A service user guide to medicinal use during the Islamic month of Ramadan.

Ramadan is a time that many Muslims look forward to. However, the prospect of fasting for a month can also be frightening for some – especially those with addictions.

When is Ramadan?

The dates for the month of Ramadan vary from year to year, as well as the hours of fasting depending on where you live. The duration of a single daily fast is carried out between dawn to sunset. To find out the dates & times for the country you live in it is always best to contact your local Imaam.

According to Google, Ramadan is set for April 23rd for the year 2020 (this is an estimate and the actual date depends on moon sighting and approval from Islamic authorities)

What does this mean for individuals with an addiction?

Ramadan is an important religious period in the Islamic calendar that requires healthy adults to fast during daylight hours – a day fast means not taking anything via the mouth from the hours between dawn to sunset

For individuals with an addiction the thought of going through more than a few hours of the day without being able to feed their craving may seem impossible or even terrifying. The stress of fasting and overcoming an addiction at the same time can be overwhelming.

 “God desires ease for you; he does not want to put you into difficulties” (Quran 2:185).

Exemptions are made for the ill, travellers, pregnancy/breast-feeding, old age/dementia, where the fast is threatening your life, or if you are compelled to break your fast. These days must be made up later. If you are too unwell to observe the fast you are not accountable and the priority is for your treatment and health.

What rules are there for Drugs & Alcohol intake during Ramadan?

You should consider Ramadan as a stepping stone for your recovery.

It is not permissible to take any intoxicants and keep a fast &/or pray during Ramadan. As it is stated:

‘”Any drink, drug, powder, or substance that intoxicates is forbidden.  Allah’s Prophet said, “Every intoxicant is khamr, and every khamr is forbidden.” (Saheeh Muslim)”

AND

“…do not approach prayer while you are intoxicated until you know what you are saying or in a state of janabah (purified)…” (Surah An-Nisa (4:34))”

If you are consuming medication due to your addiction i.e. Methadone, Physeptone, Buprenorphine or any other like this, you should seek advice from your local Imam along with your doctor about your decision. Even if the Imam or Doctor agrees that a person does not need to fast, some people will still want to observe the fast. The information below is generally thought to be a good guide and starting point if someone is unwell enough to need regular medication but well enough to decide whether fasting is appropriate and safe for them.

But what if I want to fast?

People with mental health problems (just like people with physical problems) can become unwell if they don’t or can’t take their medication properly. If you are unwell enough to need regular medication but well enough to decide to fast, the information below can be a start point to help you as there are some ways to get around the problem.

Are there mental health medicines I might not be allowed to take during daylight hours?

Usually anything that is taken by mouth (absorbed by the gut and stomach) such as tablets (chewed or swallowed) or liquids should not be taken during the hours of fasting but can be taken outside of these hours.

Which medicines are generally viewed as OK to take at any time during Ramadan?

Medicines given by other means such as:

• injections through the skin, muscles, veins or joints
• ear drops and eye drops
• patches, where the medicine is absorbed through the skin.

Please consult with your local imaam in regards to permissible items.

If I am taking medicines and decide to fast what do I need to consider?

Take time and plan ahead for Ramadan. You need to review your medicines and you need to remember how important it is to keep your fluid levels up (drink plenty) and get re-hydrated outside fasting hours. Lack of hydration can also affect levels of certain medicines. Make sure you are getting enough sleep too, even if it may not be at normal times. This is important also if your medication causes you to feel sleepy and your normal sleep pattern is broken during Ramadan.

What do I need to do?

Make a list of all your medicines:

• names
• types of medicine e.g. tablet or injection
• when you normally take them.

If you list those you can continue to take as usual you will be left with a list of medicines you need to think about further. These will mostly be tablets, capsules or liquids. Medicines are usually prescribed like this:

	Usual times	Hours between doses	What to do during Ramadan
Morning	Midday	Tea	Bedtime
Once a day					24	Take before dawn
				24	Take after sunset
Twice a day					12	Take before dawn and after sunset
Three times a day		Either		8	See below
Four times a day					6	See below

Changing the gap between doses by, say, 2, 3 or even 4 hours probably doesn’t matter too much.

• For medicines usually taken once a day (morning or night) you can take them at dawn or dusk instead. There is a study that shows that fasting while on lithium is fine if you drink enough liquid between sunset and dawn
• For medicines you usually take twice a day, roughly 12 hours apart, taking a dose at dawn and another at dusk (with an eight hour gap instead) should also be OK.
• Very few mental health medicines absolutely must be taken three or four times a day.
• For medicines taken three times a day you may be able to move one of the daytime doses to either before dawn or after sunset. Get some specialist advice about this and which way to move the daytime dose.
• For medicines taken four times a day, get specialist advice. You may be able to take the doses twice a day.

Source: NHS

Methadone during the month of Ramadan.  

The advice has been provided by a trained medical professional and is being distributed as guidelines only and can be tailored to everyone’s personal needs. 

If the person in need of Methadone is extremely unwell it is advised that they break their fast!

• Methadone has a long hard life, average of 25 hours, so timing shouldn’t be an issue. 
• If service user is struggling with withdrawal symptoms, dose can be taken at Sheri (early morning) to reduce any ‘end of dose effects’ while fasting.
• If done is not taken at once, split into two. At Iftar (sunset) and Sehri (sunrise)
• If dose is currently taken during the day, start slowly changing the time in the lead up to Ramadan.  i.e. have the dose earlier to coincide with Sehri, or later to coincide with Iftar.
• It is important to gauge how you feel for the first few fasts, the body will need time to adjust, everyone will respond differently. 
• Service users should ensure adequate hydration during the night and remember to eat nutritional foods, slow release carbohydrates, fruit & vegetables, wholemeal grains, pasta, rice, bread and porridge. There can be a tendency to eat processed and fried foods excessively.
• Monitor physical activity, regular capacity will be reduced while fasting. 

Smoking during Ramadan

It can be. If you stop smoking this can increase the amount of some drugs such as clozapine and olanzapine in your blood. If you just smoke between sunset and dawn this probably won’t be a problem but if you stop smoking completely you must seek expert advice and may need your doses changed.

Ramadan can be a very key moment for individuals to stop smoking, you are able to gain the full benefits of this holy month and will be an important step towards restoring your health. The atmosphere surrounding Ramadan helps one to have more discipline and strive to be a better Muslim in all aspects of life, it is an ideal time to give up smoking once and for all. Call one of the following national quit lines to obtain free and confidential advice in your own language.

Urdu: 0800 002288
Gujrati: 0800 002244 
Bengali: 0800 002255
Arabic: 0800 1691300

Where can I get advice?

Talk to your local pharmacist first. They will be able to tell you if your medicine is available in a different style of tablet that can be taken less often e.g. these tablets or capsules are often called slow-release or modified release (MR) tablets. A few medicines are available as patches as well as tablets. Patches are generally thought to be OK during Ramadan and may solve your problem.

Some examples include:

• Methylphenidate plain tablets – ask if you switch to once a day preparations
• Quetiapine – once a day quetiapine XL is available
• Rivastigmine – you could switch to the patches

Lithium can be used ONLY once a day. Make sure you are drinking plenty of fluids during the non-fasting hours and know what to do if you think you have signs of having lithium toxicity.

• Sodium valproate – seek advice on this. Normally should be given twice or three times a day and there may be other medications which can be considered as once a day alternatives
• Venlafaxine – once a day venlafaxine MR or XL are available
• Some antipsychotics are available as long-acting or depot injections.

You will need to see your doctor (depending on your treatment type this could be your G.P, CGL doctor or Psychiatrist) to get these different medicines prescribed. Make sure you do this in good time before Ramadan. You could also check http://www.nhs.uk/livewell/healthyramadan/Pages/healthyramadanhome.aspx.