INFO - Medication changes suggested during Ramadan fast

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Medication changes suggested during Ramadan fast

Rheumawire

Oct 7, 2004

Janis

Casablanca, Morocco - Ramadan begins October 15, issuing in a month of

abstinence from food, beverages, and oral drugs between sunrise and

sunset for over 1 billion Muslims worldwide. Dr Nadia Aadil (Laboratory

of Pharmacology and Toxicology, Faculty of Medicine, Casablanca,

Morocco) and colleagues review the clinical implications of the Ramadan

fast in the October 2, 2004 issue of BMJ [1].

" Dosing schedules have to be altered during Ramadan. In fact, drug doses

can be taken only between sunset and dawn, and the time span between

them is shorter than outside Ramadan, " Aadil writes.

Patients who are ill are not required to perform the Ramadan fast, but

many who live with chronic diseases elect to do so. Potential problems

depend in part on the drug dosing schedule. With drugs taken once daily,

time of dosing is important. Drugs usually taken in the evening pose

little problem. Aadil says that with once-daily drugs usually taken in

the morning or during the day, care should be taken when delaying the

dose until evening, since this can alter treatment efficacy or the

adverse-events profile.

Drugs requiring 2 or more daily doses are more problematic. " During

Ramadan, accurate distribution of drugs prescribed twice a day is

difficult to achieve between the break from fasting and the beginning of

fasting. Refraining from fasting according to the Islamic rules could be

a wiser prescription. Nonetheless, patients with 2 doses could take the

first one at the break of fasting and the second one before the

beginning of fasting, in which case the dosing time and the time span

between doses are both altered, " Aadil says.

Switching to slow-release formulations or to a drug with a longer

elimination half-life may permit reducing the number of doses required

each day. " Patients who are prescribed drugs such as ibuprofen

(half-life 2 to 3 hours) or flurbiprofen (half-life 3 to 4 hours) need

to take doses 3 or 4 times a day to maintain a concentration of the drug

in the body tissues sufficient to provide adequate pain relief. These

drugs could be replaced by a single daily dose of piroxicam (half-life

26 to 38 hours), which is more suitable for the fasting patient, " Aadil

says.

When meals are eaten can alter drug bioavailability. For example,

alendronate taken either 60 or 30 minutes before a meal is 40% less

bioavailable than if taken 2 hours before eating. Aadil says that during

Ramadan in Morocco, 3 meals are typically served between sunset and

dawn. The first, immediately after sunset, contains considerable fat and

carbohydrates, which can alter drug bioavailability. The second meal is

mainly meat, eaten 3 to 4 hours later. The third is a breakfast-like

meal eaten 30 minutes to 1 hour before sunrise.

The situation is complicated by the fact that during Ramadan, patients

often change the times of medication doses, the number of doses, the

interval between doses, and even the total daily dosage of drugs taken

without consulting a physician.

" For patients with chronic diseases, the new dosage regimen to be used

during Ramadan needs to be established beforehand. Patients must also be

informed about when they should take their drugs (before, during, or

after food intake), particularly when they are treated with drugs of

which the absorption could be impaired by food intake, " Aadil says.

Several types of medication are allowed throughout Ramadan, including

creams and medicated plasters with substances absorbed through the skin

and drugs given by injections through the skin, muscle, joints, or veins

(except for intravenous feeding).

Source

Aadil N, Houti IE, Moussamih S. Drug intake during

Ramadan. BMJ 2004; 329:778-782.

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Mayo Clinic in Rochester

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