenced by a number of factors,
including what branch of a particular religion or belief they belong to, and how strong their religious
beliefs are (for example, orthodox or reformed, moderate or fundamentalist) (1). For this reason, each
person should be treated as an individual, and those treating them should try to ascertain their views
and preferences before treatment begins.

This document introduces the issues to consider when using pharmaceuticals in patients who believe
in Islam.

Answer
What does Halal and Haram mean?

In Islam, Halal means ‘permissible’ whilst ‘Haram’ means ‘prohibited’ (3). The teachings of the Quran
and Hadith provide Muslims with guidance on what is allowed and not allowed in all matters including
personal behaviour and food/drink consumption. The aspects of Halal and Haram will be a
fundamental determining factor in the decision making process by practising Muslims with respect to
anything they consume, including pharmaceuticals.

Islamic law (or Shariah Law) gives Muslims the freedom to eat and drink anything as long as it is not
Haram (3). A number of other Shariah Law terms may be used in relation to Halal or Haram
pharmaceuticals such as Mushbooh which means that the origins of the constituent of a product are in
doubt and cannot be classified as Haram or Halal. The term Mushbooh can also apply to situations
where scholars or opinions may differ on whether a product is Halal or Haram. The term Tayyib (with
respect to pharmaceutical products) means that the product is of good quality (a requirement of any

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product under Shariah Law) and produced under standardised processes. In terms of UK licensing,
this would equate to a product and manufacturing licence (3).

Examples of pharmaceutical constituents considered Halal or Haram

Alcohol can lead to addiction, misbehaviour and negative impacts on health, therefore it is judged as
Haram for Muslims. Any animal that was not slaughtered based on Shariah Law or any animal that is
unhealthy, diseased or could cause death would be considered Haram. Any medicines which contain
porcine or Haram excipients or ingredients may pose a problem to Muslim patients (3).

Porcine (pork) derived products will be avoided by practising Muslims; however porcine gelatin used
in medicines can be contentious (4). In 2001, the World Health Organization reported on Islamic Legal
Scholars’ verdict that pork gelatin is sufficiently transformed and permissible for consumption (5). For
example, the gelatin which is used as a stabiliser in the intranasal influenza vaccine is highly purified.
Scientific tests indicate that the gelatin in this vaccine is so degraded that the original source cannot
be identified and the vaccine has not been shown to contain any detectable DNA from pigs (6). More
recently in 2013 Public Health England (PHE) was made aware by some leading Muslim
organisations that the WHO document was not accepted by some schools of Islamic jurisprudence
(6).

Other constituents derived from animals that may not be slaughtered in accordance with Shariah Law
and may be found in pharmaceuticals include bovine (cow), hamster ovary, murine (mouse), and
equine (horse) (4).

In addition to the pharmaceutical constituents, the preparation process needs to be considered as

products could be rendered Haram by the process (7), e.g. Halal meat cooked in sauce containing
alcohol.

A practising Muslim may take all this into account when considering their medication options. Similar
principles will apply to the choice of enteral feed and nutritional supplements (8).

Suppliers of Halal pharmaceuticals in the UK

At present, the production of solely Halal pharmaceuticals is limited to manufacturers’ in

predominantly Muslim-based countries (7). All imported POMs have to be approved by the Medicines
and Health products Regulatory Agency (MHRA) to be allowed entry into the UK, which is a huge
barrier to the supply and accessibility of such medicines. However, Halal medicines may be available
from some retailers for consumer purchase.

The Halal Food Authority (HFA) (http://halalfoodauthority.com/) is an example of a halal certification

company in the UK. These companies certify mostly food although some over the counter (OTC)
medicines are included in their lists of products – see HFA website for examples. Rosemont is an
example of a pharmaceutical company that has obtained HFA certification for some of its prescription
only medicine (POM) liquid formulations (9).

Where to find information about specific medicines

Healthcare professionals and patients should obtain details on the constituents and the preparation
process to determine if individual products are suitable for a Halal diet. Obtaining written
correspondence from manufacturers of pharmaceutical products remains a considerable challenge
but would still be considered the main point of contact.

Some manufacturers are starting to respond to dietary choices by marketing products as ‘sourced
from Halal gelatin’ for example (10). The Summary of Product Characteristics (SPC) should be
consulted with care since the details of any Haram active ingredient/source or excipient requires an

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understanding on what would be considered Haram. For example, some Muslims would consider the
alcohol content in medicines acceptable since it would not cause intoxication but others may wish to
avoid all alcohol containing medicines (11). Table 1 gives examples of the relevant information found
in various sections of an SPC when using the electronic Medicines Compendium (eMC); this is not an
exhaustive list of medications licensed in the UK.

Table 1: Examples of searches within SPCs held on the eMC to identify constituents of UK
licensed medications that may be considered Haram by some Muslim groups

Advanced Product listed eMC section Relevant information

search
term
(limited to
SPC)
Porcine Creon 40,000 capsules (12) 5.1 Pharmacodynamic Contains porcine pancreatin
properties formulated as enteric-coated
(acid-resistant) mini-
microspheres within gelatin
capsules.
Curosurf (13) 2. Qualitative and One 1.5 ml vial contains 120mg
quantitative of phospholipid fraction from
composition porcine lung (poractant alfa).
Defitelio 80mg/ml solution 2. Qualitative and Produced from porcine intestinal
for infusion (14) quantitative mucosa.
composition
Fluenz Tetra nasal spray 6. List of excipients Gelatin (porcine, Type A).
(15)
Fragmin 5,000 IU (16) 5.1 Pharmacodynamic Produced from porcine-derived
properties heparin sodium.
Hypurin Porcine (17) Active ingredients Insulin, porcine insulin, pork
insulin
Pancrease HL (18) 5.1 Pharmacodynamic Porcine-derived pancreatic
properties enzymes (lipases, proteases,
and amylases).
Pancrex (19) 5.1 Pharmacodynamic Porcine-derived pancreatic
properties enzymes (lipases, proteases,
and amylases).
Pork Hypurin Porcine 30/70 mix Active ingredients Insulin, porcine insulin, pork
cartridges (17) insulin.

Bovine Hypurin Bovine Isophane Active ingredients Beef insulin, bovine insulin,
Cartridges (20) insulin.
InductOs (dibotermin alfa) 6.1 List of excipients Bovine Type I collagen.
(21)
NovoSeven (22) 4.4 Special warnings May contain trace amounts of
and precautions for mouse IgG, bovine IgG and
use other residual culture proteins
(hamster and bovine serum
proteins).
Alcohol Codeine Phosphate Syrup 2. Qualitative and Each 5ml of syrup contains 2.1
(23) quantitative vol% of ethanol (alcohol).
composition
DAKTARIN Oral Gel (24) 4.4 Special warnings This medicinal product contains
and precautions for small amounts of ethanol
use (alcohol), less than 100mg per
dose.
Ethanol Diazepam 5mg/ml Solution 2. Qualitative and Ethanol 96% 100mg/ml.
for Injection (25) quantitative

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composition
Amitriptyline Hydrochloride 2. Qualitative and Approximately 10.5mg ethanol
25mg/5ml and 50mg/5ml quantitative in 5mL of solution.
Oral Solution (26) composition
Co-Trimoxazole for infusion 2. Qualitative and 13.2 vol% ethanol (alcohol) per
16 mg/ 80mg per ml (27) quantitative 5 ml.
composition
Priadel Liquid (28) 2. Qualitative and 211mg of ethanol 96% per 5mL
quantitative solution.
composition

Other pharmaceutical considerations include calcium stearate, cetyl alcohol, diglyceride, glycerine,
glycerol monostearate, lactose, magnesium stearate and monoglycerides. These may be considered
Mushbooh by some Islamic scholars (29). With respect to the gelatin in vaccinations, some Muslims
may accept the ruling by PHE that porcine gelatin in vaccines has been certified as acceptable by
some multi-faith groups (30).

The issues surrounding the Haram nature of medications is not just limited to conventional products but is also
applicable to complementary medicines, e.g. chondroitin can be sourced from bovine origins (4).

Impact of personal Islamic beliefs on medication choice

Discussions around taking a potentially Haram medication should involve a scholar well versed in the
patient’s beliefs such as an Imam. The Imam may exempt these products from Shariah Law for
medical necessity on the interpretation of the religious scriptures. The exemptions are not
straightforward. For example, porcine-derived medicines may become temporarily exempt from the
laws of diet during the time of illness.

Some Muslim patients, however, may have their own interpretations of Islam with regards to this topic,
which further complicates the issue. Healthcare professionals may therefore be called upon to define
and explain medical necessity and to explore the existence of suitable alternatives to Haram
medications, feeds and nutritional supplements.

Seeking advice from Islamic scholars and others

For patients and healthcare professionals, advice should be sought from a recognised local Imam.
The Muslim Council of Britain (MCB) can be contacted on 0845 26 26 786 or via their website at
www.mcb.org.uk, for specific queries.

Advice from a pharmacist or a medicines information service is another option as they can find out if a
product available in the UK is suitable for Muslim patients. They might also be able to suggest suitable
alternatives if they exist.

Useful websites:

There are also some useful websites which may have product information, advice, or details on how
to access advice on Halal medicines. Please note that this list of websites is not exhaustive and their
content may not be applicable to UK practice. UKMi can take no responsibility for the accuracy or
quality of the suggested websites:

 http://halalfoodauthority.com/
 www.foodguide.org.uk
 http://www.muslimconsumergroup.com/medicine.html
 https://halaltreatments.com/

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 Medicines Q&As

Summary
 In Islam, Halal means ‘permissible’ whilst ‘Haram’ means ‘prohibited’.
 Islamic law (or Shariah Law) gives Muslims the freedom to eat and drink anything as long as
it is not Haram.
 Mushbooh means that the origins of the constituent are in doubt and cannot be classified as
Haram or Halal.
 Tayyib (with respect to pharmaceutical products) means that the product is of good quality
and produced under standardised processes. In terms of UK licensing, this would equate to a
product and manufacturing license.
 There is no exhaustive or comprehensive list of medicines available which are Halal certified.
 Any medicines which contain porcine or non-Halal excipients or ingredients may pose a
problem to Muslim patients; although pork gelatin used in medicines can be contentious.
 Something considered Halal could be rendered Haram by the preparation process.
 Obtaining written correspondence detailing ingredients and sources from manufacturers of
pharmaceutical products is considered the main point of contact.
 Healthcare professionals can provide information about products and their excipients based
on the information available to them but individuals remain responsible for deciding whether
their treatment is compliant with their own religious belief system.
 For specific queries on the suitability of a medicine for individual patients, advice could be
sought from a recognised local Imam.

Limitations
Religions are followed and interpreted differently by individuals and so some practices may be
acceptable to some patients and others may not be acceptable. This needs to be kept in mind as this
document is a reference to create awareness of some of the potential medicine-related problems
which could arise in this patient population. This medicines Q&A excludes other religions.

References
1. Department of Health. Religion or belief: A practical guide for the NHS. Published January
2009. URL:
http://webarchive.nationalarchives.gov.uk/20130107105354/http:/www.dh.gov.uk/en/Publicati
onsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_093133. Accessed:
30/11/2017
2. Office for National Statistics. Full story: What does the Census tell us about religion in 2011?
Released 16th May 2013. URL: http://www.ons.gov.uk/ons/rel/census/2011-census/detailed-
characteristics-for-local-authorities-in-england-and-wales/rpt---religion.html. Accessed:
30/11/2017
3. Sarriff A. Razzaq H.A.A. Exploring the halal status of cardiovascular, endocrine and
respiratory group of medications. Malaysian Journal of Medical Sciences 2013; 20(1); 69-75.
4. Department of Health. Guideline for the use of medicines / pharmaceuticals of animal origin.
Queensland Government. Reviewed: November 2013. URL:
https://www.health.qld.gov.au/qhpolicy/docs/gdl/qh-gdl-954.pdf. Accessed: 30/11/2017
5. World Health Organization. WHO Letter Reports On Islamic Legal Scholars' Verdict on the
Medicinal Use Of Gelatin Derived From Pork Products. July 2001. URL:
http://www.immunize.org/concerns/porcine.pdf. Accessed: 30/11/2017
6. Public Health England. The children’s flu vaccination programme, the nasal flu vaccine Fluenz
and porcine gelatine: Your questions answered. December 2014.URL:
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/386842/290299
8_PHE_FluPorcine_QAforParents_FINAL_CT.pdf. Accessed: 06/12/2017
7. Halim MAA, Salleh MMM, Kashim MIAM, et al. Halal pharmaceuticals: Legal, Shari’ah issues
and fatwa of drug, gelatine and alcohol. International Journal of Asian Social Science, 2014,
4(12):1176-1190
8. British National Formulary Online January 2018: Appendix 2: Borderline substances. URL:
https://www.medicinescomplete.com/mc/bnf/current/PHP103610-borderline-substances.htm
Accessed: 29/01/2018
9. Rosemont Pharmaceuticals. About Rosemont. URL:
https://www.rosemontpharma.com/about-us. Accessed: 04/12/2017

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10. Strickland S. Dietary restrictions: implications on medication choice. British Journal of General
Practice 2014; e670.
11. Asmak A, Fatimah S, Huzaimah I, et al. Is our medicine lawful (Halal)? Middle-East Journal of
Scientific Research 23 (3): 367-373: 2015
12. Summary of Product Characteristics – Creon 40,000 Capsules. Mylan Products Limited.
Updated 08/02/2017. Accessed via https://www.medicines.org.uk/ on 30/11/2017.
13. Summary of Product Characteristics – Curosurf. Chiesi Limited. Updated 15/11/2016.
Accessed via https://www.medicines.org.uk/ on 30/11/2017.
14. Summary of Product Characteristics – Defitelio 80 mg/mL concentrate for solution for
infusion. Gentium SPA a Jazz Pharmaceuticals company. Updated 31/05/2016. Accessed via
https://www.medicines.org.uk/ on 30/11/2017.
15. Summary of Product Characteristics – Fluenz Tetra nasal spray suspension
Influenza vaccine (live attenuated, nasal). AstraZeneca UK Limited. Updated 30/08/2017.
Accessed via https://www.medicines.org.uk/ on 30/11/2017.
16. Summary of Product Characteristics – Fragmin 5000 IU. Pfizer Limited. Updated 19/05/2016.
Accessed via https://www.medicines.org.uk/ on 30/11/2017.
17. Summary of Product Characteristics – Hypurin Porcine 30/70 Mix Cartridges. Wockhardt UK
Ltd. Updated: 19/01/2016. Accessed via https://www.medicines.org.uk/ on 30/11/2017.
18. Summary of Product Characteristics – Pancreas HL Capsules. Janssen-Cilag Ltd. Updated
10/08/2015. Accessed via https://www.medicines.org.uk/ 30/11/2017.
19. Summary of Product Characteristics – Pancrex Granules. Essential Pharmaceuticals Ltd.
Updated: 16/10/2017. Accessed via https://www.medicines.org.uk/emc/medicine/1409 on
30/11/2017.
20. Summary of Product Characteristics – Hypurin® Bovine Isophane Cartridges. Wockhardt UK
Ltd. Updated 19/01/2016. Accessed via https://www.medicines.org.uk/ on 30/11/2017.
21. Summary of Product Characteristics – InductOs for implantation matrix. Medtronic Limited.
Updated: 06/11/2015. Accessed via https://www.medicines.org.uk/ on 30/11/2017.
22. Summary of Product Characteristics – NovoSeven 1 mg (50 KIU). NovoSeven 2mg (100KUI).
NovoSeven 5mg (250 KIU). NovoSeven 8MG (400 KUI) powder and solvent for solution for
injection. Novo Nordisk Limited. Updated 20/01/2017. Accessed via
https://www.medicines.org.uk/ on 30/11/2017.
23. Summary of Product Characteristics – Codeine Phosphate Syrup. Thornton & Ross. Updated
22/06/2015. Accessed via https://www.medicines.org.uk/ on 30/11/2017
24. Summary of Product Characteristics – Daktarin Oral Gel. Janssen-Cilag Ltd. Updated
24/07/2017. Accessed via https://www.medicines.org.uk/ on 30/11/2017.
25. Summary of Product Characteristics – Diazepam 5mg/ml Solution for Injection. Wockhardt UK
Ltd. Updated: 22/04/2016. Accessed via https://www.medicines.org.uk/ on 30/11/2017.
26. Summary of Product Characteristics – Amitriptyline Hydrochloride 25mg/5ml and
50mg/5mlOral Solution. Wockhardt UK Ltd. Updated: 15/02/2016. Accessed via
https://www.medicines.org.uk/ on 30/11/2017.
27. Summary of Product Characteristics – Co-Trimoxazole for infusion 16 mg/ 80mg per ml.
Aspen. Updated: 05/01/2017. Accessed via https://www.medicines.org.uk/ on 30/11/2017.
28. Summary of Product Characteristics – Priadel Liquid. SANOFI. Updated: 25/06/2015.
Accessed via https://www.medicines.org.uk/ on 30/11/2017
29. Muslim Consumer group: Your source for Halal foods information. Mushbooh ingredients list.
Accessed via http://www.muslimconsumergroup.com/halal-haram-
mushbooh_ingredients.html?panna=2 on 30/11/2017.
30. News Team. Porcine gelatine considered acceptable by multi-faith groups. The
Pharmaceutical Journal 2013 (291): 300.

Quality Assurance
Prepared by
Iram Husain, Regional Medicines Information Manager, London Medicines Information Service,
Northwick Park Hospital

Date Prepared
6th December 2017

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Checked by
Sheena Vithlani, Regional Medicines Information Manager, London Medicines Information Service,
Northwick Park Hospital

Date of check
26th January 2018

Search strategy
a. Embase via NICE Evidence (accessed 04/12/2017):

1. EMBASE; exp MUSLIM/; 1003 results.

2. EMBASE; ISLAM/; 903 results.
3. EMBASE; exp DRUG THERAPY/; 2320454 results.
4. EMBASE; halal.af; 543 results.
5. EMBASE; haram.af; 343 results.
6. EMBASE; Mushbooh.af; 1 result.
7. EMBASE; tayyib.af; 68 results.
8. EMBASE; 4 OR 5 OR 6 OR 7; 944 results.
9. EMBASE; 1 OR 2; 1813 results.
10. EMBASE; 3 AND 8; 55 results. [DT 2016-2017] = 16
11. EMBASE; 3 AND 9; 96 results. [DT 2016-2017] = 52

b. Medline via NICE Evidence (accessed 04/12/2017; limits and fields feature not functioning
correctly):

1. Medline; ISLAM/; 4766 results.

2. Medline; exp DRUG THERAPY/; 1268591 results.
3. Medline; 1 AND 2; 78 results.
4. Medline; exp PHARMACEUTICAL VEHICLES/; 30132 results.
5. Medline; 1 AND 4; 1 result.
6. Medline; RELIGION AND MEDICINE/; 10865 results.
7. Medline; 1 AND 6; 698 results.
8. Medline; haram.ti.ab; 38 results.
9. Medline; halal.ti,ab; 166 results.
10. Medline; Mushbooh.ti.ab; 1 result.
11. Medline; tayyib.ti.ab; 0 results.
12. Medline; 8 OR 9 OR 10 OR 11; 199 results.
13. Medline; 6 AND 12; 5 results.
14. Medline; 4 AND 12; 0 results.

c. Medline via PubMed (accessed 04/12/2017) from Jan 2016:

"Islam"[Mesh] AND "Religion and Medicine"[Mesh] AND (("2013/01/01"[PDAT]:
"2015/12/31"[PDAT]) AND "humans"[MeSH Terms]) = 146 results

d. MiDatabank Viewer (accessed 30/11/2017): free text search [halal]

All centres: 1 result
Own centre: 10 results
e. NICE Evidence (accessed 30/11/2017): free text [halal medication]; free text [halal]; free text
[Muslim and medications]
f. Medicines Complete (AHFS Drug Information, BNF for Children, British National Formulary, Drug
Administration via Enteral Feeding Tubes, Drugs in Pregnancy and Lactation, Handbook on
Injectable Drugs, Herbal Medicines, Martindale: The Complete Drug Reference, Stockley’s Drug
Interactions, accessed 30/11/2017): free text [halal]
g. Micromedex DrugDex (accessed 30/11/2017): free text [halal] [Moslem] [Muslim] [haram] [Islam]
h. UpToDate (accessed 30/11/2017): free text [halal] [Moslem] [Muslim] [haram] [Islam]
i. Electronic Medicines Compendium (accessed 30/11/2017): free text [porcine] [pork] [bovine] [beef]
[alcohol] [ethanol]
j. Google (accessed 04/12/2017): free text [halal medication]

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