Supplying Medication Containing Unlawful Substances

Can I Prescribe Medication With Gelatin When a Less Efficacious Alternative is Available?

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Shafi'i Fiqh

Shaykh Jamir Meah answers a question related to the permissibility of prescribing medication which contains gelatin.

 

Question:

Salaam,

I know it is haram to take medicine that has haram elements in it (like gelatin capsules) if there is a reasonable alternative (such as tablets). So as a muslim psychiatrist, many of our medicines have extended release formulations that have many advantages over the immediate release formulations. The immediate release formulations do not have gelatin capsules, and right now, that’s really their advantage. For example, effexor XR has a decreased risk of side effects including nausea and people only have to take it once a day, and this is why the immediate release tablets have fallen out of favor (though the IR tablets have no gelatin). The other thing is that compliance with psychiatric medications is found to be low, and once daily medications are more likely to have increased compliance as well. The other consideration is that extended release formulations have less risk of withdrawal syndromes (which are non-fatal but really really uncomfortable and can make you sick) compared to immediate release formulations.

Is it haram to prescribe XR on the basis of the issue of gelatin and I can only recommend IR to my patients (even if they are non-Muslim) as to avoid direct assistance in sin?

 

Answer:

Wa’alaykum assalam, thank you for your question.
Most scholars hold the position that gelatine from animals not Islamically slaughtered remains impure and is therefore unlawful. The exception for when it would permissible to take or prescribe impure gelatine is when:

1. It is known that the medicine will be effective

2. The medicine is needed

3. There is no permissible alternative reasonably available

4. The above has been established by a Muslim doctor who is at least outwardly upright or by previous experience.
[Mughni al Muhtaj]
In regards your specific question and field of work, if it is in fact true that the extended release (XR) formulation has numerous benefits over the immediate release (IR) drug, and the side effects are fewer, then it would seem that this would be a valid case for the permissibility of prescribing the slow release version. However, when prescribing to Muslims, you should inform them of the option and give them the choice.
Considerations

The above answer is according to the restrictions of the field you work in and the boundaries of conventional medicine. Another perspective to this is that natural alternatives do exist, are very effective, and carry no side effects. The side effects of conventional medicines such as the ones you have mentioned are disturbing. Furthermore, many patients also complain about the serious come downs associated with the XR formulations you mention compared to the IR formula, and this should be looked into further and taken into account.
Nevertheless, if what you have stated is indeed true in regards the two formulas, then you are only required to work within your own capacity and area of expertise, and based on that, it would be permissible for you to prescribe the XR version if the patient also chooses such a course of treatment. And Allah knows best.

Please also refer to the following answers:

Warmest salams,

Jamir
Checked and approved by Shaykh Faraz Rabbani

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