There is confusion among patients and physicians about which medications can be used during fasting without breaking it. Even when consensus is reached among scholars, it takes a long time for Muslim physicians to learn about the rulings and inform their patients of what they can and cannot use during their fast. To settle differences in point of view and standardize the choice of routes, a religious-medical symposium about “The Islamic view of certain contemporary medical issues” was held in Morocco in June 1997. One of the main topics discussed was the substances and actions that nullify fasting. The participants included distinguished Muslim jurists and religion experts, medical practitioners, pharmacologists, and specialists in other human sciences. They agreed unanimously that the following administration routes do NOT nullify fasting:

  1. Eye and ear drops
  2. All substances absorbed into the body through the skin, such as creams, ointments, patches and medicated plasters
  3. Insertion into the vagina of pessaries, medical ovules, and vaginal washes
  4. Injections through the skin, muscle, joints, or veins, with the exception of intravenous feeding
  5. Oxygen and anesthetic gases
  6. Nitroglycerin tablets placed under the tongue for the treatment of angina
  7. Mouthwash, gargle, or oral spray, provided nothing is swallowed into the stomach

A majority of participants added:

  1. Nose drops, nose sprays, and inhalers
  2. Anal enemas
  3. Surgeries requiring general anesthesia, if the patient decided to fast and there is no health risks as determined by qualified physicians

Patients with chronic illnesses, like Diabetes, Hypertension, Heart Diseases, Hypercholesteremia, COPD and Asthma may need to adjust their medication regimens, routes, and doses after consultation with a physician who is familiar with the health consequences of fasting. A diabetic patient, for example, may need to cut the dose of his/her antihyperglycemic medications during fasting. A patient who is on three or four doses of an oral medication may need to switch to longer acting medications during fasting, if possible.

Diet also should be modified for patients who require special diets, like Diabetes, Chronic liver and kidney diseases. A nutritionist or a physician may be consulted for the changes in diet and types of food recommended.

It is especially important for patients with chronic diseases to eat balanced meals, adequate fruits and vegetables, drink enough fluid, and avoid overeating. It is also equally important to eat the early predawn snack (Sohor) and not to limit it to food rich with carbohydrate.

Happy and healthy Ramadan to all.

By Dr Zaher Sahloul