Women from Islamic and African cultures who have vaginal yeast infections may prefer oral drugs to vaginally inserted medications. Latin Americans expect injections, and they may consequently believe that oral medications are less effective.

In some cultures, the practice of religious fasting can affect medication schedules or interfere with drug absorption. Mexican and Puerto Rican patients’ concerns about the addictive effects of drug therapy can lead to their reluctance to take medications over the long term. In some cases, Vietnamese patients have taken only half of their prescribed medications in the belief that the drug or dose is too strong.

PHYSIOLOGICAL RESPONSE TO MEDICATIONS

A patient’s race or ethnic background influences how medications are metabolized. Common genetic polymorphisms (multiple forms of enzymes used for drug metabolism) affect the metabolism of many important medications. For some polymorphisms, the proportion of rapid metabolizers and slow metabolizers varies according to the patient’s ethnicity. For example, only 3% to 5% of Caucasians are poor metabolizers of drugs affected by mephenytoin polymorphism (e.g., diazepam, imipramine), but 15% to 20% of Chinese and Japanese are poor metaboliz-ers of mephenytoin and related drugs. Clinically, there may be an increase or decrease in the expected drug effect, and dosage adjustments may be necessary. For example, Asians and Native Alaskans need lower doses of anxiolytic agents than Caucasian patients. Asians, Indians, and Pakistanis require lower doses of lithium and antipsychotic drugs. Symptoms among African-Americans generally improve faster after they take neuroleptic and anxiolytic agents. Hispanic patients may require lower doses of antidepressants than Caucasians. Because some drugs within the same drug class are often cleared by different metabolic pathways, their metabolism may vary within the same drug class, depending on differences in ethnicity.

Explicit recognition of ethnic differences can be a sensitive subject because of a fear of offending people. However, these examples of ethnic diversity serve only to show that we are all members of ethnic groups, all of which have cultural values that influence our behavior and our physiological responses to medications. That knowledge should help us avoid a “we/they” attitude when caring for patients from a culture that differs from our own. canadian antibiotics

The large number of ethnic cultures in the U.S. makes it difficult to be knowledgeable about each one; however, we can approach patients with respect while assessing their likelihood of acting on cultural beliefs that could adversely affect treatment outcomes. Individuals who are recent immigrants; live in ethnic enclaves; prefer using their native tongue; travel frequently to their country of origin; and have frequent contact with others within their ethnic group are more likely to adhere to strongly held cultural beliefs. While misinformation or lack of information should be addressed, we should strive to bring effective health care to patients within a psychosocial context that is appropriate for their culture.