Medication with Unlawful Ingredients

 

Bismihi Ta’ala

Introduction

There are many scenarios in which a Muslim patient may be advised to take medication that is comprised of unlawful substances (“haram medication”).  Is a Muslim allowed to use medication that would be considered unlawful to consume or take benefit of by Islamic law?  If so, in what circumstances?  This article discusses the issue of haram medication and its related rulings based on principles that scholars have derived from the Quran and Sunnah, and provides examples of how these principles can be applied to modern medications and treatments. 

Ahadith that Discuss Haram Medication

There are numerous ahadith that discuss the topic of medicine, and many of these ahadith discuss the use of haram medication.  Some ahadith mention examples of things that are normally prohibited to consume being used as medicine, pointing towards the permissibility of using haram medication:

Anas (r.a.) said, “Some people of `Ukl or `Uraina tribe came to Medina and its climate did not suit them. So the Prophet (ﷺ) ordered them to go to the herd of (Milch) camels and to drink their milk and urine (as a medicine). (Bukhari)

عن أنس بن مالك رضي الله عنه قال: قدم ناس من عُكْلٍ أو عُرَيْنَةَ، فاجتوَوُوا المدينة، فأمرهم النبي -صلى الله عليه وسلم- بلِقَاحٍ، وأن يشربوا من أبوالها وألبانها

Anas (r.a.) states, “The Prophet (ﷺ) allowed Az-Zubair and `Abdur-Rahman to wear silk because they were suffering from an itch.” (Bukhari)

عَنْ أَنَسٍ، قَالَ رَخَّصَ النَّبِيُّ صلى الله عليه وسلم لِلزُّبَيْرِ وَعَبْدِ الرَّحْمَنِ فِي لُبْسِ الْحَرِيرِ لِحِكَّةٍ بِهِمَا‏.‏

‘Urfajah bin As’ad (r.a.) said, “My nose was severed on the Day of Al-Kulab during Jahiliyyah. So I got a nose of silver which caused an infection for me, so the Messenger of Allah (ﷺ) ordered me to get a node made of gold.” (Tirmidhi)

عَنْ عَرْفَجَةَ بْنِ أَسْعَدَ، قَالَ أُصِيبَ أَنْفِي يَوْمَ الْكُلاَبِ فِي الْجَاهِلِيَّةِ فَاتَّخَذْتُ أَنْفًا مِنْ وَرِقٍ فَأَنْتَنَ عَلَىَّ فَأَمَرَنِي رَسُولُ اللَّهِ صلى الله عليه وسلم أَنْ أَتَّخِذَ أَنْفًا مِنْ ذَهَبٍ ‏.

‏Normally, drinking urine is prohibited, just as wearing silk or gold is prohibited for men. Their use for medicinal purposes in the above ahadith indicate that haram medication could be permissible to use. But there there are other ahadith that mention the impermissibility of using haram medication:

Abu ad-Darda (r.a.) said, “The Prophet (ﷺ) said: Allah has sent down both the disease and the cure, and He has appointed a cure for every disease, so treat yourselves medically, but use nothing unlawful.” (Abu Dawud)

عَنْ أَبِي الدَّرْدَاءِ، قَالَ قَالَ رَسُولُ اللَّهِ صلى الله عليه وسلم ‏ “‏ إِنَّ اللَّهَ أَنْزَلَ الدَّاءَ وَالدَّوَاءَ وَجَعَلَ لِكُلِّ دَاءٍ دَوَاءً فَتَدَاوَوْا وَلاَ تَدَاوَوْا بِحَرَامٍ ‏

Abu Hurayrah (r.a) said, “The Messenger of Allah (ﷺ) prohibited unclean medicine.” (Abu Dawud)

عَنْ أَبِي هُرَيْرَةَ، قَالَ نَهَى رَسُولُ اللَّهِ صلى الله عليه وسلم عَنِ الدَّوَاءِ الْخَبِيثِ

Tariq ibn Suwayd or Suwayd ibn Tariq (r.a) asked the Prophet (ﷺ) about wine, but he forbade it. He again asked him, but he forbade him. He said to him: Prophet of Allah, it is a medicine. The Prophet (ﷺ) said: No it is a disease.” (Abu Dawud)

عَنْ عَلْقَمَةَ بْنِ وَائِلٍ، عَنْ أَبِيهِ، ذَكَرَ طَارِقَ بْنَ سُوَيْدٍ أَوْ سُوَيْدَ بْنَ طَارِقٍ سَأَلَ النَّبِيَّ صلى الله عليه وسلم عَنِ الْخَمْرِ فَنَهَاهُ ثُمَّ سَأَلَهُ فَنَهَاهُ فَقَالَ لَهُ يَا نَبِيَّ اللَّهِ إِنَّهَا دَوَاءٌ ‏.‏ قَالَ النَّبِيُّ صلى الله عليه وسلم ‏ “‏ لاَ وَلَكِنَّهَا دَاءٌ ‏”‏ ‏.‏

Umm Salamah said, “The Prophet (ﷺ) said: “Verily, Allah has not made your cure in that which he has forbidden for you” (ibn Hibban)

عن أم سلمة، أن النبي صلى الله عليه وسلم قال: ” إن الله لم يجعل شفاءكم فيما حرم عليكم

The above ahadith seem to point towards different rulings regarding the use of haram medications.  Based on this, some scholars state that it is impermissible to use haram medication, while others state that it is permissible in certain situations.  In addition to these ahadith, the scholars have also applied the following verse of the Quran to the use of haram medication:

إِنَّمَا حَرَّمَ عَلَيْكُمُ الْمَيْتَةَ وَالدَّمَ وَلَحْمَ الْخِنزِيرِ وَمَا أُهِلَّ بِهِ لِغَيْرِ اللّهِ فَمَنِ اضْطُرَّ غَيْرَ بَاغٍ وَلاَ عَادٍ فَلا إِثْمَ عَلَيْهِ إِنَّ اللّهَ غَفُورٌ رَّحِيم

“He has only prohibited for you carrion, blood, the flesh of swine and that upon which a name of someone other than “Allah” has been invoked. Then, whoever is compelled by necessity, neither seeking pleasure nor transgressing, there is no sin on him. Verily, Allah is Most-Forgiving, Very-Merciful” (Surah al-Baqarah, 173)

This verse of the Quran explains that in situations of necessity, a person would not be sinful for consuming that which is normally prohibited.  Scholars of tafsir explain that this pertains to cases of extreme hunger or thirst, when there is a danger to one’s life. In this case, he may consume that which is unlawful to the extent of the need, and only to that extent.  Scholars have further explained that using haram medicine, either externally or internally, can fall under this category and can be used when necessity exists.  Just as with thirst and hunger, this would apply when one’s life would be in danger without its use as medicine, and a lawful alternative is not available.  And just as with haram food in the case of extreme hunger, it should only be used to the extent of the need[1].

Rulings Pertaining to the Use of Haram Medication

Scholars that consider the use of haram medications to be permissible in certain situations explain that the ahadith that indicate the impermissibility of using haram medication refer to cases in which a halal alternative is available.  In addition, they can refer to cases in which there is doubt that the haram medication is a cure for the illness[2].  

For example, scholars explain that the hadith mentioned above, “verily, Allah has not made your cure in that which he has made forbidden for you”, pertains to cases in which the haram medicine is not actually a cure for the illness. As for things in which there is a cure, then there is no harm in it, i.e. it would not be forbidden for you in that case.  This is similar to the case of drinking alcohol for the thirsty person, as it is considered permissible for him to drink the alcohol out of necessity (to the extent needed for survival).[3]

This hadith can also pertain to using haram medicine when one is aware of a halal alternative, because in that case one could suffice with that which is permissible.  However, when there is no alternative cure from halal medicine, it can be said that the impermissibility of using the haram medicine has been removed by the presence of necessity. So therefore, one would not actually be seeking a cure with something that is haram, because the previously haram medicine would actually be permissible in such a situation[4]

Based on this understanding, the ahadith that indicate the permissibility of using haram medication refer to cases in which a halal alternative is not available, and in which there is no doubt that the haram medication is a cure for the illness.  If these conditions have been met, then the use of the haram medication would be permissible.  Amongst Hanafi scholars, this is the relied upon opinion, and the fatwa has been given on this ruling[5]

Regarding the condition of having no doubt that the medication is a cure for the particular illness, this does not mean that the medication has to be effective 100% of the time.  It means that there is no doubt that the haram medication is an appropriate treatment for the illness, and can be expected to bring a cure.  For example, a doctor may prescribe an antibiotic for a bacterial infection, but there is a chance that the bacteria that is causing the infection is resistant to the antibiotic, and therefore the infection would not be cured by that antibiotic.  Similarly, a doctor may prescribe a medication for the treatment of hypertension, but the patient’s blood pressure may remain elevated in certain cases.  In both examples, there was no doubt that the medication that was prescribed was an appropriate treatment for the illness. If  the medication was haram but no halal alternative was available, it would still have been considered permissible for the patient to use. 

In centuries-old books of Islamic law, scholars have mentioned various examples of haram medicine including wine, urine, blood, carrion and a woman’s breast milk.  Some other medications were considered to be disliked (makruh), such as donkey’s milk, donkey’s meat, cow’s urine, horse’s meat, and pigeon droppings.[6]   Based on the principles discussed above, the scholars have explained that the haram medications in these examples would only be permissible to use when for a Muslim patient when he is sure that the haram medication is a cure for his disease and there is no halal alternative.  The scholars mention that if an experienced doctor tells him to take this medication, then it satisfies the condition of having certainty that a cure lies in the medication[7].

The haram medications mentioned in these texts may be centuries-old, but modern medicine often uses medications and treatments from similar prohibited sources.  For example, medications may be derived from animals (carrion), pigs, human blood, human body parts, and alcohol.  Therefore, the same principles that were applied to the haram medications mentioned in these texts can be applied to the many haram medications and treatments that exist today.   Some examples follow:

Medications in Capsule Form

Doctors may prescribe medication that is contained in a capsule. Capsules commonly contain gelatin, which scholars consider impermissible to consume unless it is from halal sources (such as fish or halal animals).  Based on this, most medications in capsule form would be considered haram consume. Therefore, based on the principles discussed above, when a Muslim patient is prescribed a medication in capsule form, the following needs to be considered:

  • Is he certain that this medicine can provide a cure? 
  • Is there a halal alternative available?

If he has been prescribed the medication by a trained and experienced doctor, then we can consider the first condition to have been met.  However, regarding the second condition, he may need to ask his doctor if there are alternative treatments that do not come in capsule form.  If the doctor advises that there are alternatives, then it would not be permissible for the patient to consume the capsule if it is from haram sources (such as animal-derived gelatin).

One common scenario would be the use of antibiotics to treat an infection.  For example, a patient with a throat infection may be prescribed the antibiotic clindamycin, which comes in capsule form[8].  However, in most cases the same infection can be treated with an antibiotic that comes in tablet form, such as amoxicillin-clavulanate.   There are exceptions, such as cases in which the bacteria causing the infection is known to be resistant to a particular type of antibiotic.  Therefore, although the patient cannot decide to switch the antibiotic on his own, it is necessary for him to inform the doctor that he needs to avoid medications in capsule form unless there is no acceptable alternative. 

For some medications, both capsule and tablet forms exist.  The commonly used antibiotic doxycycline is an example of this[9].  The capsule form contains gelatin, so if the tablet form is equally effective for treating a particular infection, then it would not be permissible for the Muslim patient to use the capsule form. On the other hand, certain medications in capsule form, such as some extended-release medications, may act differently in their tablet forms, so it is necessary for the Muslim patient to be aware of this and to discuss treatment options with his doctor prior to taking the capsule.  

If a Muslim ends up consuming the capsule medication when a halal alternative in tablet form was available, then this would not satisfy the requirements mentioned above for being allowed to consume a medication with a haram ingredient (the gelatin in the capsule in this case). 

Meningitis Vaccines with Pork Ingredients

The administration of meningitis vaccines are required in numerous situations, including for those who plan to perform hajj or umrah.  Most formulations of this vaccine contain pork-derived ingredients.  Vaccines would not even fall under the discussion of the use of haram medications discussed above, because they are not a cure for a disease, but rather a tool to prevent future infection.  As mentioned above, a Muslim may use a medication that contains a haram ingredient when he is certain that it contains a cure for a disease, and no halal alternative is available.  In this case, he is not infected by meningitis, so no cure is even needed. Therefore, if the vaccine contains a haram ingredient, then it cannot be used unless necessary.

Vaccines such as those used for preventing meningitis may be necessary in certain cases due to legal requirements, such as travel or when a student is living in a college dormitory in the USA.  In these situations, scholars may state that it is permissible to use the vaccines with haram ingredients if no halal alternatives are available, so a Muslim who is required to receive such a vaccine should inquire about its permissibility from a scholar.  But if a halal alternative does exist, then the haram vaccine would no longer be necessary to use. For example, in the case of meningitis vaccines, one of the more recent formulations, manufactured under the brand-name Menveo, does not contain pork derived ingredients[10].  Therefore, a Muslim who is required to receive a meningitis vaccine should discuss the availability of non-porcine vaccines such as this one.  If the pork-free alternative is available for his use, then it would not be permissible to use the vaccines that contain pork.

Mouthwash Containing Alcohol

The consumption of khamr (alcohol derived from grapes or dates) is considered haram , even in miniscule amounts[11].  However, even for other types of alcohol such as ethanol, it is considered haram to consume drinks that are intoxicating.  As stated above, alcohol can be used in medicine when certain conditions are met, such as being advised to use that medicine by a doctor when no alternative exists. 

For dental health, people often purchase mouthwash, and many formulations contain alcohol.  Some may contain miniscule amounts of synthetic alcohol and are not intoxicating, and are therefore considered permissible to use by scholars.  However, others contain large amounts of ethanol, up to 26.9%, more than 5 times the ethanol concentration in beer.  Consumption of even a small amount of such a mouthwash could cause intoxication.[12].  Therefore, this would be classified as a medication that is haram to use. 

If a Muslim buys mouthwash over-the-counter at his own direction just for freshening his breath or cleaning his teeth without being instructed to do so by a doctor or dentist, then it would not be permissible to use a mouthwash that could be intoxicating.  Many alcohol-free alternatives would be available for him to purchase.  On the other hand, if for example this Muslim has an oral or dental disease and was prescribed a mouthwash that contains alcohol, then the same conditions discussed above would need to be met for him to be allowed to use it.  Is its use necessary for the cure of his disease? Is there a halal alternative available?  Does it contain a potentially intoxicating level of alcohol? Prior to using this mouthwash that has been prescribed, he should discuss this with the prescribing doctor or dentist.  If there are halal alternatives available for the treatment of his condition, then this mouthwash would not be considered permissible to use as medicine if it is potentially intoxicating. 

Blood Transfusions

According to the shariah, blood is considered to be impure once it exits the body. Therefore, scholars consider it to be in the same category as other types of impure substances in being considered impermissible to use for medicinal purposes[13].   Just as with other types of haram medication, blood transfusions can only be used when a doctor states that there is a cure in it, and no permissible alternative is available.  Examples include cases of severe anemia with a dangerously low hemoglobin level and rapid blood loss due to bleeding[14].  However, in many cases, alternative treatments that do not require blood transfusion can be used, such as iron supplementation in cases of iron deficiency, and medications that stimulate blood cell production in the bone marrow, such as epoetin alfa[15].  Therefore, when a blood transfusion is being considered for a Muslim patient, it would not be considered permissible if the prescribing doctor could expect a cure from one of these alternative treatments.   As in the examples mentioned above, the Muslim patient should ask his doctor if other effective treatments are available before proceeding with the transfusion.

A Further Point of Research

It should be noted that certain materials undergo a complete chemical metamorphosis during the manufacturing process of modern medications.  Scholars explain that when this occurs, the material would be lawful to consume even if it was originally from an haram source, due to the complete transformation that has occurred[16].  Therefore, this could make some medications that contain ingredients sourced from haram sources halal to consume.  However, this requires research into the manufacturing process of the particular medication and cannot be assumed to occur without verification and investigation.   Most contemporary scholars do not consider the examples of gelatin and porcine vaccines mentioned above to fall under this category. 

Conclusion

According to the shariah, haram medication can only be used when certain conditions are met.  A Muslim patient can only use haram medication, both internally or externally, when instructed to do so by an experienced doctor (thereby making him certain that a cure can be expected from the medication), and when an alternative halal medication is not available.  Therefore, Muslim patients need to be aware that haram materials need to be avoided in medications just as haram ingredients need to avoided in food.  It is advised that they seek treatment from an experienced Muslim doctor who is aware of these issues when possible, and if it is not possible, then they must discuss the availability of halal treatment options prior to taking any haram medication. 

And Allah knows best

Mufti Adil Farooki, MD


[1] Maariful Quran, English Translation by Prof. Muhammad Hasan Askari & Prof. Muhammad Shamim (1/436)

[2]  البحر الرائق شرح كنز الدقائق ومنحة الخالق وتكملة الطوري (1/ 122)

[3] البحر الرائق شرح كنز الدقائق ومنحة الخالق وتكملة الطوري (1/ 122)

[4]  الدر المختار وحاشية ابن عابدين (رد المحتار) – دار الفكر-بيروت  (5/ 228)

[5]  الدر المختار وحاشية ابن عابدين (رد المحتار) – دار الفكر-بيروت  (1/210)

[6] الفتاوى الهندية (5/355)

[7] الفتاوى الهندية (5/355)

[8] Gerber MA, Baltimore RS, Eaton CB, et al. Circulation 2009; 119:1541.

[9] https://www.drugs.com/doxycycline.html

[10] https://gsksource.com/pharma/content/dam/GlaxoSmithKline/US/en/Prescribing_Information/Menveo/pdf/MENVEO.PDF

[11](1/204) مختصر القدوري

[12] Shulman, Pediatric Dentistry – 19:6, 199

[13](43/ 484) الفتاوى الهندية

[14] Wang JK, Klein HG. Vox Sang 2010; 98:2.

[15] Rogers DM, Crookston KP. Transfusion 2006; 46:1471.

[16] البرهاني في الفقه النعماني (1/ 206)