Medicines/pharmaceuticals of animal origin

Medicines/pharmaceuticals of animal origin - This guideline provides

information for all clinical staff within Hospital and Health Services (HHS) on

best practice for avoidance of issues related to animal products.

Medicines/pharmaceuticals

of animal origin

V3.0 November 2020

Medicines/pharmaceuticals of animal origin - V3.0 November 2020 Page 2

Medicines/pharmaceuticals of animal origin - V3.0 November 2020

Published by the State of Queensland (Queensland Health), November 2020

This document is licensed under a Creative

Commons Attribution 3.0 Australia licence.

To view a copy of this licence, visit creativecommons.org/licenses/by/3.0/au

You are free to copy, communicate and adapt the work, as long as you attribute the State of Queensland

(Queensland Health).

For more information contact:

Medication Services Queensland, Queensland Health, GPO Box 48, Brisbane QLD 4001,

email InfoMSQ@health.qld.gov.au

An electronic version of this document is available at

https://www.health.qld.gov.au/__data/assets/pdf_file/0024/147507/qh-gdl-954.pdf

Disclaimer:

The content presented in this publication is distributed by the Queensland Government as

an information source only. The State of Queensland makes no statements, representations

or warranties about the accuracy, completeness or reliability of any information contained

in this publication. The State of Queensland disclaims all responsibility and all liability

(including without limitation for liability in negligence) for all expenses, losses, damages

and costs you might incur as a result of the information being inaccurate or incomplete in

any way, and for any reason reliance was placed on such information.

Medicines/pharmaceuticals of animal origin - V3.0 November 2020 Page 3

Table of Contents

1 Purpose 4

2 Scope 4

3 Background 4

4 Religious restrictions 5

4.1 Organisations consulted: 7

5 Resources 7

6 Appendices 9

Appendix A - Porcine (Pig) products 9

Appendix B - Bovine (Cow) products 11

Bovine – Manufacture includes exposure to bovine materials “Bovine-Indirect 14

Appendix C Chinese Hamster Ovary (CHO) cells 17

Appendix D - Murine (mouse) 21

Appendix E - Equine (Horse) 25

Appendix F - Egg/Chicken 26

Appendix G – Other Animals 29

Appendix H - Excipients that may be of animal origin 31

7 References 32

8 Approval 33

9 Version Control 33

Medicines/pharmaceuticals of animal origin - V3.0 November 2020 Page 4

1 Purpose

This guideline provides information for clinicians to assist patients wishing to avoid animal

product, to make informed decisions about their treatment/care.

2 Scope

People with food allergies or intolerances, or who want to avoid animal products for

religious, cultural or secular reasons may want to know about the origin/source of drugs and

excipients contained within their medicines, to enable them to make a fully informed

decision about their treatment. This wish is supported by the Australian Charter of

Healthcare Rights which states that ‘patients have a right to have their culture, identity,

beliefs and choices recognised and respected’. This document provides information for

clinicians to assist patients in making this choice.

This guideline provides information for all clinicians involved in the medicines management

cycle within Hospital and Health Services (HHS). While the information contained in the

tables of products in the appendices is compiled from the best information available, it

should not be regarded as fully comprehensive. Information on enteral and infant feeds (and

many herbal and complimentary medicines) is not included in this document. Please refer to

a dietitian for advice on enteral/infant feed composition.

3 Background

Person-centred care is the gold standard approach to healthcare delivery and has been

shown to improve the safety and quality of health care, improve patient outcomes and

experience, and improve the performance of health service organisations

. For this reason,

healthcare professionals must take into consideration patients’ patients’ religious beliefs

and lifestyles when prescribing and administering medicines.

Many different medicines and vaccines, or specific formulations of a medicine such as

tablets, capsules, creams or mixtures contain animal products or are animal derived. For

example, gelatin is a partially hydrolysed collagen which is usually bovine (beef) or porcine

(pig) in origin. Gelatin is used in making capsule shells and is one of many types of

stabilisers added to pharmaceutical products such as vaccines.

Heparin, an injectable

anticoagulant, is prepared from a porcine source. Further examples of pharmaceutical

products known to be of animal origin are listed in the appendices

Several of the world’s most prominent religions have objected to the use of certain animal-

derived products, including Muslim, Hindu, Christian, Jewish and Buddhist faiths (see table

1). A growing number of individuals are also increasingly restricting their consumption and

use of animal-derived products for ethical reasons such as animal welfare and objections to

the intentional killing of animals, environmental concerns and perceived health benefits,

However, neither religious nor secular groups are homogeneous in their views on the use of

Medicines/pharmaceuticals of animal origin - V3.0 November 2020 Page 5

animal-derived products used in their care. Consequently, there is considerable diversity of

opinion, and membership of a particular group does not necessarily dictate an individual’s

convictions

. However, informing patients about the origins of their proposed medication (if

animal derived and no suitable synthetic alterative exists) will assist them in making

informed decisions regarding their treatment.

There may be provisions within various

religious groups to provide some form of dispensation, depending on the nature of the need

for treatment.

NB All medicines must undergo testing in non-human animals before they can proceed to testing in

humans in order to gain a product license

4 Religious restrictions

Table 1 Religious restrictions

Religion

Countries where widely

practiced (relevant to

Queensland)

Restrictions

Buddhism

Tibet, Bhutan, India, Nepal, Sri

Lanka, Burma, Thailand, Laos,

Cambodia, Malaysia, Vietnam, China,

Bangladesh, Korea, Japan,

Singapore, parts of Russia.

For some vegetarian Buddhists - all

animal products prohibited

however, no fixed rules.

Hinduism

India, Nepal, Bangladesh, Indonesia,

Pakistan, Sri Lanka, Philippines, Fiji,

UK, Mauritius, Bhutan, South Africa,

Burma, Singapore

For majority who are vegetarian –

all animal products including egg

prohibited

For those who are not vegetarian,

restrictions still include bovine*

and porcine products

Islam

Indonesia, India, Pakistan,

Bangladesh, Egypt, Turkey, Iran,

Nigeria, Ethiopia, Afghanistan,

Sudan, Iraq, Malaysia, Tanzania,

Somalia, Cote d’Ivoire, Congo,

Philippines, Sierra Leone, Thailand,

Eritrea, Lebanon

Porcine products prohibited

All animal products not killed in

the prescribed ritualistic way

(halal) prohibited

Products containing alcohol

prohibited

Please note gelatin is

contentious**

Medicines/pharmaceuticals of animal origin - V3.0 November 2020 Page 6

Religion

Countries where widely

practiced (relevant to

Queensland)

Restrictions

Jehovah’s

witnesses

A 24 hours a day

service for

clinicians treating

Jehovah’s

Witnesses is

available. The

number can be

found via the

‘Contacts’ Button

on their site

Australia, USA, Mexico, Brazil and

many other countries (240 in total)

Abstain from blood products e.g.

blood transfusions.

[The use of fractions derived from the

primary components of blood is not

absolutely prohibited see – religious and

ethical position medical therapy]

Queensland Blood Management

provide information on consent

and refusal see: consent-refusal

Many HHSs have procedures for

refusal of blood products.

Judaism

USA, Israel, France, Canada, UK,

Russia, Argentina, Ukraine, Brazil

and South Africa

All porcine and shellfish products

prohibited

Other rules about animal products

that can be ingested:

• land animals must be

mammals which chew their cud

and have cloven hooves

• birds of prey are prohibited

• fish must have fins and scales

• non-fish seafood is prohibited

e.g. shellfish

• meat and milk (any dairy)

cannot be mixed

Observers only consume kosher

products – complex set of rules

Seventh Day

Adventist

Australia, USA, South America, some

African countries

Some abstain from meat, but eggs

are permissible.

Sikh

India, Pakistan, Malaysia, Singapore,

Fiji, New Zealand, USA and UK

For some who are vegetarian – all

animal products including egg

prohibited

For those who are not vegetarian,

restrictions still include bovine and

porcine products

All animal products from halal

sources prohibited

Products containing alcohol

prohibited.

Adapted from Multicultural Clinical Support Resource Folder- Health and Religion available at

https://www.health.qld.gov.au/__data/assets/pdf_file/0025/158740/8mcrs_hlth_relgn.pdf

accessed 03/08/2020

Medicines/pharmaceuticals of animal origin - V3.0 November 2020 Page 7

4.1 Organisations consulted:

• Buddhist Council of Queensland (President)

• Hindu Society of Queensland (President)

• Brisbane Sikh Temple (President)

• Seventh-day Adventist Church South Queensland (President)

• Jehovah’s witnesses Hospital Information Services International Office

• The Islamic Council of Queensland (Secretary)

• Vegan Australia

• Queensland Jewish Board of Deputies Incorporated

5 Resources

A United Kingdom publication titled “Drugs of porcine origin and their clinical alternatives -

An introductory guide”

(written in 2004, accessed 26/08/2020) gives further information on

drugs of porcine origin and is available at:

http://archive.mcb.org.uk/wp-

content/uploads/2015/12/Drugs-Derived-From-Pigs-and-their-Clinical-

Alternatives_Booklet.pdf

A Canadian question and answer document produced by the Alberta Health Services –

Calgary provides healthcare professionals with an introduction to the religious and cultural

issues associated with drugs of animal origin and the need for informed choice in a

multicultural society.

This document, titled “Medications derived from animals and

culturally diverse patients” is available at:

https://www.albertahealthservices.ca/assets/programs/ps-1026227-health-care-religious-

beliefs.pdf

The Vegan society (England and Wales) has two blogs about medication:

Is my medication vegan? available at:

https://www.vegansociety.com/whats-new/blog/my-

medication-vegan and What vegans should know pre-operatively available at:

https://www.vegansociety.com/whats-new/blog/what-vegans-should-know-pre-operatively

The manufacturer’s Product Information (PI) gives details on the composition of the

medicine (i.e. listing the active and inactive constituents/ingredients) and provides some

form of description on how the medicine is produced (e.g. whether manufacture of the

product included exposure to animal derived materials). Also, Consumer Medicine

Information (CMI) leaflets are available for most prescription medicines which enable

patients to check the medicine’s ingredients. However, these leaflets are produced in English

only, so further assistance may be needed.

There appears to be no consistently practical way of identifying whether the gelatin in

products has come from beef or pork. This information is not always stated in

manufacturers’ PI or CMI leaflets but may be important for Jewish, Muslim and Hindu people

who may want to avoid even traces of these particular animal products. If patients are

concerned about whether the drug or excipients within their medicine are of animal origin,

Medicines/pharmaceuticals of animal origin - V3.0 November 2020 Page 8

they could seek the information from their pharmacist or doctor who can check the

medicine's PI or CMI. Alternatively, patients can call the National Prescribing Services (NPS)

Medicines Line (1300 888 763)

or contact the Medical Information Department of the

pharmaceutical company that makes the medicine

For further clarification, the patient could seek guidance from their religious organisation.

Medicines/pharmaceuticals of animal origin - V3.0 November 2020 Page 9

6 Appendices

Appendix A - Porcine (Pig) products

Product name Generic name Therapeutic class Comment

Clexane Enoxaparin

Anticoagulant,

Antithrombotics

derived from porcine

intestinal mucosa

Creon Pancrelipase

Digestive

supplements and

cholelitholytics

Pancreatic extract

(porcine)

Creon Micro Enteric

coated granules

Pancrelipase

Digestive

supplements and

cholelitholytics

Pancreatic extract

(porcine)

Curosurf Poractant alfa Respiratory agent

natural porcine lung

surfactant

Ethical Nutrients

Digestion plus

Herbal

gastrointestinal

preparations

pepsin (porcine)

Fragmin Dalteparin Anticoagulant pig mucosa

Gamunex

Normal

immunoglobulin

(Human)

Immunoglobulin

porcine parvovirus

(PPV) as a model for

human parvovirus

B19

Heparin sodium

injection

Heparin sodium Anticoagulant Porcine mucous

Heparinised saline Heparin sodium Anticoagulant Porcine mucous

Heparinised saline

injection

Heparin sodium Anticoagulant Porcine mucous

Imogam Rabies

Pasteurized

Rabies immune

globulin (human)

Rabies immune

globulin (human)

Porcine

pseudorabies virus

was selected to

model hepatitis B

virus and herpes

virus

M-M-R II Powder for

injection

Measles, mumps and

rubella virus vaccine

live

Vaccine Porcine gelatin

Obizur Susoctocog alfa Haemostatic agent Porcine sequence

Medicines/pharmaceuticals of animal origin - V3.0 November 2020 Page 10

Product name Generic name Therapeutic class Comment

Orgaran Danaparoid Haemostatic agent

From animal mucosa

(Porcine)

Panzytrat 25000

Amylase, Lipase,

Pancrelipase,

Protease

Digestive

supplement

Pancreatic extract

(porcine)

Prothrombinex-VF

Human prothrombin

complex

Haemostatic agent Heparin, porcine

ProQuad

Measles, Mumps,

Rubella and Varicella

Virus Vaccine Live

Vaccine

hydrolysed porcine

gelatin

Rotarix

Human rotavirus live

attenuated vaccine

Vaccine

Contains porcine

circovirus type 1

(PCV-1)

RotaTeq

Rotavirus vaccine

live oral pentavalent

Vaccine

porcine circoviruses

(PCV) 1 and 2

Varivax Refrigerated

Powder for injection

Live varicella vaccine. Vaccine

hydrolysed porcine

gelatin

Zostavax

Zoster virus vaccine

live

Vaccine

hydrolysed porcine

gelatin

Appendices A to G compiled from reference 9

Medicines/pharmaceuticals of animal origin - V3.0 November 2020 Page 11

Appendix B - Bovine (Cow) products

Product name Generic name Therapeutic class Comment

Artiss

Aprotinin (synthetic),

factor XIII,

fibrinogen, thrombin

and calcium chloride

dihydrate

Surgical antiseptics

and applications

Artiss contains

synthetic aprotinin.

As synthetic

aprotinin is

structurally identical

to bovine aprotinin,

the use of Artiss in

patients with

allergies to bovine

proteins should be

carefully evaluated

Benadryl Children's

Cough 2 years +

Herbal respiratory

preparation

lactoferrin - bovine

(from cow's milk)

BioHeme

Iron – vitamin and

mineral

bovine lactoferrin

(derived from cow's

milk)

Blackmores

Immunodefence

capsules

Immune supplement

Lactoferrin, bovine

(dairy)

Blackmores Joint

Formula, Joint

Formula Advanced &

Joint Formula

Advanced with MSM

Booster

Herbal analgesics

and anti-

inflammatories

Chondroitin sulfate

bovine

ChondroCare Excel

Herbal analgesics

and anti-

inflammatories

Chondroitin sulfate

bovine

ChondroPlex

Herbal analgesics

and anti-

inflammatories

Chondroitin sulfate

bovine

Duro-Tuss Children's

Cough Liquid

Herbal respiratory

preparation

lactoferrin bovine

Ethical Nutrients

Inner Health plus

capsules

Lactobacillus

acidophilus, Bovine

colostrum

Digestive

supplements

Ethical nutrients

inner health plus

powder

Lactobacillus

acidophilus, Bovine

colostrum

Digestive

supplements

Medicines/pharmaceuticals of animal origin - V3.0 November 2020 Page 12

Product name Generic name Therapeutic class Comment

Gelofusine Gelatin succinylated

Plasma volume

expander

Gelatin derived from

bovine material

Haemaccel Polygeline

Plasma volume

expander

Bovine Lactoferrin

Cow’s milk protein

Immune-5

Digestive

supplements and

cholelitholytics

Inner Health Plus

capsules and Inner

Health powder

Digestive

supplements and

cholelitholytics

Bovine colostrum

Jespect

Inactivated Japanese

encephalitis vaccine

Vaccine

Should not be

administered to

individuals who have

previously

experienced a

serious reaction to

bovine serum

albumin

Lactoferrin Enhanced

& Lactoferrin Plus SB

Herbal and other

complementary

medicines

Lactoferrin (bovine)

Methylpred,

Methylprednisolone

Alphapharm & Solu-

Medrol

Methylprednisolone

sodium succinate

Adrenal steroid

hormones

40 mg strength

includes lactose

from cow's milk

M-M-R II

Measles, mumps and

rubella virus vaccine

live

Vaccine

This product may

contain residual

foetal bovine serum

NovoSeven RT

Eptacog alfa

(activated)

Haemostatic agents

contains trace

amounts bovine IgG

protein and other

bovine proteins

ProQuad

Measles, Mumps,

Rubella and Varicella

(Oka/Merck) Virus

Vaccine Live

contains residual

components bovine

serum albumin

Medicines/pharmaceuticals of animal origin - V3.0 November 2020 Page 13

Product name Generic name Therapeutic class Comment

Quadracel

Pertussis vaccine

acellular, diphtheria

and tetanus toxoids

(adsorbed),

inactivated

poliovirus types 1, 2

and 3

bovine serum

albumin

Recombinate Octocog alfa

contains trace

amounts of mouse,

hamster and bovine

protein

Survanta Beractant

pulmonary

surfactant

bovine lung extract

Thyrogen Thyrotropin alfa Diagnostic Agents

Use with caution in

patients previously

treated with bovine

TSH

Tisseel VH S/D

Solution

Aprotinin - Factor XIII

- Fibrinogen, Calcium

chloride dihydrate -

Thrombin

Haemostatic agent

Use with caution in

patients with

allergies to bovine

proteins

Totally Natural

Products Exit Pain

Herbal analgesics

and anti-

inflammatories

chondroitin sulfate

(bovine)

Travelan Bovine colostrum Anti-diarrhoeal

VAQTA & VAQTA

Paediatric/adolescent

Hepatitis A virus bovine albumin

Varivax

Varicella zoster

vaccine, live

Vaccines

Inactive components

include hydrolysed

gelatin and traces of

bovine serum.

Vivaxim

Hepatitis A vaccine;

Salmonella typhi

vaccine

Vaccines

Bovine serum

albumin <10 ng

(Inactive component)

Vivotif Oral

Oral Typhoid Vaccine

Salmonella typhi

strain Ty21a

gelatin (bovine

derived)

Zostavax

Live varicella

vaccine.

bovine calf serum

Medicines/pharmaceuticals of animal origin - V3.0 November 2020 Page 14

Bovine – Manufacture includes exposure to bovine

materials “Bovine-Indirect

Product name Generic name Therapeutic class Comment

Adacel

Pertussis vaccine,

Diphtheria toxoid,

Tetanus toxoid,

Poliomyelitis vaccine

Vaccine

Adacel Polio

Acellular pertussis,

diphtheria, tetanus

and poliovirus type 1,

2 and 3

Vaccines

Avaxim Hepatitis A vaccine Vaccine

Boostrix

Diphtheria toxoid,

Tetanus toxoid,

Pertussis vaccine

Vaccine

Boostrix – IPV

suspension for

injection

Diphtheria toxoid,

Tetanus toxoid,

Pertussis vaccine,

Poliomyelitis vaccine

Vaccine

Engerix-B Adult and

Paediatric

Hepatitis B vaccine Vaccine

Havrix 1440 Hepatitis A vaccine Vaccine

Havrix Junior Hepatitis A vaccine Vaccine

Hexaxim

Diphtheria, tetanus,

pertussis, hepatitis B,

poliomyelitis and

Haemophilus

influenzae type b

conjugate vaccine

Vaccine

Hiberix

Haemophilus B

conjugate vaccine

Vaccine

Infanrix

Diphtheria, tetanus,

acellular pertussis

(DTPa) vaccine

Vaccine

Infanrix-IPV

Diphtheria, tetanus,

acellular pertussis

(DTPa) and

inactivated

poliovirus vaccine

Vaccine

Medicines/pharmaceuticals of animal origin - V3.0 November 2020 Page 15

Product name Generic name Therapeutic class Comment

Ipol

Poliovirus

(inactivated)

Vaccine

Merieux inactivated

rabies vaccine

Rabies vaccine Vaccine

M-M-R II

Measles, mumps and

rubella virus vaccine

live

Vaccine

This product may

contain residual

foetal bovine serum

NeisVac-C Vaccine

Meningococcal group

C polysaccharide

conjugate vaccine

Vaccines

Pneumovax 23

Pneumococcal

purified capsular

polysaccharides

Vaccine

Priorix

Measles, mumps &

rubella vaccine

Vaccines

Priorix-tetra

Varicella zoster

vaccine, Rubella

vaccine, Mumps

vaccine, Measles

vaccine

Vaccines

ProQuad

Measles, Mumps,

Rubella and Varicella

(Oka/Merck) Virus

Vaccine Live

Vaccines

contains residual

components of

bovine serum

albumin

Quadracel

Pertussis vaccine

acellular, diphtheria

and tetanus toxoids

(adsorbed),

inactivated

poliovirus types 1, 2

and 3

Vaccines

bovine serum

albumin

Rabipur Rabies vaccine Vaccines

contraindicated in

subjects with a

known severe

hypersensitivity to

chicken eggs, chicken

protein, bovine

gelatin

Rotarix Oral Liquid

Human Rotavirus

(live attenuated oral

vaccine)

Vaccines

Medicines/pharmaceuticals of animal origin - V3.0 November 2020 Page 16

Product name Generic name Therapeutic class Comment

RotaTeq Rotavirus vaccine Vaccines

Saizen & Saizen 3

Somatropin (rmc),

recombinant human

growth hormone

Pituitary hormones

prepared from

genetically

engineered

mammalian cells

(recombinant mouse

cells - C127)

transformed with a

bovine papilloma

virus vector

Stamaril Yellow Fever Vaccine Vaccines

Tripacel

Pertussis vaccine-

acellular, combined

with diphtheria and

tetanus toxoids

Vaccines

Twinrix & Twinrix

Junior

Combined hepatitis A

and hepatitis B

vaccine

Vaccines

Typhim Vi

Salmonella typhi Vi

polysaccharide

vaccine

Vaccines

Varilrix HSA-Free Live varicella vaccine Vaccines

Varivax

Varicella zoster

vaccine, live

Vaccines

Inactive components

include hydrolysed

gelatin and traces of

bovine serum.

Fluarix

Influenza virus

vaccine

Vaccine

ADT Booster Diphtheria toxoid Vaccine

Medicines/pharmaceuticals of animal origin - V3.0 November 2020 Page 17

Appendix C Chinese Hamster Ovary (CHO) cells

Product name Generic name Therapeutic class Comment

Actemra Tocilizumab Immunomodifiers

contraindicated in patients

with:

known hypersensitivity to

any CHO products

Adcetris

Brentuximab

vedotin

Antineoplastic

Advate Octocog alfa Haemostatic agent

Adynovate

Rurioctocog alfa

pegol

Haemostatic agent

derived from octocog alfa

(Advate)

Ajovy Fremanezumab

Antimigraine

preparations

fully humanised monoclonal

antibody produced in CHO

cells

Aldurazyme Laronidase

Enzyme

replacement

therapy

genetically engineered

Chinese hamster ovary cell

line

Aranesp Darbepoietin Haemopoietic agent produced in CHO cells

Avastin Bevacizumab Antineoplastic

produced by recombinant

DNA technology in a CHO

mammalian cell expression

system

Avonex Interferon beta-1a Immunomodifier

produced by mammalian

(CHO) cells

Bavencio Avelumab. Antineoplastic produced in CHO cells

Bemfola Follitropin alfa (rch) Pituitary hormone produced by a CHO cell

BeneFIX Nonacog alfa Haemostatic agent

contraindicated in patients

with previous allergy to

hamster protein

Besponsa

Inotuzumab

ozogamicin (rch)

Antineoplastic

Blincyto Blinatumomab (rch) Antineoplastic

Brenzys Etanercept.

Antirheumatoid

agents

Brineura Cerliponase alfa.

Endocrine and

metabolic agents

Medicines/pharmaceuticals of animal origin - V3.0 November 2020 Page 18

Product name Generic name Therapeutic class Comment

CellCept

Mycophenolate

mofetil.

Immunomodifiers

Based on Chinese hamster

inosine-5'-monophosphate

dehydrogenase

Cerezyme Imiglucerase

Enzyme

replacement

therapy

Cosentyx Secukinumab (rch) Immunomodifier

Darzalex Daratumumab Antineoplastic

Dupixent Dupilumab (rch) Immunomodifier

Elonva Corifollitropin alfa Pituitary hormones

Emgality Galcanezumab Antimigraine

Enbrel Etanercept Immunomodifier

Entyvio Vedolizumab Immunomodifier

Eprex Epoietin-alfa Haemopoietic agent

Eylea Aflibercept

Ophthalmic

medication

Fabrazyme Agalsidase beta

Enzyme

replacement

therapy

Fasenra Benralizumab Immunomodifier

Gonal-f Follitropin alfa Pituitary hormone

Granocyte Lenograstim Supportive therapy

expressed in a mammalian

host cell system, (CHO) cells

Hemlibra Emicizumab Haemostatic agent

Herceptin Trastuzumab Antineoplastic agent

contraindicated in patients

with known hypersensitivity

to CHO cell proteins

Hyqvia

Normal

immunoglobulin

(human) with

vorhyaluronidase

alfa

Immunoglobulin

The vorhyaluronidase alfa.is

produced from CHO cells

Medicines/pharmaceuticals of animal origin - V3.0 November 2020 Page 19

Product name Generic name Therapeutic class Comment

Ilumya Tildrakizumab (rch) Immunomodifier

Kadcyla

Trastuzumab

emtansine.

Antineoplastic agent

Kanjinti Trastuzumab Antineoplastic agent biosimilar to Herceptin.

Keytruda

Pembrolizumab

(rch)

Antineoplastic agent

Kogenate FS Octocog alfa Haemostatic agent

Trace amounts of mouse and

hamster protein present

Lemtrada Alemtuzumab (rch) Immunomodifier

Luveris 75 IU Lutropin alfa Pituitary hormone

Mabcampath Alemtuzumab Antineoplastic agent

Mabthera Rituximab Antineoplastic agent

Metalyse Tenecteplase Fibrinolytic agent

Mircera

Methoxy

polyethylene glycol-

epoetin beta

Haemopoietic agent

Recombinant DNA

technology in CHO cells

MycoCept Mycophenolate Immunomodifiers

Based on Chinese hamster

inosine-5'-monophosphate

dehydrogenase

Myozyme Alglucosidase alfa.

Endocrine and

metabolic agents

Naglazyme Galsulfase (rch)

Endocrine and

metabolic agent

NeoRecormon Epoietin beta Haemopoietic agent

Novicrit Epoetin lambda Haemopoietic agent Purified from a CHO cell

NovoSeven RT Eptacog alfa Haemostatic agent Baby hamster kidney cells

Nucala Mepolizumab Respiratory agent

Obizur Susoctocog alfa Haemostatic agent Baby hamster kidney cells

Medicines/pharmaceuticals of animal origin - V3.0 November 2020 Page 20

Product name Generic name Therapeutic class Comment

Ogivri Trastuzumab. Antineoplastic agent

contraindicated in patients

with hypersensitivity Chinese

hamster ovary cell proteins

Ontruzant Trastuzumab. Antineoplastic agent

biosimilar medicine to

Herceptin

Opdivo Nivolumab Antineoplastic agent

Orencia Abatacept Immunomodifier

Recombinant DNA

technology in CHO cells

Ovidrel

Choriogonadotropin

alfa

Pituitary hormone

Pergoveris

Follitropin alfa

(rch)/lutropin alfa

(rch)

Pituitary hormone

Perjeta Pertuzumab Antineoplastic agent

contraindicated in patients

with hypersensitivity to

Chinese hamster ovary cell

proteins

Praluent Alirocumab (rch)

Hypolipidaemic

agent

Prolia Denosumab

Affects calcium and

bone metabolism

Pulmozyme Dornase alfa Respiratory agent

contraindicated in patients

who have hypersensitivity to

Chinese hamster ovary cell

Puregon Follitropin beta Pituitary hormone

Rebif Interferon beta-1a Immunomodifier

Recombinate

antihaemophilic

factor

Haemostatic agent

Rekovelle Follitropin delta Pituitary hormone

Repatha Evolocumab

Hypolipidaemic

agent

Rixubis

Recombinant

Coagulation Factor

IX (rFIX), Nonacog

gamma (rch)

Haemostatic agent

contraindicated in patients

with known hypersensitivity

hamster protein

Medicines/pharmaceuticals of animal origin - V3.0 November 2020 Page 21

Product name Generic name Therapeutic class Comment

Strensiq Asfotase alfa rch

Endocrine and

metabolic agent

Sylvant siltuximab (rmc) Antineoplastic agent

Thyrogen Thyrotrophin alfa Diagnostic agent

Trazimera Trastuzumab

Antineoplastic

agents

biosimilar to Herceptin

Vectibix Panitumumab

Antineoplastic

agents

Recombinant DNA

technology in CHO cells

Vimizim Elosulfase alfa (rch)

Endocrine and

metabolic agent

Xgeva Denosumab Antineoplastic agent

Xolair Omalizumab Respiratory agent

Xyntha Moroctocog alfa Haemostatic agent

contraindicated in patients

with a known history of

hypersensitivity to hamster

proteins

Yervoy Ipilimumab Antineoplastic agent

Zinplava Bezlotoxumab

Antibiotics and anti-

infective

Appendix D - Murine (mouse)

Product name Generic name Therapeutic class Comment

Advate Octocog alfa Haemostatic agent

contains trace amounts of

mouse immunoglobulin G

Contraindicated in known

hypersensitivity to mouse

proteins

Adynovate

Rurioctocog alfa

pegol

Haemostatic agent

derived from octocog alfa

(Advate)

Arzerra Ofatumumab Antineoplastic agent

produced in a recombinant

murine cell line

Avastin Bevacizumab Antineoplastic agent

Humanised murine

antibody

Medicines/pharmaceuticals of animal origin - V3.0 November 2020 Page 22

Product name Generic name Therapeutic class Comment

Ceprotin Protein C

Anticoagulant,

antithrombotic

may contain traces of

mouse protein

Cyramza Ramucirumab Antineoplastic agent

produced in murine (NS0)

cells

Empliciti Elotuzumab Antineoplastic agent

consists of regions of

mouse antibody grafted

onto human IgG1

Erbitux Cetuximab Antineoplastic agent

produced in mammalian

cell culture by mouse

myeloma cells (Sp2/0)

Gazyva Obinutuzumab Antineoplastic agent

contraindicated in patients

with known

hypersensitivity to murine

proteins

Herceptin Trastuzumab Antineoplastic agent

Murine anti-p185 HER2

antibody

Inflectra Infliximab Immunomodifier

biosimilar to Remicade

should not be given to

patients with a history of

hypersensitivity to murine

proteins

Kanjinti Trastuzumab Antineoplastic agent Biosimilar to Herceptin

Kogenate Octocog alfa Haemostatic agent

Trace amounts of mouse

protein are present

Kymriah Tisagenlecleucel Antineoplastic agent

contains a murine single

chain antibody fragment

Lemtrada Alemtuzumab Immunomodifier

humanised monoclonal

antibody with regions from

a murine monoclonal

antibody

Lucentis Ranibizumab

Ophthalmic

medication

Immunoglobulin G1, with

human-mouse monoclonal

rhuFab V2 κ-chain

MabCampath Alemtuzumab Immunomodifier

contraindicated in patients

with a known

hypersensitivity to murine

proteins

Medicines/pharmaceuticals of animal origin - V3.0 November 2020 Page 23

Product name Generic name Therapeutic class Comment

Mabthera Rituximab Antineoplastic agent

Genetically engineered

chimeric murine/human

monoclonal antibody

NovoSeven RT Eptacog alfa Haemostatic agent

contains trace amounts of

mouse IgG protein

Ogivri Trastuzumab Antineoplastic agent Biosimilar to Herceptin

Ontruzant Trastuzumab Antineoplastic agent Biosimilar to Herceptin

Praxbind Idarucizumab

Detoxifying agent,

antidote

humanised monoclonal

antibody derived from

murine IgG1 isotype

antibody molecule

Recombinate Octocog alfa Haemostatic agent

contains trace amounts of

mouse protein

Remicade Infliximab Immunomodifier

Monoclonal antibody

composed of human

constant and murine

variable regions

Renflexis Infliximab Immunomodifier

biosimilar medicine to

Remicade

Riximyo Rituximab Antineoplastic agent

biosimilar medicine to

Mabthera

Saizen Somatropin Pituitary hormone

prepared from genetically

engineered mammalian

cells (recombinant mouse

cells

Simponi

prefilled

syringe

solution

Golimumab

Antirheumatoid agent

Murine hybridoma cell line

with recombinant DNA

technology

Simulect Basiliximab Immunomodifier

Murine/human chimeric

monoclonal antibody

Soliris Eculizumab Immunomodifier

Human/murine hybrid

monoclonal antibody

produced by murine

myeloma cell culture

Sylvant siltuximab Antineoplastic agent

chimeric human murine

monoclonal antibody

Medicines/pharmaceuticals of animal origin - V3.0 November 2020 Page 24

Product name Generic name Therapeutic class Comment

Synagis Palivizumab Immunomodifier

5% murine amino acid

sequences

Trazimera Trastuzumab Antineoplastic agent Biosimilar to Herceptin

Tysabri Natalizumab Immunomodifier

Human/murine hybrid

monoclonal antibody

produced in murine

myeloma cells

Xolair Omalizumab Respiratory agent

recombinant monoclonal

antibody that contains

regions of a humanised

murine antibody

Yescarta

axicabtagene

ciloleucel

Antineoplastic agent

patient's own T cells are

harvested and genetically

modified ex vivo by

retroviral transduction to

express a chimeric antigen

receptor (CAR) comprising

a murine anti-CD19 single

chain variable fragment

Medicines/pharmaceuticals of animal origin - V3.0 November 2020 Page 25

Appendix E - Equine (Horse)

Product name Generic name

Therapeutic

class

Comment

ATGAM

Equine Antithymocyte

globulin

Immunomodifier

Black snake

antivenom

Black snake antivenom Antivenom

Brown snake

antivenom

Brown snake antivenom Antivenom

Death adder

antivenom

Death adder antivenom Antivenom

Duavive

Conjugated

estrogens/bazedoxifene.

Gonadal hormone

Polyvalent

snake

antivenom

Brown snake antivenom,

Death adder antivenom,

King brown snake

antivenom, Taipan

antivenom, Tiger snake

antivenom

Antivenom

Premarin

tablets

Oestrogens, Conjugated Gonadal hormone

Red back spider

antivenom

Red back spider

antivenom

Antivenom

Sea snake

antivenom

Sea snake antivenom Antivenom

Stonefish

antivenom

Stonefish antivenom Antivenom

TachoSil

Human fibrinogen and

human thrombin

Surgical

Preparation

equine collagen

Taipan

antivenom

Taipan antivenom Antivenom

Tiger snake

antivenom

Tiger snake antivenom Antivenom

Medicines/pharmaceuticals of animal origin - V3.0 November 2020 Page 26

Appendix F - Egg/Chicken

Product name Generic name Therapeutic use Comment

Afluria Quad

quadrivalent

influenza vaccine

Vaccine

manufactured in eggs.

trace amounts of

ovalbumin (< 1

microgram/0.5 mL dose),

may be present

Agrippal

Influenza virus

vaccine

Vaccine

vaccine may contain egg,

chicken

Cleviprex Clevidipine

Antihypertensive

agent

Contraindicated in

patients with known

allergies to eggs or egg

products as contains egg

lecithin

ClinOleic 20% Olive oil and soya oil

Parenteral vitamins,

minerals and

nutrition

Contraindicated in

patients with known

hypersensitivity to egg as

contains egg lecithin

Diprivan Propofol Anaesthetics Contains egg lecithin

Fluarix

Influenza virus

vaccine

Vaccine

prepared using whole

virus cultivated in

embryonated hen eggs

Fluad

Influenza virus

vaccine

Vaccine

grown in hens' eggs

May also contain chicken

proteins (such as

ovalbumin0

Fluad Quad

quadrivalent

influenza vaccine

Vaccine grown in hens' eggs

FluQuadri

Quadrivalent

Influenza Vaccine

Vaccine

propagated in chicken

eggs

Fluzone High-

Dose

trivalent influenza

vaccine

Vaccine

propagated in chicken

eggs

Fresofol 1%

Injection &

Fresofol 1%

MCT/LCT

Propofol Anaesthetics Contains egg lecithin

Influvac

Influenza virus

vaccine

Vaccine

prepared from virus

grown in the allantoic

cavity of embryonated

eggs

Medicines/pharmaceuticals of animal origin - V3.0 November 2020 Page 27

Product name Generic name Therapeutic use Comment

Intralipid Soya oil

Parenteral vitamins,

minerals and

nutrition

Contains egg lecithin

Kabiven G11% &

Kabiven G19%

Parenteral vitamins,

minerals and

nutrition

Contains egg lecithin

Kanuma Sebelipase alfa

endocrine and

metabolic agent

Contraindicated in

patients with

hypersensitivity to egg as

produced in egg white

M-M-R II

Measles, mumps and

rubella virus vaccine l

Vaccine

produced in chick embryo

cell culture

Olimel,

PeriOlimel

Parenteral vitamins,

minerals and

nutrition

contains egg lecithin

Priorix

Measles, mumps and

rubella virus vaccine

Vaccine

produced in chick embryo

cell culture, may contain

traces of egg protein

Priorix-Tetra &

ProQuad

Measles, mumps,

rubella and varicella

vaccine

Vaccine

produced in chick embryo

cell culture, may contain

traces of egg protein

Propofol Sandoz

Propofol-Lipuro

1%/2%

Provive 1% and

Provive MCT-LCT

Propofol Anaesthetics Contains egg lecithin

Q-Vax & Q-Vax

Skin Test

Coxiella burnetii

vaccine

Vaccine

grown in the yolk sacs of

embryonated eggs. Trace

amounts of ovalbumin

may also be present

Rabipur Rabies vaccine Vaccine

Made from purified chick

embryo cell

Rixadone Risperidone Antipsychotic agent Contains Egg products

Stamaril Yellow Fever Vaccine Vaccine

propagated in chick

embryos

SmofKabiven

Electrolyte Free

& SmofKabiven

Parenteral vitamins,

minerals and

nutrition

Contains egg

phospholipids and Fish

oil

Medicines/pharmaceuticals of animal origin - V3.0 November 2020 Page 28

Product name Generic name Therapeutic use Comment

SMOFlipid

Parenteral vitamins,

minerals and

nutrition

Contains egg lecithin and

fish oil

Vaxigrip

Influenza virus

vaccine

Vaccine

prepared from virus

grown in the allantoic

cavity of embryonated

eggs

Visudyne Verteporfin

ophthalmic

medication

Contains egg

phosphatidylglycerol

sodium

Vitalipid N

Parenteral vitamins,

minerals and

nutrition

Contains egg lecithin

Medicines/pharmaceuticals of animal origin - V3.0 November 2020 Page 29

Appendix G – Other Animals

Product name Generic name Therapeutic uses Comment

Acarizax

house dust mite

extract

Antiallergy

preparation

Contains gelatin (fish)

Box Jellyfish

Antivenom

Box Jellyfish

Antivenom

antivenom

from the plasma of

sheep

Chondroitin Chondroitin

Complementary

osteoarthritis

From bovine or shark

cartilage

DigiFab

Digoxin binding

antibody

Digoxin-specific

antibody fragment

Antidote From sheep

Fluad

Inactivated

influenza vaccine

Vaccine

contains the oil

squalene which is

obtained from shark

liver

Funnel Web Spider

Antivenom

Funnel web spider

antivenom (rabbit)

antivenom

prepared from the

plasma of rabbits

Glucosamine Glucosamine

Complementary

osteoarthritis

From shellfish

Grazax Phleum pratense.

Antiallergy

preparation

contains gelatine (fish)

Human Insulin

(rys)

Protaphane

Mixtard 30/70.

Mixtard 50/50

Insulin Insulin preparation

Contain protamine

sulfate (a fish product)

Humira Adalimumab Immunomodifier

Mammalian cells (Not

specified)

Mono-plus

mononucleosis

test

Diagnostic Guinea pig, horse

Novoseven Eptacog alfa Haemostatic agent

Baby hamster kidney

(BHK) cells

Omacor

Eicosapentaenoic

acid (EPA) ethyl

ester,

docosahexaenoic

acid (DHA) ethyl

ester.

cardiovascular agent

obtained by the

transesterification of

the body oil of fat fish

species

Medicines/pharmaceuticals of animal origin - V3.0 November 2020 Page 30

Product name Generic name Therapeutic uses Comment

Protamine Sulfate

Injection

Haemostatic agent

Caution in patients

allergic to fish

SMOFlipid

Parenteral vitamins,

minerals and

nutrition

Contains egg lecithin

and fish oil

Thymoglobuline

Antithymocyte

globulin (rabbit)

Immunomodifier Rabbit

Compiled from reference 9

Medicines/pharmaceuticals of animal origin - V3.0 November 2020 Page 31

Appendix H - Excipients that may be of animal

origin

Product Source

Bee pollen

Gathered by bees and collected from legs of

bees

Chitin

From the exoskeletons of arthropods and

crustacean

Chymotrypsin Cochineal/Carmine/Carminic

acid

Ox pancreas

Cochineal/carmine/carmininc acid Red pigment from crushed cochineal insects

Disodium inosinate From meat extract

Gelatin

From pig skin, bovine hide and pork and cattle

bones. Used for many capsules

Glycerol May be derived from animal fats

Lactose

From cows’ milk (by-product of dairy

industry). Usually made synthetically

(Common filler in tablets)

Lanolin Fat extracted from sheep’s wool

Oleic oil and oleostearin From pressed tallow

Propolis Bee glue

Shellac Insect secretion

Stearic acid

Fat from cows, sheep, dogs or cats.

Can be obtained from vegetable sources

Trypsin Enzyme from pork pancreas

Compiled from references 11, 12

Medicines/pharmaceuticals of animal origin - V3.0 November 2020 Page 32

7 References

1. Reproduced with permission from Partnering with patients in their own care, developed by

the Australian Commission on Safety and Quality in Health Care (ACSQHC). ACSQHC: Sydney

2. United Kingdom. National Prescribing Centre. Task Force on Medicines Partnership. Drugs

of porcine origin and their clinical alternatives. An introductory guide. March 2004 [11

December 2007] Available from: http://archive.mcb.org.uk/wp-

content/uploads/2015/12/Drugs-Derived-From-Pigs-and-their-Clinical-

Alternatives_Booklet.pdf

3. Eldred BE, Dean AJ, McGuire TM, Nash AL. Vaccine components and constituents:

responding to consumer concerns. MJA 2006;184 (4):170-175.

4. Rodger, D., Blackshaw, B.P. Using animal-derived constituents in anaesthesia and surgery:

the case for disclosing to patients. BMC Med Ethics 20, 14 (2019. Available at

https://doi.org/10.1186/s12910-019-0351-4

5. Alberta Health Services – Calgary. Medications derived from animals and culturally diverse

patients. 2nd edition. Available at

https://www.albertahealthservices.ca/assets/programs/ps-1026227-health-care-religious-

beliefs.pdf

6. National Prescribing Services (NPS). Pharmaceutical excipients – where do we begin? 1

August 2011 DOI: 10.18773/austprescr.2011.060

7. What are excipients doing in medicinal products? Drug and Therapeutics Bulletin

2009;47:81-84. http://dx.doi.org/10.1136/dtb.2009.06.0026

8. United States. Immunization Action Coalition. World Health Organisation Regional Office

for the Eastern Mediterranean - The use of unlawful or juridically unclean substances in food

and medicine (correspondence dated 17 July 2001). [27 June 2007] Available from:

www.immunize.org/concerns/porcine.pdf

9. MIMS Online. Retrieved from http://www.mims.com.au

10. Australian Register of Therapeutic Goods (ARTG). Therapeutic Goods Administration.

Department of Health and Ageing. Australian Government available from

http://www.tga.gov.au/industry/artg.htm

11. Sriaandhal Sabalingam1, W. J. A. Banukie N. Jayasuriya. Pharmaceutical Excipients of

Marine and Animal origin: A Review Biological and Chemical Research (ISSN 2312-0088), Vol.6,

184-196

12. Alamgir A.N.M. (2018) Bioactive Compounds and Pharmaceutical Excipients Derived from

Animals, Marine Organisms, Microorganisms, Minerals, Synthesized Compounds, and

Pharmaceutical Drugs. In: Therapeutic Use of Medicinal Plants and their Extracts: Volume 2.

Progress in Drug Research, vol 74. Springer, Cham. https://doi.org/10.1007/978-3-319-92387-1_4

13 The Vegan society (England and Wales) Is my medication vegan? available at:

https://www.vegansociety.com/whats-new/blog/my-medication-vegan

Medicines/pharmaceuticals of animal origin - V3.0 November 2020 Page 33

8 Approval

Approving Officer:

Justin Lee

Director

Medication Services Queensland

2020

9 Version Control

Version Amendments Author/s Approved

2.0

Supersedes original version published in

2007

A Jagels November 2013

2.1

Fixed broken link to booklet on porcine

medicines. Updated organisational details

A Jagels April 2019

3.0 Review

J Quin

A Jagels

November 2020