Download Information for healthcare professionals on fasting and medicines

Information for healthcare professionals on fasting and medicines during
Ramadan
Introduction
Ramadan is one of the most holy months in the Muslim calendar. During this period
Muslims fast for 30 days during daylight hours. The first fast is subject to the sighting of
the new moon. This year it is expected to be around June 17.
Fasting commences at dawn and ends at sunset. Each fasting day will be getting later
as the month progresses. Please refer to the Unified Islamic Prayer Timetable for
London which can be found here. The East London Mosque Ramadan timetable can be
found here.
Until recently little was known of medication compliance during Ramadan. A project was
undertaken, at Barts Health, to determine medication usage in the Tower Hamlets
Muslim population during Ramadan. The results were quite alarming. It was found that
23% of patients did not take their medication at all during the holy month, and a further
48% doubled their evening dose to compensate for medicines normally taken twice a
day. Doubling the dose of twice-daily medication or omitting a dose altogether could in
some cases cause severe adverse effects and is an important point to consider when
prescribing or counselling this group of patients especially when acute therapy is
prescribed during this time.
Action:
As healthcare professionals we can advise patients on whether it is safe to fast in the
first instance and advise on safe ways to fast,
The general Islamic ruling is, if a person‟s health is at risk due to a medical condition
they should not fast or they can break their fast.
Below are some specific rulings
Figure 1:
The following persons are exempt from fasting:
 Children under the age of puberty.
 Persons incapable of fasting due to:
a) old age
b) incurable disease i.e. cancer / HIV infection ?
c) chronic disease e.g. diabetes, COPD, cardiovascular disease
d) Severe diseases e.g. cancer, kidney disease,
Menstruating women or women with post partum bleeding should not fast.
Any food or medicine used as a substitute for food that reaches the body by mouth or
any other means will invalidate fasting.
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There is no restriction on having or using the following items during Ramadan:
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Having a blood test.
Having an injection (which is not a substitute for food).
Using eye drops
Taking tablets invalidates the fast.
According to the Islamic ruling (Shariah) you can take Insulin while fasting on the basis
that it is purely for medical use and does not constitute nutritional consumption.
With the use of inhaler, the Islamic ruling excuses one from fasting in this instance, but
must make it up when health permits otherwise pay a charitable contribution (fidyah).The
other Islamic rulings allows the use of the inhaler in this instance.
The table below gives guidance on the safety of fasting by patients with medical
conditions.
Further information is available on the Faith in Health website, which can be found on
East London Mosque website. Direct link to the website http://www.faithinhealth.com
Dietary Advice:
There are three stages to the fast during Ramadan. Firstly there is the pre-dawn
breakfast, which should consist of a light meal and water. The fasting period runs from
sunrise to sunset. At sunset the fast is broken with a small snack and dinner is eaten in
the evening. There is no need for excess. All patients must maintain a balanced diet
consisting of items from the following five groups, that is, meat or bean, bread or cereal,
milk, vegetable and fruit. The following advice is particularly useful:
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Encourage fluids especially water to prevent dehydration. (Break the fast with fruit
and water).
Consume sufficient vegetables at mealtimes.
Avoid caffeine-containing beverages such as tea, coffee and cola etc. (Reduce the
quantity consumed before Ramadan to prevent headache, irritability and mood
swings)
Avoid intake of refined sugar (table sugar, sucrose) in food such as sweets or other
forms.
Avoid spicy foods.
Ramadan is a good time to quit smoking. It provides a great opportunity to change
unhealthy habits such as smoking
NHS Choices has information about a „Healthy Ramadan‟ which can be found here:
http://www.nhs.uk/livewell/healthyramadan/Pages/healthyramadanhome.aspx
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References
1. Ramadan health guide; a guide to healthy fasting;
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/document
s/digitalasset/dh_078408.pdf
2. Athar, S. “Health Concerns for Believers; contemporary issues.”
http://www.islam-usa.com/h8.htm
3. Nomani,
M.Z.A.
“Diet
during
Ramadan
http://www.islamicity.com/articles/articles.asp?ref=RR0210-1775
4. Azizi, F. and Behnam, S. “Ramadan fasting and diabetes mellitus.” (1998) Int. Journ.
Ramadan. Fasting Res. 2:8-17. http://www/labs.net/ains/j98ar2.htm
5. Athar, S. “Medical aspects of Islamic fasting.” http://www.islam-usa.com/im15.html
6. 5. Aprilawati, L. (translated by Green, C.) “Fasting for Muslims with AIDS” (1998)
PROCARE.
http://www.essentialdrugs.org/programs/provcaarehma/procare.199801/msg00000.html
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Information on Fasting and Medicines during Ramadan
Disease state:
Type 1&2-Insulin Dependent
Diabetes
Type 2-Non-Insulin Dependent
Diabetes
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Diet controlled
Oral medication
Chronic respiratory disease
COPD, emphysema, bronchitis
Asthma
Advice
Safe way to fast
Type 1 and Type 2 insulin dependent  Patients must maintain their normal diet, i.e. low fat and
diabetic patients should not fast, especially
low sugar diet, when breaking the fast and maintain their
if less than 20 years or pregnant.
normal daily activity.
 Patients must also drink sufficient water in the hours
Diet controlled diabetic patients can fast
before and after the fasting period to prevent dehydration.
safely.
 It may be possible make changes to their medication in
Patients taking oral hypoglycaemic agents
order to help them take tablets outside the times of fasting.
should not fast unless their diabetes is
Recommend to discuss with health care staff.
controlled.
 All patients must be counselled of the warning signs
of dehydration and hypoglycaemia. If either occurs
they must break the fast immediately.
Patients should only fast if the diabetes is
controlled.
It is not safe to fast and patients who fast 
may experience severe illness.
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Chronic heart disease
Coronary artery disease
Severe uncontrolled hypertension
It is not safe to fast and patients who fast 
may experience severe illness
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Chronic renal disease
Renal dialysis
Renal transplant
Nephrotic syndrome
It is not safe to fast.
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Unsafe
Mild or moderate asthmatic patients can fast providing
they continue all regular medication. Inhalers can be used
during the fasting period
Asthma UK information can be found here
Unsafe
In controlled hypertension with no other coexisting
cardiovascular disease patients can fast, but must
continue all regular medication. It may be a good
opportunity to review current treatment and medicines
adherence
Discuss with health care staff if any concerns
Patients should maintain their normal diet and fluid intake
Patients should continue taking their medicines as
prescribed and attend appointments as planned
Information on Fasting and Medicines during Ramadan
Disease state:
Immunocompromised
On immunosuppressants
including: steroids,
ciclosporin,
mycophenolate,
azathioprine, tacrolimus
HIV/AIDS infection
Aged over 65 years
Advice
 It is safe to fast providing the patient is
generally well. Most medicines are taken once
or twice daily. Doses can be adjusted to suit
the meal times i.e. sunset and sunrise meals
 It is not safe to fast if the patient is unwell, or
has reduced weight or poor hepatic or renal
function.
 Refer patients with HIV to their HIV centre who
can give more individualised advice on the
treatment regime.
 It is not safe to fast if taking saquinavir (must
be taken after food), or zalcitabine, which must
be taken three times a day.
It is safe to fast providing the patient is of good
health generally.
Safe way to fast
 The steroid dose must be taken with food and is best
taken in the morning (the pre-dawn meal) to mimic the
body‟s normal release.
 Ensure adequate fluid intake between the fasting periods
to prevent dehydration and to aid clearance of the
medication.
 Safe to fast if not taking any anti-retroviral or only taking
prophylactic anti-infective agents i.e. anti-fungal, antituberculous or anti-PCP (pneumocystis carinii pneumonia)
medication.
 Refer patients taking antiretrovirals to their HIV centre.
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A balanced diet comprising all nutrients. Break the fast
with fruits and water.
Ensure sufficient water is taken between the fasting
periods.
Menstruating women
Post partum bleeding
Pregnant and nursing
mothers
Exempt from fasting. Women can make up the
days missed at an alternative time.
They have the provision to break their fast if However the woman will need to make up those fasts
needed.
later.
Epilepsy
Patients with epilepsy are more likely to have
seizures during Ramadan
Taking your medications at the same time and
every day can help to prevent seizures
If you require further advice please call the Barts Health
epilepsy team on 0203 594 0701 or
[email protected]
or speak with your nurse, doctor or pharmacist.
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Get enough sleep, as tiredness can provoke
seizures
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