Pharmacists can work together with Muslims observing Ramadan to advise on best use of medicines and managing conditions, write Jarrod McMaugh and Fizza Mahmood
Ramadan is a month when Muslims worldwide fast from dawn to sunset. It is a sacred month for several reasons, and is considered an important religious observation. It is practiced as a method of learning self-control through abstinence from food and drink.
While Ramadan is observed widely by Muslims, some individuals will be given exemption from observance – usually due to health considerations. This may include women who are pregnant or breastfeeding or during a menstrual period; those who are very frail or elderly; and those individuals whose doctor advises to abstain due to acute or chronic health considerations.
During the observance of Ramadan, if an individual’s health declines due to abstaining from food and drink during daylight hours, they will be advised to cease their observance of Ramadan and return to their normal routine.
During Ramadan individuals will have two main meals – a meal before the fast begins prior to dawn, and a meal at the breaking of the fast at sunset. To ensure ongoing health and energy, these meals will contain the same amount of calories and nutrients as would be consumed in three meals at other times of the year.
The composition of these meals may consist of more carbohydrates (especially complex carbohydrates) than normal to ensure energy levels are adequate throughout the fasting period. Simple carbohydrates may be utilised in the last meal of the day to ensure a quick recovery of energy.
It is advised to avoid foods that are very spicy, fried foods, and sweet foods for the two meals due to a higher chance of heartburn, indigestion, or weight gain. It is also advisable to ensure adequate fluid intake is a part of these meals to prevent dehydration through the fasting period.
How does Ramadan affect medication and health?
Many individuals who observe Ramadan will be able to alter their medication regimen without too much difficulty. For instance, prescribers may be able to select dose forms that reduce the number of doses required per day, allowing medication to be taken outside of daylight hours.
Advances in pharmaceutical technology and pharmacological development have allowed for a greater number of options that provide a longer half-life or a sustained release mechanism. Some medications may have transdermal or depot options that obviate the need to “consume” a dose.
Pharmacists can provide advice to individuals about how medication dose times can be altered to suit the observance of Ramadan. For medications or dose forms that require mid-day dosing, the pharmacist may be able to recommend an alteration to their therapy with a referral to their general practitioner.
Some chronic conditions provide a greater challenge for the observance of Ramadan – especially diabetes. Generally speaking, individuals with type 2 diabetes who maintain blood glucose levels with diet and lifestyle will be able to fast.
Alternatively, those who require oral hypoglycaemic medications or insulin for type 1 or type 2 diabetes will need to be cautious about fasting. For these individuals, fasting may cause significant impact on their health. Even if medications with a longer half-life can be used, the act of fasting may still have an impact on blood glucose levels that are undesirable.
Chronic conditions that have an inflammatory component will also require due consideration about fasting – these conditions impart a significant amount of stress on the individual, and fasting may amplify this. Similar considerations will need to be made by individuals who have a high burden of chronic disease or who have had recent surgery. Adequate nutritional intake should be achievable during Ramadan, but when this is not possible, reliable advice from a health professional is invaluable.
Pharmacists can provide a valuable advisory role to people who wish to observe Ramadan, but are unsure about the impact of fasting on their medication and health. It is important to individualise this advice, as each person will have a different set of considerations pertaining to their medication and health.
It is also critical to provide this advice in a manner that is collaborative with the individual – there is no point telling a person what they ‘must’ do with their medication.
Advising patients about alternative dosing should also be accompanied with a discussion on the consequences of missing important medications or reducing the bioavailability of their doses. With this information, people can make an informed decision on how they may take their medications during Ramadan without putting their health at risk.
 It should be noted that while insulin can be used during daylight hours as this is not an oral dose form, the impact of insulin at a time when a person is fasting would lead to dangerous hypoglycaemia.