Hamad Medical Corporation (HMC) has issued some general recommendations for the use of medications during Ramadan.
Prof Moza al-Hail executive director of pharmacy, HMC says that according to recent studies, many patients change their medication routine without talking to their physician which can lead to suboptimal management of their medical disorders.
Therefore, all patients are advised to consult their doctors before deciding to fast for optimal care during the holy month of Ramadan.
She has also cautioned the patients neither to stop taking medication nor change the doses without consulting the physician.
She has also asked to avoid taking any medication on empty stomach before Iftar to avoid gastric irritation.
She has also noted that certain treatments and procedures do not invalidate fasting according to resolutions and recommendations of the council of the Islamic Fiqh Academy. These are: Eye and ear drops; all substances absorbed into the body through the skin, such as creams, ointments, and medicated plasters; injections through the skin, muscle, joints, or veins, with the exception of intravenous feeding; oxygen and anaesthetic gases; nitroglycerin tablets placed under the tongue for the treatment of angina; mouthwashes or oral sprays provided nothing swallowed enters the stomach; suppositories/pessaries (rectal/vaginal); nebuliser; enema and asthma inhaler The official told that if medication is taken once a day for high blood pressure, it can be taken after Suhoor or Iftar preferably after Taraweeh Prayer at the same time every day.
If more than one medication is needed, it can be distributed between Iftar and Suhoor.
Patients should consult their physician before deciding to fast, especially in case of heart catheterization and stent placement because the patients exposed to contrast media during catheterization and who wish to fast, may have an effect on their kidney function.
According to the official, nitrate spray and sublingual tablets do not invalidate fasting, as they do not reach the throat.
Patients on swallowed nitrates tablets are advised to take their pills after Taraweeh Prayer at the same time every day to avoid dizziness while praying.
It is advisable to take blood thinner medications such as aspirin, clopidogrel an hour after Iftar.
Patients with heart valve disease and atrial fibrillation are advised to take warfarin, which is used to prevent blood clots, after an hour of Iftar and keep checking their international normalized ratio level to see the effect of fasting.
Patients who are on diuretics (water pill) like Lasix are advised to not take the medication with Suhoor as these medications usually last for six hours and may result in decreasing the amount of water in the body. Further, diuretics can decrease the amount of magnesium and potassium levels that are important for the function of the heart. If the patient is taking salt supplement tablets such as magnesium, it is advisable to take it with Suhoor meal to replace the loss during fasting.
If patients with irregular heart rate decide to fast, they should consume potassium and magnesium-rich food such as strawberry and banana. For a high level of cholesterol, long-acting drugs such as Rosuvastatin and Atorvastatin can be taken after Iftar, while short-acting drugs such as Simvastatin and Pravastatin can be taken before sleep.
For people with heartburn, medications such as Pantoprazole and Ranitidine should be taken before Suhoor to reduce acidity during fasting.
Patients with migraine should consult their physicians before deciding to fast, to avoid migraine episodes.
Medications for treating an acute episode of migraine are available now as inhalers and subcutaneous injections which do not invalidate fasting; therefore patients can continue using them while fasting.
Inhalers used by asthmatic patients do not invalidate fasting because it does not reach the stomach.
Patients taking antibiotics should consult their physicians before deciding to fast during the antibiotic course and should drink enough fluids after Iftar.
If it is once daily dose it can be taken after Iftar, and if twice daily, it should be after Iftar and Suhoor but if the dose is three times or more, fasting will be difficult as the non-fasting period is only nine hours.
Patients taking medications for enlarged prostate and overactive bladders like tamsulosin and Solifenacin should take their dose after Iftar or after Taraweeh.
The effect of fasting may vary between diabetic patients depending on their blood sugar levels.
Hence, all diabetic patients should consult their physicians before Ramadan because some medications need to be adjusted.
Patients on Metformin are advised to take the dose after the full meal to reduce gastric irritation.
Patients on insulin are advised to test their blood sugar levels before Iftar especially in the first days of Ramadan and inform the physician about the readings in order to adjust their insulin doses at Suhoor time.
In relation to the insulin dose after Iftar, it is advisable to administer it with the main meal because it may reduce the sugar level in blood.
Patients on one daily dose of medications that stimulate the pancreatic beta cells to secrete insulin such as Glibenclamide and Gliclazide can take their doses after Iftar.
However, if the patients are taking their doses twice daily, they should consult their physician before Ramadan.
Patients should be aware of the signs of low blood sugar such as sweating and rapid heartbeat.
Blood sugar testing should be performed and the patient should break his/her fasting if the blood sugar is low.
Some anti-diabetic medications may cause dehydration like Dapagliflozin so it is recommended to take it after iftar and drink a good amount of fluids.
Patients with seizure are highly recommended to consult their physicians before deciding to fast.
If the medication is taken once daily, it can be taken after Iftar or suhoor. If the medication is taken multiple times during the day, the patient should consult their physician.
Cancer patients should consult their physicians before deciding to fast because the effect of fasting on cancer patients relies on several factors including the type of cancer, progression of cancer, therapeutic plan (medications and side effects).
As for thyroid disorders, the proper administration time for thyroxine is half an hour before Suhoor as it makes it feasible to be on empty stomach.
Corticosteroid medications like prednisolone and hydrocortisone are better to be given after Suhoor.
Pain management medications like ibuprofen can be taken after full iftar meal to avoid gastric irritation.
Pregnant women are advised to seek their physicians’ advice before deciding to fast.
Pregnant women can fast if they do not have complications.
They should stay well hydrated in the evening hours and stay out of the heat when possible.
Pregnant women must break their fasting and consult their physicians immediately if they experience any of the following symptoms: dizziness, heart palpitations, severe headache, vision disorders, or decreased fetal movement.
Breastfeeding women are advised to seek their physicians’ advice before deciding to fast. They can fast if they are healthy. They also have to follow a balanced diet before and during Ramadan to maintain healthy milk production.
Breastfeeding women are advised to drink plenty of water, milk, yogurt and fresh juices that are rich in vitamins. They should avoid strenuous activities during fasting to prevent fluid and calorie loss.
Further information about medications can be collected from the corporate pharmacy drug information center at 4026-0747/4026-0760/4026-0759.
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