Advice for the sick who fast
By Saghir Akhtar
The sick are exempt, but many continue to fast and, therefore, abstain not only from eating and drinking but also from taking oral medications and intravenous fluids.
Ramadan fasting is obligatory for healthy adults, but when fasting may significantly affect the health of the fasting individual or when one is genuinely sick, Islam exempts them from fasting. However, a significant number of ill patients do decide to observe the fast. And such patients need to seek the opinion of health professionals on an individual basis.
Those suffering from minor ailments really do not have any problems fasting. Those suffering from acute conditions may need advice about altering their dosing regimen, or the amount and frequency of their medications. Drugs that are normally required to be taken frequently, such as many antibiotics, can be problematic for the fasting patient. However, the increasing availability of alternative drugs with long half-lives (circulation times in the body) and the increasing formulation of short-acting drugs as sustained release preparations offer much needed assistance to fasting patients.
Patients suffering from acute upper respiratory infections, such as a severe sore throat may still be able to fast. Normally, such a patient may be prescribed antibiotics that have to be taken 3 or 4 times a day and would not be able to fast. However in order to facilitate fasting, the patient could be given a long-acting antibiotic such as Septrin (co-trimaxozole), which only needs to be taken once every 12 hours, or Zithromax (azithromycin), which only needs to be taken once daily. This can only be done when the infecting organisms are treatable with the alternative antibiotics and this needs to be discussed with the patients own doctor on a case-by-case basis.
Alternative routes of drug administration, such as use of transdermal (skin) patches, may help fasting patients. Those suffering from mild forms of angina pectoris, a heart condition, could benefit from taking their medication, glyceryl trinitrate, as a skin patch rather than sub-lingual tablets. Here, the drug would be effective by entering the blood stream through the skin, and not orally (which would break the fast). Again, this may only be possible in specific patients and needs to be discussed with their doctor. Pharmacists are generally willing to advise patients on the availability of alternative dosage forms for medication during Ramadan.
Sustained release formulations may help fasting patients suffering from mild forms of hypertension (high blood pressure). The patients can be given their drug in formulations that only require once-daily dosing. The drug can be administered orally at Sehri, and the special formulation then allows the drug to slowly release into the body over a day. In fact, there is a school of thought among medical practitioners that those patients who have mild to moderate high blood pressure, and are also overweight, should be encouraged to fast as fasting may help to lower their blood pressure. Such patients should see their physician to adjust medication. For example, the dose of diuretics should be reduced to avoid dehydration, and sustained release formulations such as Inderal LA can be given once a day before Sehri.
Medical practitioners are likely to advise patients suffering from diabetes mellitus about fasting. Many Muslims, especially of Asian descent, have an increased risk of suffering from some form of diabetes. The International Journal of Ramadan Fasting Research has suggested the following guidelines: Diabetic patients who are controlled by diet alone can fast and hopefully, with weight reduction, their diabetes may even be improved. Diabetics who are taking oral hypoglycaemic agents along with dietary control should exercise extreme caution if they decide to fast. These patients should consult their doctors for dose adjustment. If they develop low blood sugar symptoms in the daytime, they should end the fast immediately.
In addition, diabetics taking insulin should consult their doctor to see if their dose can be adjusted for them to fast during Ramadan. In all cases of Muslim diabetics fasting, they should closely monitor their blood sugar levels, especially before and after meals.
In summary, Islam offers an exemption to the sick from observing their fast during the holy month of Ramadan. However, some patients may be able to fast if their health is not adversely affected during the period of fasting. In such cases, advice from pharmacists and doctors about changing prescriptions to equally effective drugs that have reduced dosing may be beneficial. In all cases of illness, it is recommended that Muslim patients, if they fast, do so under medical supervision.
Source: BBC
