Ramadan and other fasts: how to combine them with your medication

Fasting with a long-term condition is possible in many cases, but you need to plan with your doctor how and when to take each medicine.

You can combine Ramadan or another fast with your medication if you plan it with your doctor in good time: doses are usually moved to the hours when you can eat and drink, but some medicines need dose or regimen changes that only your doctor can decide. What you should never do is stop your treatment or change it yourself.

In this article we explain how to prepare, what to ask and when you should break the fast.

Can you fast during Ramadan if you take daily medication?

It depends on your condition, your medicines and your general health. Many people with stable long-term conditions can fast by adjusting the timing of their doses with their doctor's help, but there are situations in which fasting is not advisable.

The safe fasting guidance from NHS North East London (2023) notes that fasting is not considered compulsory for people with an acute illness or a long-term condition that may be worsened by fasting, nor for people who are very frail, among others. In Spain, the leaflet on diabetes and Ramadan from Melilla District Hospital (INGESA) lists contraindications including kidney or liver failure, dementia, uncontrolled cardiovascular disease and malnutrition.

How far ahead should you talk to your doctor?

Weeks or even months ahead. The INGESA leaflet advises booking an appointment with your doctor before Ramadan to plan how to manage your diabetes, and the NHS guidance says it is prudent to discuss medication changes a few weeks or even months beforehand.

1. Take your complete medication list, with times and doses.
2. Explain when you will eat (before dawn and after sunset) and how many hours the fast will last.
3. Ask which medicines can change timing, which cannot and whether any need a dose adjustment. Never make that adjustment yourself.
4. Ask which symptoms or readings should make you break the fast and whom to call if that happens.
5. Ask your pharmacist to help you reorganise your doses around the new times.

How are doses usually reorganised?

In general, oral medicines are moved to the times when you can eat and drink: the pre-dawn meal (suhoor) and the meal after sunset (iftar). But every case is different, and some medicines have critical timings that cannot simply be moved at will.

As for inhalers, injections or drops, the NHS guidance says inhalers are generally considered compatible with fasting, although schools of religious thought differ. The religious question is for your imam or the religious authority you consult; the medical one is for your doctor. If you have diabetes, there is more on day-to-day management in type 2 diabetes and work.

When should you break the fast?

When your health is at risk. If you have diabetes, the INGESA leaflet says to break the fast if your blood glucose falls below 60 mg/dl, below 70 mg/dl in the first hours of fasting, or rises above 250 mg/dl. Your doctor may give you different figures for your case.

• Symptoms of low blood sugar: sweating, shaking, irritability, dizziness or confusion.
• Signs of dehydration: intense thirst, dry mouth, headache, cramps or palpitations.
• Your condition getting worse, such as more breathlessness, swollen ankles or chest pain.

In any of these situations, break the fast, take what you have been told to take and contact your health centre or A&E if you do not improve.

What if you follow another kind of fast?

The same principles apply to other religious fasts, such as Yom Kippur or those of some Christian traditions, and to intermittent fasting for health or weight reasons. If you are going to go many hours without eating or drinking, check with your doctor or pharmacist first, especially if you take medicines for diabetes, blood pressure, your heart or anticoagulants. For general guidance on doses taken on an empty stomach, you can read our tips for taking medication on an empty stomach.

A practical example: Youssef and his first Ramadan on medication

Let us take the case of Youssef, 49, a delivery driver with type 2 diabetes and high blood pressure. He takes a diabetes medicine twice a day, a blood pressure tablet in the morning and a statin at night, and wants to fast this year. Two months beforehand, he books an appointment with his GP and takes his medication list.

His GP assesses that his diabetes is well controlled, goes through with him which medicines he can take at suhoor and which at iftar, and tells him when to check his blood glucose and when he must break the fast, especially while driving for work. His pharmacist prepares a sheet with the new times. Youssef also asks his imam about his religious questions. The case is illustrative: every regimen is decided by the doctor.

How can IMA Health help?

When your mealtimes change, having each dose ready avoids confusion. With IMA Health, a specialised pharmacy prepares your medication by day and time of each dose, following the regimen your doctor has set, and personalised follow-up helps you adapt it when your routines change. IMA coordinates with the pharmacy and delivers to your home.

Sources

• INGESA, Melilla District Hospital: Diabetes and Ramadan (2021, in Spanish)
• NHS North East London: Guidance for Safe Fasting During Ramadan (2023)

This article is for information only and does not replace advice from your doctor or pharmacist.