This is an important cultural awareness topic! The simplest solution is to open the capsules as previously suggested. Alternatively, we have used compounding
pharmacy to obtain RIF suspension for an adult TB pt. with a G-tube needing all meds administered as liquids. The suspension should be sufficiently concentrated for adult dosing, and avoid high osmotic ingredients that can cause GI side effects (request
Ora-Plus for suspension vehicle without Ora-Sweet – can add own flavor if needed).
On the wider question on permissibility of using capsules that are made from gelatin, Islamic scholars apparently differ in their interpretations, and it might
be helpful to have patient consult their local religious leader. The WHO Eastern Mediterranean office published a consensus statement from experts in Islamic law in 2001 stating “The Gelatin formed as a result of the transformation of the bones, ski and
tendons of a judicially impure animal is pure, and it is judicially permissible to eat it.”
https://www.immunize.org/talking-about-vaccines/porcine.pdf I found a helpful reference on the intersection of religious practices & medications in UK publication “Prescriber” – see
4th page for discussion of Halal or haram status of medications
https://www.prescriber.co.uk/wp-content/uploads/sites/23/2016/12/Prescribing-religion-KLWEB.pdf
Appreciate this forum to gain insights from each other!
Ann
Ann Lund RN
Public Health Nurse
Pronouns: she/her/hers
________________________________________________________________
Whatcom County Health Department
1500 North State St., Bellingham, WA 98225
Direct: (360) 778-6112 | Cell: (360) 305-9350
alund@whatcomcounty.us
My incoming and outgoing email communication is subject to public disclosure laws.
From: tbnurses@ntca.simplelists.com [mailto:tbnurses@ntca.simplelists.com]
On Behalf Of Morse, Darlene
Sent: Friday, May 08, 2020 9:46 AM
To: tbnurses@ntca.simplelists.com
Subject: RE: TB Nurse Question: RIF gelatin capsules?
I had a nurse who called the manufacturer a while ago and confirmed the make up. It is a challenge because our concern was also for this religious belief.
Darlene
Darlene Morse, MSN, RN, M.Ed., CIC
Public Health Nurse Program Manager
NH TB Nurse Consultant
NH Bureau of Infectious Disease Control
Phone: 603-271-4494
Fax: 603-271-0545
E-Mail:
Darlene.morse@dhhs.nh.gov
ATTENTION: please visit the DHHS COVID-19 website for the latest COVID-19 information, resources and guidance:
https://www.nh.gov/covid19/
From: tbnurses@ntca.simplelists.com <tbnurses@ntca.simplelists.com>
On Behalf Of Lorna Will
Sent: Friday, May 8, 2020 12:11 PM
To: tbnurses@ntca.simplelists.com
Subject: Re: TB Nurse Question: RIF gelatin capsules?
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EXTERNAL:
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Lana,
You could check on the FDA site, or the manufacturer site, or the package insert (also online) to see if the source of gelatin is listed. Or just call the manufacturer customer service. I’m sure this issue has come up before as this drug
is used in many countries.
Hope you and yours are doing well and staying safe!
On Fri, May 8, 2020 at 11:05 Tyer, Lana K (DOH) <lana.tyer@doh.wa.gov> wrote:
Hello brilliant TB Nurses!
I hope you are all enjoying nurses week and are planning to take a little time for yourself soon. You are all so wonderful and I hope you feel appreciated. J
I have a question that came from a county health jurisdiction and I hope the wisdom of this group can help me with. Below you will see the case situation and question.
“We have a contact of an active case with a positive QFT and normal CXR. She was prescribed Rifampin. The patient is Muslim from SE Asia. When she saw the capsules she said she wouldn’t take them because the capsule is made with gelatin and gelatin can be made with pork products. Never ran into that. I did some research and found some interesting things on the topic. Don’t know if anyone else has run into that. Always something new.”
Any resources, alternatives, suggestions are GREATLY appreciated.
Lana
Lana Kay Tyer, RN MSN
Gender Pronouns: she/her
Tuberculosis Nurse Consultant
Office of Communicable Disease Epidemiology
Division of Disease Control & Health Statistics
Washington State Department of Health
206-418-5581 | www.doh.wa.gov
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