Islamic reasoning and the use of prohibited medicines among Muslim patients: A qualitative study

Abstract Background: Muslim patients often avoid medicines containing ingredients prohibited by their faith (haram), such as alcohol, gelatine, or porcine derivatives. While Islamic law permits exceptions based on necessity (darura) or biotransformation (istihala), the way these principles influence medication adherence and shape patient–healthcare provider (HCP) interaction is largely underexplored. Aim: To explore how Muslims apply Islamic reasoning to medication adherence decisions involving medicines containing haram ingredients. Methods: Thirteen ethnically diverse Muslim adults were purposively sampled to participate in semi-structured interviews. A prior scoping review and mosque-based public and patient involvement (PPI) informed the interview guide. Interview data were analysed using Braun and Clarke’s Reflexive Thematic Analysis (RTA), with themes constructed inductively. Data interpretation was guided by the Necessity–Concerns Framework (NCF) and locus of control (LOC) theory. Results: Four main themes emerged: halal as worldview, motivations for consumption, minor illness or major disease, and personalised care. These themes reflected how participants perceived illness severity, the semantic framing of ingredients, and how far HCPs were viewed as trustworthy, culturally competent, and responsive to religious disclosure, all of which shaped adherence decisions. The rulings of darura and istihala were applied with flexibility in chronic or life-threatening illness. Participants commonly avoided prohibited medicines for minor conditions, instead favouring complementary therapies perceived as natural and religiously aligned. Conclusion: Islamic reasoning influenced how participants engaged with medicines deemed haram. Supporting adherence requires pharmacy practice that incorporates religious literacy and responds to concerns about transparent labelling and faith-sensitive communication. These steps will strengthen patient-centred care by aligning religious and ethical reasoning with treatment decisions, thereby fostering trust, enhancing adherence, and supporting more equitable care for Muslim patients.