This week, Muslims will welcome the arrival of Ramadan, during which we will fast for over 12 hours a day for a month. Changes in our daily routine, especially our diet, can sometimes lead to confusion for patients who take medication regularly.
From a religious perspective, there is flexibility for patients who are unable to fast. For those with chronic illnesses, discuss this matter with the treating doctor beforehand.
Generally, two issues commonly arise. The first is about changes in the timing and dosage of medications. The second issue is the use of certain medications that may either invalidate or be permitted during fasting.
BEFORE OR AFTER MEALS?
For medication that needs to be taken before meals, the recommended time is 1 hour before the pre-dawn meal (sahur), before the main meal at iftar, or 2 hours after iftar.
For medication that needs to be taken after meals, it can be taken after sahur or iftar.
TAKING MEDICINES SEVERAL TIMES A DAY
ONCE A DAY
Medication taken once a day can be taken during iftar or sahur. However, ensure that the time of intake is consistent. If taken during sahur, maintain that time throughout Ramadan.
TWICE A DAY
Medication of this type can be taken during iftar and sahur. Do not take lightly the instructions for taking medication before or after meals. Follow the rules outlined above.
THREE TIMES A DAY
For medication that needs to be taken three times a day, the suggested times are during sahur, iftar, and before bedtime.
FOUR TIMES A DAY
For medication of this type, discuss with your doctor and pharmacist. You may be advised not to fast to ensure your health. However, for some treatments, there may be alternative medications that can be taken two or three times a day. Do not adjust your dosage on your own.
CHANGES IN MEDICINE DOSAGES FOR DIABETICS
Some diabetic patients may require changes in medication or insulin dosages due to significant changes in their eating routines. However, these changes should not be made independently.
The patient's blood sugar control level needs to be monitored by a doctor. Discuss this matter with your doctor and pharmacist.
If fasting, patients need to be aware of symptoms of hypoglycaemia (low blood sugar) or hyperglycaemia (high blood sugar). Immediately break your fast if you experience these symptoms and seek medical attention as it may harm your health.
The symptoms for HYPOGLYCAEMIA are:
- Drowsiness/ lethargy
- Excessive hunger
- Shaking/ trembling
- Cold sweats
- Confusion/ emotional disturbances/ restlessness/ anxiety
- Dizziness/ fainting
The symptoms for HYPERGLYCAEMIA are:
- Excessive thirst
- Frequent urination
- Extreme fatigue
IS TAKING MEDICINES INVALIDATE FASTING?
There is a dispute over the use of some types of medication such as inhalers and suppositories whether it nullifies the fast or not. This matter is often discussed by various parties, sometimes causing controversy.
To accommodate opinions and official schools of thought in Malaysia, I suggest that all parties refer to the guidelines issued by JAKIM. The writing in this article will use what has been outlined by JAKIM in 2013. If there is any doubt on this issue, refer to the muftis and hold on to the opinion that you believe.
Types of medications that invalidate fasting include the following:
- Pills/ capsules/ tablets/ syrups that are taken orally
- Inhalers
- Pessaries inserted into the vagina
- Enemas or suppositories inserted into the rectum
- General anaesthesia that causes the patient to lose consciousness
Types of medications that do not invalidate fasting include the following:
- Eye and ear drops, provided they do not reach the eardrum
- Sublingual tablets (under the tongue)
- Injections, whether through the skin, muscle, joint or bloodstream
- Topical medications
- Mouthwash
- Nasal sprays that are not inhaled
- Local or regional anesthesia
- The use of haemorrhoid medication that involves inserting it back into the haemorrhoid area without involving the deeper cavity
Recommendations for Patients Who Need to Use Inhalers
Typically, patients are provided with two types of inhalers. The first type is used for controlling the disease, while the second type is used to relieve breathing difficulties during an attack.
I advise patients to prioritize the use of the control medication that has been prescribed. This is because the medication is typically used twice a day, and can be taken during the pre-dawn meal and the evening meal to avoid any attacks.
Good control can reduce the likelihood of using relief medication. Although some opinions state that using inhalers does not invalidate fasting, it is better to err on the side of caution.
Hope that this simple guide will benefit Muslims who are fasting. May Allah bless us with good health and grant us the strength to fast with sincerity and devotion. Ramadan Mubarak!
Fahmi Hassan is a content creator under the Newswav Creator programme, where you get to express yourself, be a citizen journalist, and at the same time monetize your content & reach millions of users on Newswav. Log in to creator.newswav.com and become a Newswav Creator now!
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