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Inert Medication Ingredients Causing Nonadherence Due to Religious Beliefs

Assistant Professor of Psychiatry and Associate Director of Residency Training, Creighton University/University of Nebraska; Staff Psychiatrist, Substance Abuse Treatment Center, Omaha Veterans Affairs Medical Center, Omaha, NE

Mohammed Shakeel Ahmed, MD

PGY4 Psychiatry Resident, Creighton University/University of Nebraska

Farhan Majeed, MD

PGY2 Internal Medicine Resident, University of Nebraska

Frederick Petty, PhD MD

Professor of Psychiatry and Vice Chairman, Department of Psychiatry, Creighton University; Associate Chief of Staff and Chief of Research, Department of Mental and Health and Behavior Science, Omaha VA Medical Center

Reprints: S Pirzada Sattar MD, Substance Abuse Treatment Center, Omaha VA Medical Center, 4101 Woolworth Ave., #116A, Omaha, NE 68105-1850, fax 402/449-0677, syed.sattar{at}med.va.gov

OBJECTIVE: To report 4 cases of medication nonadherence due to presence of inert ingredients forbidden by the patients' religion.

CASE SUMMARIES: We describe 4 cases in which religious concerns about prescribed medications' inert components led to discontinuation of these medications. These inert components are gelatin and stearic acid, which might be derived from pork or beef products. In these 4 cases, patients of Muslim, Orthodox Christian, and Seventh Day Adventist faiths, who consider it against their religion to consume pork products, stopped their medications on discovering this possibility. This led to relapse of their illnesses.

DISCUSSION: These cases demonstrate that, for some patients, inert medication components that are forbidden by their religion may lead to discontinuation of medications. This could lead to relapse of symptoms and might even lead to hospitalization. Therefore, it is important for prescribers to inform patients of this possibility when treating patients whose religious background might conflict with these inert medication components.

CONCLUSIONS: Patients with religion prohibitions against consumption of pork and/or beef products might stop their medications when prescribed those with pork- and beef-derived gelatin and/or stearic acid. Prescribers should discuss this possibility with their patients, perhaps as part of informed consent.

Key Words: culture, ethics, gelatin, informed consent, nonadherence, noncompliance, religion, stearic acid

Published Online, February 6, 2004. www.theannals.com, DOI 10.1345/aph.1D324

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