Fasting during Ramadan could cause problems for Muslim patients taking prescribed drugs, doctors have warned.
During the Islamic holy month of Ramadan, which began last Friday, adult Muslims are required to refrain from taking any food, drink or oral drugs between dawn and dusk. And although patients with chronic disease are exempted by Islamic rules, many insist on fasting.
Writing in the British Medical Journal, Dr Nadia Aadil and colleagues from the Faculty of Medicine and Pharmacy, University of Casablanca, Morocco, said patients arbitrarily modified the times of doses, the number of doses and even the total daily dosage of drugs during Ramadan without seeking medical advice.
According to the Islamic faith, the first meal is taken immediately after sunset (Iftar). The second meal, equivalent to dinner, is taken three hours later with the last meal taken shortly before dawn (Sohour). This eating pattern can make it difficult to regulate drug dosages.
A survey of 325 patients in a Kuwaiti hospital found that 64 per cent changed their drug regimes during Ramadan. Some 18 per cent of those surveyed took their medication in a single intake. Patients with chronic obstructive pulmonary disease (COPD) and epilepsy were especially at risk, they said. The withdrawal of anti-epilepsy drugs is the main reason for the recurrence of epilepsy among Muslim patients.
The authors examined the effect of food-drug interaction on the availability of drugs in the body. They found that the absorption of thyroid hormone (Thyroxine) is increased when it is taken on an empty stomach. And they noted that the tranquilliser, Diazepam, is absorbed in greater quantities when taken with grapefruit juice.
Dr Aadil and her colleagues found a relative dearth of research on the subject. "This lack of information is a problem for doctors, as they cannot give unbiased advice," they said, adding that further research would enable guidelines to be drawn up on how to modify the administration of drugs during the month of fasting. Such guidelines, they said, would enable health professionals in countries with a Muslim population "to provide accurate and standardised advice on the appropriate use of drugs during their holy month of Ramadan".