Ramadan Medication Tips | Johns Hopkins Aramco Healthcare

Safe Medication During Ramadan

As the holy month of Ramadan draws near, special considerations regarding medication compliance and appropriate diet can be anticipated. The pharmacist plays a key role in providing personalized, person-centered counseling to ensure that patients are fully informed about treatment options and dose timing changes.

Disclaimer: This information is designed to provide practical advice about safe medication use during the holy month of Ramadan to ensure healthy and safe fasting and provide general tips. Any lifestyle or medication change must be discussed first and approved by the clinician.

General patient tips for safe medication use during the holy month of Ramadan

Drugs with a single daily dose in the evening do not need modification.
For drugs with a single daily dose in the morning, the dose can be switched to the evening. However, you should discuss these changes with your clinician and pharmacist as they will assess any risks that might occur from shifting the dose to the evening, considering the change in eating and sleeping habits.
For medications that are taken twice daily, you can take the usual morning dose at the predawn meal (Suhoor)) and the second dose at the sunset meal (Iftar).
For medications that are taken three times a day or more, you may discuss with your clinician the potential to switch to different medications, such as sustained-release formulas that are taken once or twice a day. The clinician may also consider the use of non-oral formulations such as patches or topical preparations.

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Essential questions that patients may need to ask the healthcare professional

Do I need to make any changes to my medication or treatment regimen? What are the risks based on my specific health history?
Can I maintain my usual level of physical activity during Ramadan?
Are there any situations where I should break my fast?
After I finish my fast, will I need to book a follow-up appointment?
If I am a diabetic patient, how should I control my blood sugar levels during Ramadan? What changes will I need to make to my diet during Ramadan to ensure my diabetes is appropriately controlled?
Whom should I contact in case of an emergency?

Safety tips for Diabetic patients

Long gaps between food intake and certain diabetes medications (such as insulin or oral diabetic medications) are well-known risk factors for hypoglycemia (low blood sugar). Some Diabetic patients might require adjustments to their insulin or oral diabetic medications doses.
You may also want to schedule a follow-up consultation after Ramadan to discuss any necessary readjustments of your medication(s).
Seek Help: You should break your fast and seek emergency assistance if you experience symptoms of hypoglycemia or any of the following:
- Low blood sugar – Blood glucose less than 70 mg/dl.
- High blood sugar – Blood glucose higher than 300 mg/dl.
It is essential to monitor your blood sugar level closely during Ramadan and consult your healthcare professional immediately if you have problems managing your condition.

General recommendations for the management of Diabetes medications for patients on:

*Discuss changes with the clinician first*

If before the holey month of Ramadan you diet and exercise, then during the holy month of Ramadan you should:

Avoid exercise if your blood glucose is low
Avoid exercise before sunset meal (Iftar)

*Discuss changes with the clinician first*

Metformin

According to your daily dosage before Ramadan, your daily dose may require modification during the holey month of Ramadan.

Once-daily before Ramadan | No dose modification required during Ramadan.

Twice daily before Ramadan | Take it with sunset meal ( Iftar) and at predawn meal (Suhoor) during Ramadan.

Thrice daily before Ramadan | Combine the morning and afternoon dose with sunset meal (Iftar) and dinner dose to be taken with predawn meal during Ramadan.

Sulfonylureas e.g. Glibenclamide, Glimepiride, Glipizide

According to your daily dosage before Ramadan, your daily dose may require modification during the holey month of Ramadan.

Once-daily before Ramadan | Take before sunset meal (Iftar). If blood glucose is well controlled, dose may be reduced during Ramadan.

Twice daily before Ramadan | One full dose to be taken before the sunset meal (Iftar) and half of the dose before predawn meal ( Suhoor) during Ramadan.

Pioglitazone, Linagliptin, Empagliflozin, Dapagliflozin

No change is needed during Ramadan, but the dose should be taken with sunset meal (Iftar).

Dulaglutide , Liraglutide, Semaglutide injections

For patients already active on the once daily or once weekly formulations, no change is needed during Ramadan.

*Discuss changes with the clinician first*

Note: Diabetic patients that are on Insulin should ensure adequate fluid intake.

Basal-Bolus insulin

Basal Insulin

Dose should be reduced by 20% and be given before the sunset meal (Iftar)

Rapid acting insulin with meals

Usual pre-lunch dose should be Skipped
Same morning dose with sunset meal (Iftar)
Half of the dinner dose with predawn meal ( Suhoor )

Mixtard Insulin

Twice daily

Use the usual morning dose at the sunset meal (Iftar) and half the usual evening dose at predawn (Suhoor)

General recommendations for the management of Diabetes medications for patients on:

Diet and exercise control

*Discuss changes with the clinician first*

If before the holey month of Ramadan you diet and exercise, then during the holy month of Ramadan you should:

Avoid exercise if your blood glucose is low
Avoid exercise before sunset meal (Iftar)

Oral Diabetes medications

*Discuss changes with the clinician first*

Metformin

According to your daily dosage before Ramadan, your daily dose may require modification during the holey month of Ramadan.

Once-daily before Ramadan | No dose modification required during Ramadan.

Twice daily before Ramadan | Take it with sunset meal ( Iftar) and at predawn meal (Suhoor) during Ramadan.

Thrice daily before Ramadan | Combine the morning and afternoon dose with sunset meal (Iftar) and dinner dose to be taken with predawn meal during Ramadan.

Sulfonylureas e.g. Glibenclamide, Glimepiride, Glipizide

According to your daily dosage before Ramadan, your daily dose may require modification during the holey month of Ramadan.

Once-daily before Ramadan | Take before sunset meal (Iftar). If blood glucose is well controlled, dose may be reduced during Ramadan.

Twice daily before Ramadan | One full dose to be taken before the sunset meal (Iftar) and half of the dose before predawn meal ( Suhoor) during Ramadan.

Pioglitazone, Linagliptin, Empagliflozin, Dapagliflozin

No change is needed during Ramadan, but the dose should be taken with sunset meal (Iftar).

Dulaglutide , Liraglutide, Semaglutide injections

For patients already active on the once daily or once weekly formulations, no change is needed during Ramadan.

Insulin

*Discuss changes with the clinician first*

Note: Diabetic patients that are on Insulin should ensure adequate fluid intake.

Basal-Bolus insulin

Basal Insulin

Dose should be reduced by 20% and be given before the sunset meal (Iftar)

Rapid acting insulin with meals

Usual pre-lunch dose should be Skipped
Same morning dose with sunset meal (Iftar)
Half of the dinner dose with predawn meal ( Suhoor )

Mixtard Insulin

Twice daily

Use the usual morning dose at the sunset meal (Iftar) and half the usual evening dose at predawn (Suhoor)

Safety tips for patients using

Antibiotics

For antibiotics with a single daily dose, the dose can be taken after the sunset meal (Iftar). Follow the label instructions as some antibiotics may need to be taken with food while others need to be taken on an empty stomach.
For antibiotics that are taken twice daily, you can take the usual morning dose at the predawn meal (Suhoor)) and the second dose at the sunset meal (Iftar).
For antibiotics that are taken thrice a day or more, you may discuss with your clinician the potential to switch to different therapies that can be used twice daily.
Ensure you take the full course. Do NOT stop therapy once you feel better.

Anticoagulant medications

Discuss your condition with your health care provider and religious advisor to ensure the best regimen for you. They can determine if you are eligible to fast.
Warfarin : Instructions to avoid INR fluctuation:
Warfarin should be taken at the same time.
Do not change the amount of green vegetables consumed during Ramadan.
Rivaroxaban should be taken after the sunset meal (Iftar).

Blood pressure medications

Avoid salt-rich foods, such as pickles to ensure blood pressure control.
Most blood pressure medications are used once or twice daily, and therefore, the timing can be adjusted accordingly. Periodic blood pressure monitoring using home devices is advised.
Diuretics should be taken with the sunset meal (Iftar).

Levothyroxine

Discuss your condition with your health care provider and religious advisor to ensure the best regimen for you. They can determine if you are eligible to fast.
Levothyroxine absorption is impacted by food, therefore it is advisable to take Levothyroxine as follows:
Take the dose, wait for 30-60 minutes, then start the Iftar meal Or
Take the Iftar meal, then do not eat any food for three hours. Take the Levothyroxine dose, then wait another 60 minutes before taking any additional food.

Epilepsy medications

Discuss your condition with your health care provider and religious advisor to ensure the best regimen for you. They can determine if you are eligible to fast.

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