FASTING AND MEDICINE

Muslims fast during the holy month of Ramadan. While the Islamic Law exempts the sick from fasting many of them will still wish to fast.

In healthy people fasting does not seem to create much difficulties. The body’s normal mechanism will probably cope with the changes in eating and sleeping time. However fasting can create problems for patients with medical conditions and those taking medicine. For patients who are on medications they either have to make adjustments to their medicine taking time or not fast at all. They have to consult their doctors or pharmacists regarding their medication and also the religious teachers about their religious obligations so that they can make an informed decision on whether to fast or not.

As we know medicines that are taken through the mouth cannot be taken during the daytime when one fasts. These oral medicines may be taken once, twice, three or four times daily. It is advisable if those medicines that are taken four times daily are substituted with a medicine that can be taken less number of time a day. This can be discussed with the attending doctor, as there are many types of medicines that are now taken once or twice a day. Usually for medicines that are taken once, twice or three times daily, the time of administration can be adjusted more easily. If the medicine has to be taken three times then it can be taken at break of fast, at bedtime and during ‘sahur’. With once or twice daily dosing the adjustment for taking the medicine is much simpler.

When patients are needed to use certain medicines many times a day, such as using eye-drops every two hours then the patient has to follow strictly this instruction. Otherwise, the consequences can be very serious and would jeopardise the patient’s eyesight. In this situation the doctor or pharmacist must counsel the patient and explain to the patient the importance of compliance and the consequences of not using the eye drops regularly.

Likewise diabetic patients on insulin must use their insulin as instructed and therefore their meals must also be regular. In such situations, it is advisable that the patient that the patient seeks the permission of his doctor to continue fasting and to follow the doctor’s advice in making adjustments in the medicine taking schedule. Today, there are many several combinations of insulin with different onset and duration of action. What is required of the patient is to discuss with his/her doctor or pharmacist on the right type and combination of insulin that can be used for the patient’s condition. However, if the diabetes is serious and accompanied by several complications and other risk factors then it is most likely that the patient will not be allowed to fast.

Non-insulin dependent patients may fast if they feel that they are able to and their doctors allow them to fast. Patient education is very important in these patients. Education should be targeted on glucose monitoring and recognition of warning signs of dehydration and hypoglycemia. It is pertinent that patients know when to break their fast and to seek help from medical professionals when symptoms occur.

There are also other situations or conditions that require patient education to enable patient to recognise symptoms which require them to stop fasting. Pharmacists play this important role to guide patients while dispensing drugs to them.

Some medicines will act best if taken at a certain time of the day, for example medicine to treat hyperlipidaemia is best taken at bedtime. Therefore during the fasting month the time the medicine is taken should not be changed for this type of medicine. Diuretics (medicines used to remove water from the body) should be taken early in the morning during the ‘sahur’ time so that patients can have a good night sleep. If possible doctors should try to give this drug only once a day.

Many medicines are used by other means other than the mouth such as the ear, eyes, nose, and skin or inserted into the vagina, anus or urethra. Medicines are also injected into the muscle or blood stream. Asthma medications are sometimes inhaled as gas into the lungs. It is not very clear whether these medicines can be used through these routes or not. From the book by Sheikh Muhammad Salih Al-Munajid (www.islam-qa-com/Books/seyam/english.shtml) using medicines by these routes do not break the fast in his opinion, they are not considered as food. Injections that are given for purposes other than nutrition also do not break the fast. However in Malaysia, this issue has not been thoroughly studied and there is no formal guidance that has been issued by any religious authority. It is left to the individual to consult any religious authority if they are in doubt.

During the fasting month there will be many adjustments that have to be made by patients regarding their medicine taking. Not only the time of administration that matters but also there will be the effect of food on the medicine and the possible interaction between medicines, which require that the medicines be taken at different times. Patients have to be responsible for their own health and they must be prepared to break their fast if the circumstances warrant it because fasting must be performed sincerely as a Muslim who is duty-bound to his God. Fasting is like an exercise to strengthen a Muslim physically, mentally and spiritually and therefore its purpose is to make one healthy and not to harm oneself. Therefore patients need to care about their health especially when they fast. If they face medical problems they should always refer to health professionals such as the doctors or pharmacists while problems associated with the religion can be referred to their religious teachers. In this way patients can decide from the knowledge that they have acquired.