During Ramadan, some alterations take place in the functioning of our body. Changes in the circadian rhythm (internal body clock) of biochemical, physiological and behavioural processes also occur. As a result drug absorption, their bioavailability, toxicity as well as interaction between food and drug may be affected.
The situation may be compounded when medications are taken indiscriminately. It has been found that many patients with chronic illness often insist on fasting and do not take their medications or take all the drugs in one single dose leading to emergency hospitalization.
Patients who take their medicine two or three times a day may switch to slow-release once daily formulations. for example, patients taking drugs for high blood pressure (two or three times a day) may change over to once daily preparations. Similarly, asthmatic patients who are taking theophylline two or three times may change to slow-release once daily formulations.
Again, the absorption of some drugs are also affected by food and the quality of food. for instance, Rifampicin (a drug used in tuberculosis) should be taken in empty stomach and during Ramadan, it should be taken 30 minutes before pre-dawn meal. Moreover, quality of certain food also decrease absorption such as spicy, fatty foods taken during Ramadan decreases the absorption of certain drugs.
Intake of beverages like tea, coffee, orange juices, and smoking at the time of breaking fast can increase gastric acidity resulting in gastro-intestinal side effects. Thus, many medications need readjustment during Ramadan.
For such situations a doctor should be consulted. Fortunately many drugs are available in slow-release once daily formulations for better patient's compliance particularly during Ramadan. Studies have shown that many patients arbitrarily change the dose and timing of their medications without taking medical advices. Moreover, many patients are also not aware of the medications they can take during Ramadan without breaking the fast.
The choice of drugs and the route of administration remain a matter of concern for many patients and doctors. To settle the difference of opinions and to standardise the choice of route of administration a religious-medical seminar was held in Morocco, participated by distinguished Muslim Jurists, Religious experts, medical practitioners and pharmacologists and specialists in other human sciences.
In the seminar entitled "An Islam view of certain contemporary medical issues" the main focus was on the substances and actions that nullify fasting.
In the discussion it was agreed unanimously that the following routes of administration of drugs do not nullify fasting:
1. Anaesthetic agents.
2. All substances absorbed into the body through skin such as cream, ointments, medicated plaster etc.
3. Anal injections.
4. Eye and ear drops.
5. Insertion into the vagina of pessaries, vaginal washes, medical ovules etc.
6. Injection through the skin, muscle and joints or veins (excepting I.V. feeding).
7. Inhalers for asthma.
8. Mouth washes, gurgles, oral sprays provided nothing is swallowed.
9. Nitroglycerine tablets placed under the tongue for treatment of angina (heart pain).
10. Nasal sprays and drops.
12. Surgery involving general anaesthesia.
In conclusion, Ramadan is a period of altered body rhythm and life habits. Accordingly, drug dosing needs to be adjusted. The timing of intake of medicine (before, during or after food) influence the absorption of drugs. Ramadan is further characterized by repeated fasting and breaking of fast and altered circadian rhythm that last four weeks.
These changes influence the chronobiological parameters (i.e, the route of administration/the dosing, absorption, food-drug interaction and bioavailability etc) which can last beyond the end of the Ramadan.
Therefore, return to the pre-Ramadan bodily functions may take some more time. This fact should be kept in mind both by the patients and medical practitioners.