Sir, D. Sadoh (BDJ 2004, 197: 61) asked if there are any resources that address the provision of medicines to patients who are vegetarian or who have their diet restricted by cultural belief. He may find the booklet Drugs of porcine origin and clinical alternatives a useful resource.

Produced by the Medicines Partnership in March 2004, the booklet was put together in collaboration with the Muslim Council of Great Britain, a rabbinical authority and adviser to the Board of Deputies of British Jews, Clinical Leaders of Thrombosis UK and the Transcultural Nursing Association.

It includes practical advice and lists a number of resources for further information. It can be downloaded as a PDF file from the Medicines Partnership website at www.medicines-partnership.org, and is listed under 'Our Publications'. Paper copies can also be obtained free of charge from the Medicines Partnership by calling 020 7572 2474.

Apart from medicines derived directly from animal sources e.g. porcine insulin and heparins, many medicines contain excipients that are animal derived. They include gelatin, used for most capsule shells and stearic acid/stearates e.g. magnesium stearate which are used in the production of some tablets. There is a move within the pharmaceutical industry to using animal-free alternatives to gelatin and stearates. Lactose, used in many tablets, is derived from milk (usually bovine) and is acceptable to vegetarians, but not to vegans. Other products that contain animal derivatives include saliva orthana, which contains porcine mucin and glucosamine (an alternative medicine preparation used for arthritis). Many preparations are derived from the crushed exoskeletons of shellfish, while other products are synthetic. Chondroitin (an alternative medicine preparation used for arthritis) is made from shark or bovine cartilage. For all licensed medicines, the manufacturer's Summary of Product Characteristics (SmPC) lists the pharmaceutical excipients included in the product. For the majority of marketed medicines the SmPCs can be found on the Electronic Medicines Compendium (eMC) at http://emc.medicines.org.uk. Information on the animal content of medicines can also be obtained directly from the manufacturer, telephone numbers are listed in the back of the Dental Practitioners Formulary/British National Formulary (DPF/BNF).

Alternatively, local medicines information units can be contacted (see the inside cover of the DPF/BNF).

Sir, your correspondent wondered about which drugs are compatible with strict vegetarians or the various religious beliefs in our multi-cultural society. The source of the many ingredients used in the manufacture of medications is of great concern to orthodox Jews who only use animal products if the animals are acceptable to Jews and if they have been slaughtered according to Jewish law.

The manufacturing processes are investigated at great depth and continually updated. The information obtained is not only useful to orthodox Jews but to Muslims, (particular about Halal meat) vegetarians and others. This information is available in 'The Jewish Food Guide' available from www.kosher.org.uk.