Drug Therapy in Ramadan-Facts of Fasting

Drug Therapy in Ramadan-Facts of Fasting

Athira .M, CLINICAL PHARMACIST, KIMSALSHIFA HOSPTIAL

        Ramadan is a warm, community celebration for practicing Muslims that involves a month of fasting during daytime, intense worshiping and feasting. Ramadan is the most religious stage of the Islamic calendar and over this period, between dawn and dusk, individuals refrain from eating, drinking, smoking, intercourse and obviously from taking oral medications. The duration of daily fasting is significantly influenced by seasonal and geographical conditions, which may vary from 11 to 18 hours per day. Every year, Ramadan falls on the ninth month of the lunar Islamic calendar, which means it moves ahead by a couple of weeks on the Western (Gregorian) calendar. For the next few years, Ramadan will fall over the longest days of the year. For Muslims, the goal is to improve their spiritual and physical state and to fortify their relationship with God.

 

The excused and unexcused

     Fasting during Ramadan is mandatory for all adult Muslims who are of sound mind and physically fit to tolerate it. Anyone who is traveling, sick, pregnant or breastfeeding during Ramadan can make up the missed fasts when capable. Similarly, women who are menstruating or who have postpartum bleeding , perform their fasts after bleeding has stopped. Most important, exceptions are made for people who cannot perform the fasting safely, such as the elderly and those who are chronically ill (e.g., those with diabetes). Instead, they can honor Ramadan through charity, such as by feeding a less privileged person in lieu of fasting.

       It is also important to note that as Ramadan is believed as the month when the Holy Quran was revealed and most blessed &divine month of the Islamic calender,the spirit is high among the followers, people in our area, that is Malabar region of Kerala where most of the residents are practicing Muslims. As a result, there is a strong desire to participate in all aspects, even when exceptions can be made for chronic illness. Thus, many patients still choose to fast and do not disclose this to their health care professionals, even if it puts their health at stake. Similarly, some children may also insist upon fasting, although they usually fast for only a portion of the day.

         

The manipulations

      As the word Ramadan itself means 'to burn' ,Caring for patients who practice the holy month represents a unique undertaking for health care professionals, including pharmacists. Individuals who take chronic medications need to adjust medication schedules so they can be taken between the evening meal of Iftar (sunset) and the morning meal of Suhoor (dawn)

      According to the data that are available, patients arbitrarily modify the times of doses, the number of doses, the time span between doses, and even the total daily dosage of drugs during the month of Ramadan, often without seeking any medical advice.

The obstacles

    Although the regimen for single daily dose medications especially those which are taken 'at night or bed time' can be continued without any alterations,the doses which are to be taken more than 'once daily' remains a major concern as for most 'b.d' drugs a 12 hr interval between doses can not be maintained and for 't.i.d' or less interval doses,the doses of day time can not be administered for those who are on fasting.

--Two or more daily doses

During Ramadan, accurate distribution of drugs prescribed twice a day is difficult to achieve between the break from fasting and the beginning of fasting. Refraining from fasting according to the Islamic rules could be a wiser prescription. Nonetheless, patients with two doses could take the first one at the break of fasting and the second one before the beginning of fasting, in which case the dosing time and the time span between the doses are both altered.  In the event of therapeutic problems during Ramadan,the number of doses should be reduced by using,when available, slow release formulations or chronotherapeutic formulations

--Interaction with food intake

The difference in pattern of food intake from the usual calender -the feast when breaking a fast,consumption of high fat food into an empty stomach-can be a problem as the absorption of drug at times is  reasonably affected by the presence of food in the stomach.

For some good reasons, maintaining hydration for diabetic patients,avoiding triggers for those with migraine worries and maintaining accurate intervals between food intake for gastric patients etc, are also at risk on fasting conditions

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The Tactician

   Clinical pharmacist has a very critical role to play in managing and maintaining the better health of patient by helping them to form a strategy to bypass the relatively negative effects,if any,happen during the practicing of Ramadan, and also in identifying and counselling those who are not in a safe therapy if they still continue fasting by keeping their health at stake. The clinical pharmacists should give special consideration to the safety of fasting and address required changes in pharmacotherapy and lifestyle to avoid potential hazards of fasting.

References

1.        Kelly Grindrod,Wasem Alsabbagh.Managing Medications During Ramadan Fasting.CPJ/RPC. 2017; 150(3):146-149

2.        Ashley B. Benjamin,Leland W. Dennis,Mahshid M. Mosallaei-Benjamin.Medication concerns during ramadan fasting. Current psychiatry. 2005; 4(9):64-65.

3.        Osama H, Mohamed Ibrahim. Pharmacist Role in Pharmaceutical Care during Ramadan. Pharmacology & Pharmacy.2015; 6 :589-599