Enoxaparin (trade name: Clexane) is a low molecular weight heparin (LMWH) that does not need an activated partial thromboplastin time (aPPT) monitoring and able to deliver predictable therapeutic effect. According to Merli and Groce (2010), FDA has approved Enoxaparin injection for vein thromboembolism (VTE) prophylaxis, treatments of deep vein thrombosis (DVT) and acute
coronary syndromes (ACS).

Undoubtedly, Enoxaparin has a potential and many advantages as an anticoagulant agent. However, the former is a porcine-based drug which derived from swine’s intestine. In Islam, the questions of permissible (halal) and forbidden (haram) constitute as one of the core principles and philosophy of Islamic Law.

Due to this, it is not surprising that majority of the academic discourse on halal and haram concentrates on foods and beverages. Nevertheless, the issue has been recently extrapolated to medicinal / pharmaceutical products as well and attracts serious attention among patients, practitioners and scholars.

Muslims are expected to keep their bodies healthy physically and mentally in order to perform their obligations toward Allah SWT. When inflicted with a disease or illness, they are required to seek for treatment and its cure. Referring to one of the hadiths, the Prophet Muhammad SAW has urged his followers :

“Ask Allah for forgiveness and health, for after being granted certainty, one is given nothing better than health”. (Related in Tirmidhi)

Thus, the use of medicine for curing illnesses and diseases is generally legalized and recognized in Islam. Allah SWT has mentioned in the Quran :

“Allah has only forbidden you dead meat and blood and the flesh of swine and that on which any other name has been invoked besides that of Allah…but if one is forced by necessity, without wilful disobedience nor transgressing due limits, then is he guiltless. For Allah is Oftforgiving, Most Merciful” (Al-Baqarah: 173).

These generally ascribed principles assert that these substances such as intoxicants (al-khamr), swine and impure things could not be consumed at all costs, yet there are certain situations that heed the need of using substances such as in the case of emergency or out of the extreme necessity for survival (darurah). In explaining this, the jurists have roused debates and discussions concerning the meaning of the term and its application in real life situations.

On top of that, Enoxaparin injection comes in prefilled syringe of several different doses i.e. 20mg, 40mg and 60mg which is administered by subcutaneous injection. Due to this simplicity of administration, it has an advantage to reduce hospital stay of patients who are indicated for Enoxaparin injection. Patients could opt to have their injection at home as outpatient basis provided that they have been counselled for injection technique by the pharmacist prior to discharge.

Thus, in order to be in-line with the concept of shariah-compliance hospital; the Pharmacy Department is in the process of implementation of written informed- consent in the case of non-halal pharmaceuticals use in this hospital. This is very much consistent with the mission and vision of SASMEC @IIUM to be a leading centre of excellence and innovation for healthcare education, training and research. The implementation shall also serves as a written document of consent to reduce risk of medico legal cases as well as a medium of education to patient and advocates the right to refuse a treatment by a patient (except in emergency situations).