By Ayisha Karim (Clinical Pharmacist)

We are in the blessed month of Ramadan again, how fast it has come!

As a pharmacist, every year I get questions about medicines and if it’s ok to take certain medicines during fasting. There are always specific case by case issues, but generally in this article, I will cover what the main rulings tend to be. I always recommend that you go to see your GP/Pharmacist before you decide to change any of your medicines and confirm with them if you want to change the timings. For example, I came across a patient who was on a blood thinner and would usually have it twice a day. The same patient decided to take two tablets together at the end of their fast. This led to issues with their heart because they did not know that the tablets should be taken 12 hours apart (or as apart as possible). Please do check your medicines regime with a health care professional and what you would like to do during your fast. Your Doctor/Pharmacist can agree on a plan so that you may safely go ahead with your fast if it safe for you to do so.

Also, aside from the regular complications of medicines and fasting, we now have the virus (just in case you’ve not heard it enough) COVID-19 to add to the month. *rolls eyes*. Last year was the first Ramadan we observed with the virus and in a national lockdown. It was hard work, but we did get through it, and I know we can get through this again. However, it can be risky if you are not aware of the types of things to look out for if you are fasting, in relation to COVID-19 which I will discuss.

So, I’ll get straight to it…

What types of medicines break the fast?

Remember, always check within your school of thought, your Islamic opinion may be different. This has been taken from the British Islamic Medical Association and Muslim Council of Britain guidance:

-Inhalers

-Nebulisers

-Nasal medicines

-Oral medicines such as tablets/syrups

-Rectal suppositories

-Naso-gastric tube (although if you need this you probably would not be fasting anyway?- I hope)

What types of medicines will NOT break my fast?

-injections (intravenous, intamuscular, sub-cutaneous)- this includes the COVID-19 vaccine.

-getting bloods taken (intravenous or thumb prick)

- eye or ear drops*

-vaginal pessary

-transdermal patches (like nicotine patches)

*unless ear drum is perforated

Can I take the COVID-19 Vaccine whilst fasting?

Yes, you can take the vaccine during fasting. It does not break the fast. You may get symptoms that arise within 12 hours of the vaccine, like fever, chills, lethargy. If you begin to feel unwell and you cannot fast, then you can break your fast as you would if you were not well anyway.

How unwell do I have to be before breaking the fast?

This is an opinion that must be sought from your school of thought. According to the Muslim Council of Britain and the British Islamic Medical Association, if your illness prevents you from doing the normal functions of your daily routine, such as things like showering, then you should not fast.

If I have a condition that gets worsened by fasting, should I fast?

Again, check this with your school of thought- but according to the British Islamic Medical Association, and the Muslim Council of Britain- you do not need to fast. If you know from your experience that when you fast your condition causes you to stop functioning for daily things such as showering etc, then you do not have to fast. You can pay fidya (paying for feeding people instead) or you can make an intention to fast during the winter months to make up for it, if it is safer for you. Speak to your Alima or Imam- or someone you seek Islamic advice from for more information about what to do.

I had covid-19 but as a result, I now have Long Covid, should I fast?

If you are positive with COVID-19 and have symptoms that don’t allow you to function normally, then do not fast.

If you are now recovering from COVID-19, and you are having symptoms that could worsen as a result of being dehydrated, then you should not fast. Remember, everyone has a different experience with their illness or with COVID. Therefore, think about your body. Is it going to handle being dehydrated? Will you continually worsen if you have no food/drink and therefore result in complications later? Are you otherwise fit and healthy or do you have other conditions that have worsened as a result of COVID-19? Everyone is different, so listen to your body.

Overall, the main thing to do is check with your health care professional such as your GP about your medicines and how you plan to manage it during Ramadan. Sometimes, the GP might be able to change you to a different form/preparation to help you in doing your fasts safely, especially if you explain that you want to fast and want to know how to do this as safely as possible.

This could also mean that perhaps doing taraweeh could be too much of a physical task too. Also, if you are an elderly person or someone who is shielding, (such as someone on immunosuppresants/chemotherapy), it could be risky for you to be in contact with other people. Even if things are being eased in terms of lockdown, common-sense will tell you that sitting for an hour in a mosque praying with other people close by, even with masks, can be risky. You can always pray taraweeh at home and you can get guidance on how to do this via your local Imam/mosque.

Remember, Allah swt wants ease for us and tells us in the Quran that if we are ill we do not have to fast. Whatever you decide to do, always consult your health care professionals/Alimas/Imams whenever you have any queries.

Ramadan Mubarak!