How Pharmacists Can Optimize Care for Muslim Patients During Ramadan

Ramadan is the ninth month of the Islamic calendar. During Ramadan, Muslims stay away from eating, drinking, smoking, and sexual activity, in addition to oral medications being prohibited, from sunrise to sunset. The fasting period can last about 10 to 19 hours per day depending on the region, after which they can engage in these activities until the next fast at dawn.

Fasting during the month of Ramadan is compulsory for sane and healthy Muslim adults. Besides abstinence from food, there is also a change in the sleep pattern with a prolonged restlessness during the night.

Many Muslims see the month of Ramadan as an opportunity to make healthy changes to their lifestyle and quit harmful choices, such as smoking.

Exemptions from Fasting Ramadan

Some individuals and situations have been exempted from fasting. These include: neonates, women during their menstrual period, travelers, elderly or frail patients, mentally disabled, breastfeeding women when fasting for long hours will cause discomfort for the baby and the mother, and people living with chronic and acute diseases.

Physiological Changes That Occur During Fasting

During fasting, the body enters a state of gluconeogenesis, which is a natural process in which the body generates glucose from non-carbohydrate substrates. Since no carbohydrate is coming in, the body makes use of the excess fat to produce energy and conserves this energy during fasting.

As the fasting period prolongs, the body observes a slow metabolism. At this point, there is a reduction in the heart rate and body temperature. Some changes also occur in the hormonal levels, such as a reduced production level of insulin and a rise in glucagon.

Pharmacists need to know the changes that occur in the body during fasting. This information will help them understand the patient medical needs during fasting and make proper adjustments in the treatment regimen where necessary.

Challenges Patients Face During Ramadan

Spiritual and religious beliefs are important social determinants that can affect a patient’s attitude toward treatment. With this, health care professionals need to have a basic understanding of these socio-determinants to deliver culturally relevant care.

Some patients may feel left out from this practice when they are not allowed to fast because of their medical conditions. For example, patients with chronic or acute medical conditions or patients whose medical condition may get worse from fasting are exempted.

Despite this exception, patients may choose to discontinue medications or alter treatment regimens against medical advice. This, of course, can lead to serious complications, such as hypoglycaemia, dehydration, irritation, and forgetfulness. This supports the idea that Ramadan may be a cause for non-compliance to medications.

Ramadan can also become complicated when patients have to take medications daily, as some medications are taken more than once per day, which may invalidate the fast.

Some routes of drug administration can also invalidate fasting. Although some non-oral medications are accepted during fasting, some Islamic scholars still debate the validity of drops, suppositories, and intramuscular administration.

How Pharmacists Can Assist Their Muslim Patients

It is easy for pharmacists to make an informed choice with their Muslim patients when they know the medication types, diseases, and routes of drug administration that may invalidate fasting.

Patients, together with their health care providers, can discuss these challenges with Islamic scholars, because knowing the patient's stand on some rulings can also help the health care provider to make informed choices.

Pharmacists need to consider patients who are willing to fast, as modifications can be made to the treatment regimen. For example, if a patient is to take a medication every 8 hours, the pharmacist may suggest another alternative that can be taken once per day. Further, if there are no alternatives, the pharmacist needs to communicate clearly to the patients when fasting could particularly put their health at risk.

Pharmacists should also discuss various options available to patients suffering from chronic conditions that require them to take medicines regularly.

In all, the health of the patient is more important than fasting. In patients with diabetes, fasting can be particularly challenging because it puts patients at risk of hypoglycemia. Patients with diabetes should therefore seek the advice of their health care providers before commencing their fast due to their chronic metabolic disorder. The disorder can place them at high risk for various complications if there are changes in the pattern of their food intake. Pharmacists should also monitor the patient’s insulin level before and after fasting.

Advising patients to consume enough water before and after fasting and limiting exposure to the sun and high temperatures are also important counseling points for pharmacists.

Before the start of Ramadan, it is recommended that pharmacists plan the management of medicines and health with their patients. Pharmacists can offer professional advice to the patient’s physician when there is a need for alteration in the medicine regimens.

It is important for patients to be advised not to make changes to their prescribed medications without consulting their pharmacist or physician.

References

1.Nadia Bukhari. How Pharmacists can support and advise patients during Ramadan. Pharmaceutical Journal. 03 June 2016.

2.Heba A., Al-Moujahed A. Muslim Patients in Ramadan: A review for primary care physicians. 2017. Avicenna Journal of Medicine. 7(3): 81-87.

3.Sanvictores T., Jarett C., Martin R. Physiology, Fasting. 2020. StatPearls.