Culturally sensitive prescribing of common symptom management drugs

Many commonly used medicines contain, or are derived from, products which are unacceptable for religious or philosophical reasons. This paper discusses religious and non-religious dietary restrictions that have implications for prescribing in palliative care.

A search was undertaken of the summary of product characteristics of 18 commonly used medications in palliative care. Any animal products used in the production process were not specified. Thirty-nine pharmaceutical companies were contacted to gather specific information to address this.

Some companies were unable to provide all the requested information even after 21 days. There is considerable variation regarding excipients and products involved in the manufacturing processes between different manufacturers of the same product. Within the products considered, bovine rennet was often used to extract lactose from cow's milk; gelatine was most often, but not always, bovine; magnesium stearate was mostly non-animal in origin. If alcohol is not a matter of concern, it might appear that liquid formulations would generally be more acceptable than capsules or tablets. However, assumptions cannot be made as producers and production processes commonly change.

It has not been possible to provide definitive information about whether animal products and alcohol are involved in the manufacturing processes of these medicines. The onus is on prescribers to sensitively enquire about any dietary restrictions individuals might have, to contact companies directly to gather specific information and be prepared to discuss the impact on symptom management if equivalent alternatives are not available.