Observant Muslims fast from sunup to sundown during Ramadan, a practice that can be complicated if they must take medications. Pharmacists should know how to make adjustments in medication regimens that can help them and how to counsel their Muslim patients.
This year, Ramadan is between May 15 and June 14. Muslims who observe the fast will refrain from consuming anything by mouth between dawn and sunset, including food, water, and oral medications. Non-oral meds—injections, inhalers, suppositories, and eye or ear drops—are generally permissible.
“The general rule is if you can safely fast, then you do it,” explains Wasem Alsabbagh, PhD, a pharmacist and assistant professor at the School of Pharmacy at the University of Waterloo, Ontario, Canada. “The safety assessment usually falls on the shoulders of healthcare professionals who should approach the issue from a shared-decision point-of-view.”
The ban on oral medications can create a dilemma for patients who take part in the fast. Pharmacists can play an integral role by recommending medication adjustments and by counseling their patients on ways to avoid the potential hazards of fasting.
The Ramadan fast can be particularly challenging for people with diabetes due to the risk of hypoglycemia. The American Diabetes Association (ADA) recommends against prolonged fasting for patients with multiple diabetes complications. The ADA’s complete recommendations can be found at its website.
“Patients on insulin should measure glucose before, during, and after fasting,” advises Mohammed Jalloh, PharmD, assistant professor at Touro University in California. “I strongly encourage patients to know the hallmark signs and symptoms of low blood sugar.”
Any condition that requires medications taken several times a day or that is affected by food and drink intake (such as hypertension and thyroid disease) may require therapy adjustment. Alsabbagh says pharmacists can suggest adjustments to their medication regimens and to lifestyle to avoid any adverse effects of fasting.
Patients should be advised to consume enough water before and after fasting begins to prevent dehydration, he says. Patients should avoid too much activity and exposure to sun and high temperatures. If they become dehydrated, they should immediately break the fast and rehydrate, he says.
Jalloh says pharmacists can also adjust the times medications are taken. Once-daily formulations should be taken when patients break the fast or begin eating food after sunset, he notes.
Finally, Alsabbagh urges pharmacists to be proactive with their patients. “It is important for pharmacists to ask patients if they are considering fasting and engage in the conversation about safety and necessary adjustments, rather than restricting their intervention to patients who ask,” he concludes. Above all, pharmacists should be respectful of patients’ personal wishes and religious beliefs when offering counseling.