Ramadhan is the ninth month in the Islamic Hijri calendar where Muslims are expected to fast every day from dawn to sunset. The eating behaviour changes during Ramadhan and the abstinence of food and drinks affects the oral drugs administration and other convenience dosage forms. There is a need to highlight and illustrate the role of the pharmacists in medication adjustment challenges that the patients conquer in the Holy month of Ramadhan.
Pharmacists have an essential role in advising and counselling patients who are observing Ramadhan. By understanding the possible compliance and adherence issues, pharmacists can support Muslim patients during this time.
Patient consultation is vital when preparing patients for Ramadhan. Patients should be advised to plan ahead of fasting by visiting their local pharmacy to discuss their medicines and health needs.
It is important for healthcare professionals to recognize the changes that can occur in the body during fasting. During a fast, the body generates its own energy by burning stored excess fats, carbohydrates and sugars to produce energy. Metabolically, early fasting is characterized by a high rate of gluconeogenesis with amino acids as the primary substrates. Several hormonal changes occur during fasting, including a fall in insulin and T3 levels and a rise in glucagon and reverse T3 levels. This can provide a better understanding of patients’ medical needs and limitations, allowing them to make suitable adaptations to medicine regimens in line with the demands of Ramadhan. Medicines come in various pharmaceutical forms and can have different routes of administration. Many oral medicines come in other forms, including injections, patches, suppositories, pessaries and inhalers. Not all the different drug formulations are prohibited from use during fasting according to many classical and contemporary scholars.
Healthcare professionals should work together with patients to see if changes can be made to their medication regime or to titrate doses according to the fasting routine, however, this may not be possible in all cases. In these situations, the healthcare professional must provide the patient with all the facts and advise them to consult an Islamic scholar. Many drugs prescribed for various conditions are available as immediate-release, medium-release and sustained-release. This means that certain types of medicines can remain and be effective in the body for longer periods of time, reducing the need to take medicines multiple times during the day. Muslim Patients who are observing their fasting should inform their Pharmacists or Doctors about it to make for them alterations of some of the medicines to a different formulation or revised dose timings to fit around fasting and patients should not stop or alter any prescribed medicines without consulting their pharmacist or GP.
Patients with long-term conditions, such as diabetes, asthma, chronic obstructive pulmonary disease, high blood pressure or heart disease, need to seek medical advice from their pharmacist and GP.
Patients can be advised to discuss their medication, including types of medical devices and medicines that retain the validity of the fast, with an appropriately qualified Islamic scholar. However, this discussion should take place in conjunction with their healthcare professional who is the most qualified to determine the significance of the medication and the possible impact on the health of the patient.
The Qur’an specifically exempts patients with severe or acute medical conditions who are either at risk of getting worse from fasting or where fasting will directly impede them getting better. This also applies to patients with infections that require the immediate use of antibiotics. A patient’s health takes precedence over fasting, but patients can make up missed fasts when their condition becomes more stable.
Who is exempt from fasting?
Fasting during Ramadhan is obligatory for almost all Muslims. However, the Qur’an states that those who are exempt from fasting include: Children; women who are menstruating; elderly or frail patients; those suffering with a severe mental illness or condition; and those suffering with a chronic illness, where fasting can cause detriment to health.
Muslims fast from dawn until dusk and therefore consume meals just before dawn and after dusk (called suhoor and iftar, respectively). In the Rwanda, depending on which month Ramadhan falls in, fasts can range from between 12 hours and 14 hours.
Eating, drinking (including water), sexual activity, smoking and administration of medicines orally and intravenously are prohibited during this time. However, these activities can continue at dusk until the next fast resumes at dawn.
As a healthcare professional, it is essential to ensure that the patient’s autonomy is maintained. Patients should be given all the available information in order for them to make an informed decision. Healthcare professionals need to be sensitive of the fact that, by not fasting, not only do people feel disappointed that they cannot take part in a significant religious ritual, but they can also feel excluded from their community and family life.
The writer is a pharmacist at Mediasol Pharmacy ltd