Harrogate, TN—If asked which common medications include animal byproducts, would most pharmacists be able to provide an answer? With religious restrictions as well as increasing numbers of vegans, that is becoming a more important issue for many patients.

An article in the Journal of Osteopathic Medicine discusses the issue, pointing out that regularly prescribed medications, including blood thinners and hormones, are often derived from animal byproducts but that patients usually aren’t informed.

“Patients deserve to know what their medications are made of, yet this information is rarely shared,” said coauthor Sara Reed, student doctor at Lincoln Memorial University (LMU) DeBusk College of Osteopathic Medicine in Harrogate, Tennessee. “Putting the patient first means communicating with them about the medicine recommended for their care, and in some cases, prescribing an alternative option.”

The review points out that heparinoids are a class of medication primarily derived from pigs. The drugs are routinely used as a blood thinners to prevent blood clots and are given in many settings, including following surgery, a heart attack, or to prevent the further development of clots. In addition, conjugated estrogens, which are used to treat moderate-to-severe hot flashes and other symptoms of menopause, are equine-derived hormones.

“Generally, patients who are prescribed various hormone treatments may want to consult their physician regarding the contents,” said lead author Mary Beth Babos, PharmD, professor of pharmacology at LMU. “For example, there are no completely animal-free oral thyroid hormones on the market.”

No formal recommendations on dealing with those concerns exist in the United States, but other countries have formal guidelines—developed in 2004 in the United Kingdom and, in 2007 and updated in 2019, in Australia, according to the authors.

To reach their conclusions, the study team performed a systematic search in the PubMed, CINAHL, Cochrane, and ProQuest databases using combinations of the following terms: medication selection, medication, adherence, pharmaceutical preparations, religion and medicine, religion, animal, dietary, porcine, and bovine. Included were studies that reported using surveys or questionnaires to examine patient, physician, or religious-leader perspective on animal-derived medications published in English between 1990 and 2020.

The authors identified eight studies meeting the described criteria and came up with the following information:
• Jewish and Muslim leaders agree that the use of products derived from pigs—normally prohibited by both religions—are acceptable only when needed to protect human life.
• The Hindu Council of Australia finds bovine products, including medications derived from cows, unacceptable.
• Sikh leaders and leaders of the Hindu Vaishnav sect object to the use of medication or surgical dressing derived from animal sources, which is waived in emergency situations or in routine treatment where no alternative exists.
• Many Buddhists of the Theravada sect and Christians of the Seventh Day Adventist sect who practice vegetarianism as part of their faith may individually reject animal-derived medical products.
• Leaders of the Jehovah’s Witness sect emphasized that adherents to this faith would reject blood-derived products.

“Knowledge of animal-derived ingredients may help open conversations with patients around spiritual history and cultural competency, particularly for those patients belonging to religious sects with doctrines that define appropriate use of human- or animal-derived products,” the authors conclude. “Further formal study is needed to explore more fully the extent to which religious beliefs may impact selection of animal- or human-derived medications. Guidelines developed from this knowledge may aid in identifying individual patients with whom the discussion may be particularly relevant. More studies are needed to quantify and qualify beliefs regarding animal-derived medication constituents.”

“In the absence of governmental guidance, we hope this research will help physicians and prescribers start the conversation with patients about whether they accept animal-derived products,” Reed added. “Ultimately, it is the patient who should determine if a medication is appropriate for their lifestyle.”

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