How to manage medications during Ramadan?

Who can fast during Ramadan? Is it inclusive of those who need to consume medications regularly?

Ramadan is the holy month of Islam where Muslims perform “Sawm” or the act of fasting. Muslims are obliged to refrain from consuming any food and medication, drinking any beverages, and smoking from dawn till sunset, throughout the entire month. Usually, 2 meals are eaten throughout the day: one being Suhoor, a short meal before the break of dawn, and the other being Iftar, a meal to end the daily fast after sunset.

Ramadan fasting is mandatory for adult Muslims who are physically able and tolerant, as well as of sound mind. People who are sick, travelling, pregnant, menstruating, or breastfeeding are not obliged to do Ramadan fasting. However, it is extremely important to note that fasting is strictly not allowed for those who are unable to perform it safely, such as the elderly and chronically ill.

As Ramadan is the largest celebration for Muslims all around the globe, many would insist to participate in as many aspects as they could. This results in a part of the Muslim population not disclosing their medical conditions to healthcare professionals and choosing to fast – though this might put their health at risk.

Some medications may still be taken during Ramadan!

As long as the medication is not taken orally, it will not break an individual’s fast. Here are some permissible ones:

• Inhalers
• Ear and eye drops
• Nasal sprays/drops
• Mouthwash / oral sprays
• Injections (except IV drip)
• Skin ointments, medicated plasters, patches

Now that we know what is allowed and not allowed, let’s get to how consumption of medication could be maintained, even with such a limited time to eat in a day.

How does the change in eating pattern affect the consumption of medication during Ramadan?

With only two mealtimes a day, there is a unique way for healthcare professionals to handle patients who celebrate Ramadan and rely on medication. Generally, it is highly recommended to adjust their medication consumption schedules accordingly – so it can be done during suhoor  and iftar.

For medications with a single daily dose, it would be an easier situation to handle as it does not affect the fast. However, there are physical, mental, and behavioral cycle of changes in our body happening over roughly 24 hours – we know this as circadian rhythms – which can affect the efficacy and toxicity of various drugs. Therefore, it is highly recommended to consult with a healthcare professional to avoid the sub-optimal efficacy of the medication.

For medications with multiple daily doses, a recommended strategy for Ramadan fasting would be consuming medications with longer-acting effects or changing the dosing schedule to just once or twice per day. Although, the same strategy could not be applied to all situations as there are chronic and short-term conditions. Some could also shift towards nonoral medications such as injections, inhalations, or eye/ear drops that won’t break the fast as previously mentioned.

Role of drug-food interactions

There are some medications where efficacy or safety could also be affected by food consumption. Factors that contribute to this include the nature of the medications, the type of meal and the time interval between meal and dosing. Therefore, extra attention is required when an individual needs to consume medication on an empty stomach or after meals.

Additionally, the quality of the food eaten during iftar may also affect the absorption of some medications. For example, acidic beverages such as coffee and tea may increase the absorption of salicylates and some antibiotics; but decrease the absorption of antihistamines. The nutritional composition of the meal could also be considered, such as how fatty it is or how high-protein it is.

To conclude, it is important to take consideration of your medications, dosing and consulting with a healthcare professional while fulfilling the important deeds of Ramadan fasting.

We wish all our Muslim readers a prosperous and blessed Ramadan. Let us all gather blessings and celebrate this holy month together. Ramadan Mubarak!