Fasting whilst on medication in Ramadan: Making it work safely
The month of Ramadan will begin on the 16th of May, and in the U.K this means that many Muslims will be fasting for up to 19 hours per day for the duration of the month. Whilst fasting, all food and drink, is not consumed during daylight hours. Most medications are also restricted whilst fasting; this includes tablets, injections, inhalers, nasal sprays and drops. Although for certain drug formulations, such as inhalers, suppositories, nasal douches and drops some Islamic opinions differ on whether these can be taken during fasting or not.
Whilst the consensus may vary for the types of medications one can take if they are fasting, there is no conflict of opinion for people who are exempt from fasting. Simply put, people who are sick, and/or will be detrimentally affected by fasting should not fast.
Diabetes is one of the most challenging conditions to control and manage during Ramadan for the person with this condition and also for their medical staff. This is particularly so in countries that are currently fasting longer than 12 hours, so the U.K and countries in the northern hemisphere currently fall under this remit. Whilst people who are type 1 diabetic (i.e. requiring the use of insulin injections) are not recommended to partake in fasting, people who have type 2 diabetes (may or may not use insulin) are usually considered ok to fast as long as it is diet controlled. If you have type 2 diabetes and are taking oral medications you will need to check with your doctor if you can fast as some anti diabetic medications can be dangerous if fasting for long periods of time.
It is also important that diabetic patients who are and are not insulin dependent should speak to their doctor before starting fasting. For patients that are using insulin, the insulin dosage will need to be adjusted and reduced before starting the fast every day to avoid massive drops in blood glucose levels. It is also recommended that diabetic patients check their glucose levels more frequently and ensure that the food selected for both meals (before sunrise and after sunset) are foods that are low in Glycaemic Index (G.I.) and contain a mixture of vegetables and slowly absorbed foods to enable as much continuity in blood glucose levels throughout the day as possible. A good list of foods with low G.I is available from the Diabetes uk website with an explanation of why these are important to include in your diet, and particularly whilst fasting.
There are added risks of fasting if you are diabetic as this can make you prone to excessively low blood glucose (hypoglycaemia) throughout the day but also at risk of high blood glucose (hyperglycaemia), particularly after breaking the fast, this is due to the rapid uptake of glucose into the cells after breaking the fast, and which is why it is recommended to eat foods that are low in G.I.
People suffering from diabetes are also more prone to dehydration, which in turn can cause a risk of falls and other injuries. Dehydration can also cause an increase in the viscosity of blood, (because of the reduction of fluid intake) which in turn makes you more susceptible to blood clots.
And what about other medical conditions? If you are on high blood pressure medications and your blood pressure is well controlled, fasting should be ok for you. However if you are taking a blood pressure tablet that is more than once per day and you will be fasting for longer than 12 hours, you must speak to your doctor before fasting as you maybe able to get a longer acting medication. This would mean you could get the same blood pressure control and take a tablet once a day instead of two or three times daily. It is recommended that if you suffer from high blood pressure and intend to fast you need to monitor your blood pressure more regularly. Also pay particular attention to any feelings of dizziness and light-headedness you may experience, as this can mean you are suffering from low blood pressure.
Patients who suffer from epilepsy, should not fast as fasting will likely increase the likelihood of seizures, its also really important that they continue to take their anti-epileptic medications at the exact times that they are usually taken as any changes in these will affect their seizures.
For people that suffer from migraines and are taking medications for migraine relief, it is important that they pay close attention to their triggers for migraines, especially as long days of fasting can exacerbate migraine and can make you more sensitive to your triggers. It’s also important to ensure you stay well hydrated in evening hours and important not to miss your pre-dawn meal.
What to do if you are taking a medication for another condition that is two or three times a day? its always best to speak to your doctor initially if you have a medical condition which requires you to take medications two or three times a day. It most likely would not be appropriate to take these medications closer together in the hours that you can and this can actually be very harmful if you do. Your doctor may be able to give you medications that are longer acting and will still have the same effect.
If you need to take medications for short term conditions such as antibiotics and pain killers and are fasting, discuss this with your doctor or pharmacist and they can advise you on certain antibiotics that can be taken once per day and painkillers that are longer acting and can also be taken once per day.
- If you are diabetic, speak to your diabetic nurse or GP to check that you are safe to fast.
- If you have type 2 diabetes and use and adjust your own insulin, you will likely need to reduce your insulin dose before fasting. But ensure you check this with your nurse or doctor.
- If you are diabetic, check your blood glucose regularly throughout the day and be aware of any feelings of light headedness and dizziness. Have a sweet drink or sweets with you in case you need to break your fast.
- If you suffer from high blood pressure and it is well controlled, its recommended to monitor your blood pressure more regularly and watch out for signs of light headedness and dizziness.
- If you are fasting for longer than 12 hours and take medicines more frequently than once per day, do not double up the tablets during eating hours or take them more closely together, there is a potential to increase side effects and overdose as well as the medication not working appropriately. Check with your pharmacist or doctor for advice on how to manage this.
- For short term conditions that would require pain killers or antibiotics, ask your doctor or pharmacist on longer acting medicines that you can take less frequently, however if it is a condition that you are severely unwell you shouldn’t fast.
- Remember if your existing medical condition worsens or you feel you cannot fast you should be prepared to break your fast.
If you are unsure of whether it is safe for you to fast for not, it is important to seek advice from your doctor or pharmacist who can advise you on this and help you manage your condition and medication whilst fasting. There is more information from NHS choices which covers more questions and a great factsheet from Diabetes UK with specific information for diabetic patients and fasting in Ramadan.
Its really important for you to listen to your body whilst fasting and also ensure you keep a close eye on your family and friends who maybe fasting whilst taking medications.
Clinical Pharmacist and Director