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	The Pharmaceutical Journal Vol 269 No 7212 p247-249 24 August 2002	This page Reprint Photocopy
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Drugs of porcine origin

Should patients be informed?

From Ms C. A. Oxley, MRPharmS, and Dr J. F. Mayberry

At Leicester General Hospital we have experienced some problems with finding a suitable pancreatic enzyme supplement for some of our patients. Within the United Kingdom the only licensed agents are derived from porcine pancreas which presents problems for those who are vegetarian or of certain religious faiths. Although we are aware of the existence of plant-derived digestive enzymes, and indeed have used one such product in a small number of patients, there appears to be little information available on the safety and efficacy of such products. We would welcome some debate on the following issues:

• Do we inform a patient that his or her medicine is of porcine origin when we know that this will result in their refusal to take it? (Although our initial reaction is to say "yes", some patients have informed us that if they remain ignorant of the source of a product then they are able to take it.)

• Do we inform a patient of the existence of alternative plant-derived products when such products are unlicensed and information available about such products is limited?

Cath Oxley
Senior Pharmacist — Training and Development

John F. Mayberry
Consultant Gastroenterologist
University Hospitals of Leicester NHS Trust

STEPHEN LUTENER, head of professional conduct, Royal Pharmaceutical Society, replies:

The correspondents raise an interesting dilemma. In general, a pharmacist would not necessarily know whether a patient is vegetarian, or practises a religion in which the use of certain medicines may be unacceptable. In those circumstances, it would not be reasonable to expect pharmacists to research the composition of all medicines supplied, and to inform every patient.

Conversely, patients with strongly held beliefs might ask the pharmacist whether a prescribed medicine contains any ingredient from a source which may be objectionable. In these circumstances, the pharmacist would be expected to be open with the patient, and address any concerns. If an alternative product is available, which would not be objectionable, the prescription should be discussed with the prescriber, so that consideration can be given to prescribing the alternative. If this is unlicensed (or for use outside the terms of the marketing authorisation) the prescriber, pharmacist and patient would each need to be aware of the increased risks of using unlicensed preparations.

If the pharmacist knows (as opposed to suspects) that the patient holds strong religious or other views and that the product prescribed would be unacceptable, then he or she would need to assess whether to supply the medicine is in the patient's best interests. This must be considered with the prescriber, and a decision may be taken to supply an alternative licensed or unlicensed medicine. The pharmacist and doctor should ensure that the patient is aware of the nature of the medicines.

The patient described in the letter, who would be able to take the medicine if he remained ignorant of the composition of the medicine, would be unlikely to ask the pharmacist questions as to the origin. However, as patient information leaflets may set out the source of the ingredients, the patient may not be able to maintain his ignorance indefinitely.

If the pharmacist reasonably believed that the risks to the patient of supplying an unlicensed product outweighed the risks of the patient not taking any medicine, the pharmacist would have to consider not making the supply.

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