Medicines during Ramadan fasting: planning with long-term conditions

Fasting changes when you eat, how much you drink and when medicines can be taken. For some conditions the change is minor; for others it alters the safety of a treatment. The most reliable approach is a conversation well before Ramadan starts with a GP, nurse, specialist or pharmacist who understands both your condition and the practical shape of the fasting day.

Come with a list of your medicines and the times you take them, a note of recent blood tests or readings, and your own questions. Say whether you plan to fast every day, some days or not at all. A realistic plan made together is safer than one improvised in week one.

Islamic teaching allows exemption for people who are ill, and Diabetes UK notes that people with serious health conditions are exempt. A clinician can advise on medical risk; religious questions are for you and your imam or scholar. Many people find that hearing both views in the same week helps.

Medical risk depends on several things at once. Diabetes UK lists the type of diabetes, current HbA1c, medicines that can cause low blood sugar such as insulin and sulphonylureas, and complications such as eye, nerve, heart or kidney disease. People managed with diet alone or one medicine that does not cause hypos, with a healthy HbA1c, are in the lower-risk group.

A medicine taken three times a day does not fit neatly into the hours between dusk and dawn. Options a prescriber may consider include switching to a longer-acting form, moving doses to the pre-dawn and evening meals, or changing to a different drug. Do not rearrange tablets alone, because some are tied to meals and some must not be bunched together.

The NHS leaflet for gliclazide advises taking tablets after a meal and not skipping or delaying meals, because of the risk of low blood sugar, which is why this medicine is one to review before fasting. For co-beneldopa, a Parkinson's medicine, the NHS advises taking it at the same times each day, since delays can bring symptoms back.

Diabetes UK says insulin doses are usually reduced before fasting, that pre-mixed insulin should be avoided, and that tablets may need different doses or timing, all agreed with your team. It recommends testing blood sugar often during fasting with a meter or continuous glucose monitor, and carrying water and hypo treatment at all times.

Metformin and dapagliflozin carry a separate warning. The NHS says that vomiting, diarrhoea or a high temperature while taking either increases the risk of dehydration, and advises speaking to a pharmacist or doctor. Dapagliflozin also lists ketoacidosis among serious side effects; the NHS advises contacting 111 for extreme thirst, confusion, unusual tiredness or fruity-smelling breath.

Diabetes UK is explicit that breaking the fast is expected in some situations and is not a failure. If blood sugar drops below 4 mmol/l, break the fast and treat it with sugary food or fluid. Break it if sugars rise beyond the range agreed with your team, and if you become unwell.

For other conditions the same logic applies: severe dizziness, fainting, chest pain, breathlessness, a seizure, vomiting that stops you keeping medicines down, or confusion are all reasons to stop and seek help. For emergencies call 999.

Bring a short review with the same team a few weeks afterwards. Doses that were reduced often need returning to the usual pattern, and weight, blood pressure or glucose readings from the month give useful information. If any episode went badly, say so; it helps plan next year.