ASSESSMENT OF KNOWLEDGE, ATTITUDE AND PRACTICE TOWARDS HALAL

PHARMACEUTICALS IN TUANKU MIZAN ARMED FORCES HOSPITAL

Lt Nurhazirah Bt Zulkefli

Pharmacist, Ministry of Defence

HALAL PHARMACEUTICAL FORUM, PULLMAN BANGSAR HOTEL, 29 Sept 2018

Knowledge, Attitude, and Practice Studies Related to Halal Pharmaceuticals

No. Study Title Bibliography PopulationEnrolment

PeriodNo. of

Respondent

1KAP Regarding Halal Pharmaceuticals among General Publics in Malaysia

Saleeha S. et alGeneral Public of Penang State

Sept – Oct 2012

458

2Assessment of KAP among hospital pharmacists regarding Halal Pharmaceuticals

Saleeha S. and Azmi S.

Hospital Pharmacists, Government Setting

Jan - Mar 2013

135

3KAP among doctors working in hospitals, regarding halal pharmaceuticals; A cross sectional Assessment

Saleeha S. et alHospital Doctors, Government Setting

Jan – Feb2013

243

4KAP regarding Halal Pharmaceuticals, among academicians in various universities of Malaysia

Saleeha S. et al

Academicians, Pharmacy, Medical, Dental Schools, Private and Public Universities

Nov - Dec 2012

170

5Knowledge, Attitude and Practice towards Halal Vaccine products among public in Klang district

Umi SafinazMahmud

Public in Klang District

Oct - Nov 2015

389

6Knowledge, Attitude and Practice towards Halal Pharmaceuticals among patients in HATTM

Nur Hidayah AbdRahim

Patients in HATTMApr - May

2016390

What is Knowledge, Attitude & Practice (KAP) study

▪ Knowledge means patients awareness and understanding about what halal and haram

medicine is.

▪ Attitude can be defined as patients perspectives and opinions on Halal medicine

▪ Practice refers to the ways in which they demonstrate their knowledge and attitude

Public,

Penang

Public, Klang Patients

HATTM

Hospital

Pharmacists

Hospital

Doctors

Academicians

5.5

25.2

14.44.5 6

0.6

94.5

74.8

85.695.5 94

99.4

Percentage of Knowledge towards

Halal Pharmaceuticals

Poor Good

Public,

Penang

Public, Klang Patients

HATTM

Hospital

Pharmacists

Hospital

Doctors

Academicians

1

38.6

0.5 4 2

12

99

61.4

99.5 96 98

88

Percentage of Attitudes towards

Halal PharmaceuticalsNegative Positive

Public,

Penang

Public, Klang Patients

HATTM

Hospital

Pharmacists

Hospital

Doctors

Academicians

5

47.3

67.7

1 1 0

95

52.7

32.3

99 99 100

Percentage of Perception/Practice

towards Halal Pharmaceuticals

Poor Good

Practice

on HP

IDENTIFYING HALAL AND NON-HALAL MEDICATIONS

1. Halalkah Ubat Anda, Abd Rahman ▪ Published by Crescent News, 2012

▪ Author: Abd Rahman Baco, B. Pharm (IIUM)

▪ 14 chapters explaining the contents of the suspected drug; gelatin, alcohol, pig enzymes.

▪ Included the list of medicines banned by the National Fatwa Council and the Indonesian Ulama Council.

▪ Explains the opinions of the latest scholars and fatwa issued by local religious figures

References - Books

References - Books2. Halal Index: Pig Based Pharmaceuticals. Volume 1 (2011)• Author: Prof. Dr. Zhari Ismail, Professor in Pharmaceutical Chemistry,

USM. Chairman for drafting the MS2424 (Malaysian Standards for Halal Pharmaceutical Guidelines

• Main information derived from the Halal Pharmacopeiea Project which involves analyzing and classifying pharmaceuticals into halal categories from current pharmacopeias (BP, USP, EP, ChP, and JP) to establish a comprehensive halal pharmaceutical database.

• Identified 52 porcine based ingredients with their specific anatomy.

3. Ubat Daripada Sumber Babi dan PilihanAlternatif (2010)▪ Published by Halal Science Solution, 2010

▪ Author: Abd Rahman Baco, B. Pharm (IIUM)

▪ Information derived from authors experiences, newspapers, websites

▪ Identified 92 porcine based ingredients.

Halal Pharmaceutics and Development of Halal FORSIHAT

▪ Background: Concerning the issues of halal/haram/syubhah that might belisted in the “Formulari Ubat – Ubatan Perkhidmatan Kesihatan AngkatanTentera Malaysia (FORSIHAT)”.

▪ Purpose: To determine pig derived pharmaceutical compounds available inFORSIHAT.

▪ Methods: The API listed in the formulary were cross referenced with fivesources of halal/haram databases:

▪ Halal Index

▪ Ubat Daripada Sumber Babi dan Pilihan Alternatif

▪ University Malaya Medical Centre (UMMC) Formulary

▪ Halal/Haram Book (in progress by Prof Noorizan A. Aziz, UITM)

▪ Assessment of Halal Medicines in HAT Tuanku Mizan from CUCMS studies.

▪ The analysis then categorized into RED, GREY, GREEN lists

1. Halal FORSIHAT Apps• 7 items are red list• 75 Items are grey list

References - Apps

Bil Generic name Brand name Source

1. GASTROINTESTINAL & HEPATOBILIARY SYSTEM

1 Loperamide Imodium Gelatine (bone, connective tissue, organs)

2Pancreatic Enzymes & Vitamins

Enzyplex Pancrease of the hog, ox

3 Pancreatin Creon 10,000 Pancrease of the hog, ox

2. CARDIOVASCULAR & HEMATOPOITIC SYSTEM

4 Enoxaparin Sodium Clexane Porcine (intestinal mucosa)

5 Nadroparin Calcium Fraxiparine Porcine (intestinal mucosa)

6 Tinzaparin Innohep 10,000 iu Enzyme from porcine mucosal heparin

3. HORMONES

7Recombinant Human Somatropin

Genotropin Porcine (anterior pituitary gland)

RED LIST

Purchased 2016:64 bot of 100’s (RM10,752.00)

Purchased 2016:40mg/0.4ml – 292 box of 2’s (RM11,586.56)60mg/0.6ml – 305 box (RM14,823.00)

GREY LIST

19

15

12

9

53 3 2 2 1 1 1 1 1

Grey List by Pharmacological Group

bilangan item (n = 75)

GREY LISTPharmacology Source of Ingredient

Allergy & Immune System – Antivenoms Animal non-porcine

Cardiovascular - Recombinant

Coagulation Factor VIIA (Novoseven)Human venous plasma

Endocrine & Metabolic System –

ThyroxineSynthetic, Animal non-porcine

Oncology – Bevacizumab Chinese hamster ovary

Contraceptive Agents -

Levonorgesterel/Ethinylestradiol (Loette)Synthetic, Animal non-porcine

Genitourinary System - Chorionic

Gonadotrophin Human

Human gonadotropins, Chinese

hamster ovary

Antiinfectives - Peginterferon Alpha 2-ArDNA technology of cloned human

leucocyte

Respiratory – Beractant Bovine

Eye - Ranibizumab (Lucentis) Animal non-porcine

IV & Other Sterile Solution -

Human Albumin

Fraction of human blood/plasma

serum/placenta

References - Apps2. UMMC On-line Formulary

• 119 items are of animal origins

• Only 6 are porcine based

References - Apps

3. MyJAKIM apps• Useful info for the public to ascertain

halal status• Just type brand name• ie. Uphamol (acetominophen

/paracetamol) by CCM

References - Apps

e-Fatwa

www.e-fatwa.gov.my/admin/

The Use of Ethanol and Issues

▪ Highly advisable to follow the limit of 0.5% alcohol based on similarity of functionin both food and pharmaceuticals.

▪ The use of ethanol in pharmaceutical syrup and suspension dosage form shouldnot be allowed due to two ethical issues:

▪ Syrup or suspension dosage form is usually formulated for infants/children.Hence, the percentage allowed should be minimal.

▪ It is for consumption and can be misused regardless of its ability to intoxicateor not

Muzakarah Khas

JK Fatwa Majlis

Kebangsaan Bagi

Hal Ehwal Ugama

Islam pada:

14 – 16 Julai 2011

Source: Kausar Ahmad, Manufacturing of Halal Pharmaceuticals, 2015

Take Home Message

▪ We need more R&D in Halal Pharmaceutical

▪ Good knowledge and attitude will lead to patients having good

practice in finding halal alternatives.

▪ Educate, educate, educate patients that they have an

informed right to have halal alternatives medicine