Over the next few weeks, Muslims around the world will fast from sunrise to sunset during the holy month of Ramadan. As practicing pharmacists and fellow healthcare professionals (HCPs), we will be asked for advice from Muslim patients across all sectors about how to best manage their medication and condition before and during Ramadan and it is important for pharmacists to know where the latest guidelines and updates are and refer to where necessary. There is huge amount of information available for Muslim diabetic patients especially but there are many other chronic and acute conditions that Muslim patients have that require further intervention, ideally before they start fasting during Ramadan. We have listed some of the very best references and resources available, in no particular order, all in this one handy blog to help you with your patients to best optimise their medication during Ramadan.
There are exemptions for some Muslim patients to be exempt from fasting if they have high-risk conditions such as Type 1 diabetes, chronic kidney disease (CKD) stages 4 & 5 and Covid-19 positive for example as well as those that are currently suffering from acute illnesses such as AKI (acute kidney injury) and DKA (diabetic ketoacidosis). Of course, these patients will also need risk-assessing and further advice from their specialist and/or from their imams. However, despite these exemptions, there will be some patients that still want to participate fasting during Ramadan against medical advice and if they are on medications, they may come to seek advice from their pharmacists. Pharmacists can advise patients to adjust certain doses or timings of their regular medications as well as changing formulations such as prolonged-release forms.
There are some forms of medications such as inhalers and nasal drops, that there are some contentious disagreements between different Muslim scholars whether they are permissible for Muslim patients to take whilst fasting during Ramadan or not, so for these patients they will need to speak to their local imams/clerics as well as their HCP to confirm they are satisfied to use these formulations. Regarding the Covid-19 vaccination, most Muslim scholars agree that Muslim patients can be vaccinated during the month of Ramadan without nullifying the fast, but some may prefer to take the vaccine later on in the evening to avoid the long queues during the day.
This handy Ramadan Health Factsheet from the Muslim Council of Britain gives an easy-to-understand information for both HCPs and patients alike.
Resources for chronic condition patients
British Islamic Muslim Association – Ramadan Rapid Review
Hamad Medical Corporation – Medication Management During Ramadan
The Centre for Evidenced-Based Medicine – Is it safe for patients with Covid-19 to fast on Ramadan
Moorfields Eye Hospital – Using eye drops during Ramadan
Al Balagh Academy – Medical Fiqh of Fasting (See the YouTube video at 40:00 on which forms of medication are permissible for Muslim patients whilst fasting)
Productive Medic – Ramadan Risk Assessment Tools for chronic conditions
Resources for diabetes-specific patients
The South Asian Health Foundation Update – Managing people with Diabetes Fasting for Ramadan during the Covid-19 pandemic by S. Hanif et al
The South Asian Health Foundation (UK) Guidelines for managing diabetes: 2020 Update
International Diabetes Federation (IDF) and Diabetes & Ramadan International Alliance (DAR) – IDF-DAR Practical Guidelines 2021
DAR HCP Academy App – Excellent FREE risk-assessment tool for HCPs to help decide if Muslim patients should be fasting during Ramadan based on their current medication history
Diabetes & Primary Care – How to manage diabetes during Ramadan
Diabetes UK – Ramadan and Diabetes