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Medicines and ramadan . How and when to take them .

 We came across this brilliant guide attributed to  Dr. Maqbool Al Balushi

Drug Intake During The Ramadan!


As we are approaching towards the holy month of Ramadan, it's important to ensure that the patient's in our circle are taking their medications at the right time to maintain their health and well-being. This is particularly important for those who are managing chronic conditions that require multiple medications.

Being pharmacists it's our utmost duty to counsel and guide the patient's that will help them in keeping track of their medications time during Ramadan.

For this, Dr. Maqbool Al Balushi did a great effort and put together a list of mostly used drugs and their recommended timings for iftar or suhoor. By following this list, you can ensure that the patient's will stay on top of their medication schedule and can maintain their health throughout the holy month.

Some important counselling points are:

✓Try to switch to longer acting (Extended-release form that requires to be given once or twice daily)
✓Patients with chronic unstable medical conditions should be advised not to fast (Patients may be reminded about conditions that exempted from fasting according to Islamic scholars rules if possible) but choice of fasting is entirely left on patient to decide, we as healthcare professional are involved in advising and informing the patient.
✓Special attention must give to elderly patients and patients with chronic co-mordities (multiple medical
conditions) who are on polypharmacy that may further pose their health at risk.
✓Always seek advice for clinical judgment

I hope you find this resource helpful, and wish you a blessed Ramadan! 


Ramadan drug modification support tool

original below 

https://media.licdn.com/dms/document/C4D1FAQGslls4hveBbw/feedshare-document-pdf-analyzed/0/1679146920663?e=1680739200&v=beta&t=HOVkWY0uvmmG00_iYFk54TPdMSO4BTO0lFMJRQTn6B0


first few pasted below 


DRUG INTAKE DURING RAMADAN
DISEADRUGSPECIFICATIONRECOMMENDATION
SECATEGORY
Beta- Blockers
BisoprololODTake after Suhoor
. MetoprololODTake after Suhoor
. AtenololODTake after Iftar and Suhoor
PropranololBID/TIDTake after Iftar and Suhoor
LabetololBID/TID/QIDCalculate the TDD and give BID after
MethyldopaBID/TID/QIDIftar(2/3) and Suhoor(1/3)
ClonidineBID/TID
CarvedilolBIDTake with fatty meal (dinner) to avoid abrupt
fall in BP
ACEsOD - Monitor for posturalTake after Ishaa praying
Avoid taking with largehypotension e.g. dizziness
amounts of dates, bananas,BID/TID – Shift to long-acting
oranges, green leafyLisinopril OD - Monitor forTake after Ishaa praying
vegetablespostural hypotension e.g. dizziness
Enalapril 5mg
ARBsValsartan OD/BIDTake after Ishaa prayer
Losasartan ODTake after Iftar and Suhoor
CCBs
Dihydropyridine e.g.
amlodipine or nifedipineOD/ BIDTake after Iftar or Suhoor
Non–dihydropyridine e.g.Take after Iftar and Suhoor
verapamil and diltiazemOD/BID/TID
Thiazide diuretic
HydrochlorothiazideOD - might cause dehydrationTake after Ishaa prayer
MetalazoneAvoid taking suhoor time
Loop diuretic.OD - might cause dehydration
- furosemideBID- TID – Change to OD or BIDTake after Ishaa prayer
For HTN ODAvoid Suhoor time
For HF depends on patientsTake after Iftar (larger dose) and midnight
clinical condition – OD/BID(dose)
Carbonic AnhydraseAcetazolamide 250mg OD/BIDFor OD take after iftar
InhibitorsFor BID take after Iftar and midnight
Amiloride 5mg/OD
SpironolactoneOD – HF-depends on patientTake after iftar prayer
clinical conditionLiver cirrhosis – fasting not advisable
BID /TID – Liver cirrhosis
HydralazineEvery 6 or 8 hoursOption 1:
Take the total dose in two divided doses,
monitor blood pressure
Option 2:
Change the drug if possible to longer acting

Alpha blocker;OD –
- Tamsulosin - BPHMonitor for postural hypotension
- Alfasulosin - BPHe.g. dizzinessTake after Iftar
- Terazosin - HTNBD/TID/QID – change to
- Prazosin - HTNextended-release OD
Monitor for postural hypotension
DISEASEDRUGSPECIFICATIONRECOMMENDATION
CATEGORY
Antiplatelet e.g.OD - Aspirin and clopidogrelOD: take after the full Iftar meal (preferably
aspirin,Increased resistance in diabetic8pm):
clopidogrel andpatients during fastingCombination : take after the full Iftar meal
dyrypidimoleCombination of aspirin and(preferably 8pm):
clopidogrel1-To achieve the full synergistic effect next
day morning 10 am where platelet
aggregation is at highest rate induced by
both drugs
2-After meal to avoid the stomach irritation.
Strict adherence is recommend
Antiplatelet e.g.BIDAfter Iftar and Suhoor Interval between
ticagrelordoses should not be less than 8 hours
Contrast mediaIncrease risk of contrast inducedAdvise not to fast
after angioplastynephropathy due to dehydration
Nitrates (MR) e.g.ODTake after Ishaa Iftar
IsosorbideMonitor for postural hypotension
Monotrate
Nitrates (IR) e.g.BID/TIDOption 1: Convert to long acting
IsosorbideOption 2: Give Bid the same dose and to be
dinitratetaken 2 hours after Iftar and 30 min before
Suhoor.
Fasting reduces Sympathetic Nervous
System where the possibility of angina
attacks will be low.
Seek clinical judgment
Contrast mediaIncrease risk of contrast inducedAdvise not to fast
after angioplastynephropathy dehydration
GTN spray/tabletPRNDoes not invalidate fast
Anytime as needed

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