Guidance for taking medication during Ramadan

9th May 2018

Ramadan fasting can be safe for patients with heart failure say experts.

Ramadan commences from Tuesday 15 May to Thursday 14 June 2018.

There are over one billion Muslims around the world who will abstain from food, drink, and oral medications from dawn to sunset during the holy month of Ramadan. The fasting period typically lasts 15 to 16 hours, and two meals are eaten during the night.   

Symptoms of heart failure include shortness of breath, ankle swelling, and fatigue. Patients are advised to limit daily intake of fluid to less than two litres and sodium to less than 2500 mg. Medications include angiotensin converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs), beta blockers, diuretics and digoxin.

“Patients with heart failure frequently ask their doctor if it is safe to fast but until now we didn’t have any evidence on which to base our advice,” said author Dr Rami Abazid, cardiologist, Prince Sultan Cardiac Centre, Qassim, Saudi Arabia. 

The study assessed 249 outpatients from three heart failure clinics who had planned to fast during Ramadan in 2017.Information was obtained the month before and during Ramadan, including diagnosis, clinical assessment, hospitalization and ED visits.

The study found that patients with worsening symptoms were less likely to have adhered to fluid and salt restrictions (39% versus 79%, p<0.0001) and were less adherent to heart failure drugs (67% versus 94%, p<0.0001) than those with stable or improved symptoms.

Dr Abazid said: “Patients who don’t follow the fluid and salt recommendations during Ramadan report that it is because of the increase in socialising. When they visit friends the food has a normal or high salt content, and they drink a lot of fluids within a short period time, which can cause fluid shifts in the body.”

Regarding non-adherence to medications, Dr Abazid said: “Some patients stop or reduce their use of diuretics because they are afraid of being thirsty during fasting hours. In addition, for medications that should be taken twice daily they either omit one dose or take both doses together.”

Dr Abazid said: “Ramadan fasting is safe for most patients with chronic heart failure and reduced ejection fraction. My advice to patients is to adhere to fluid and salt restrictions, and do not omit any doses of drugs. For drugs with two daily doses, take them with as wide a gap as possible during non-fasting hours.

If feasible, we advise doctors to shift patients to drugs with a single daily dose that can be taken during non-fasting hours,” he continued. “This is possible for most heart failure medications.”

Cardiomyopathy Nurse Jayne Partridge said “This research will assist doctors when advising patients with heart failure who wish to fast over Ramadan. It’s worth noting this research is applicable to patients in warmer climates and may not apply to patients in cooler climates. Further research is required to verify the results of this research and to ascertain whether fasting is safe for all patients with heart failure or not.

It is important that patients adhere to their fluid and salt restrictions during this time and seek advice from their consultant or GP for guidance on adjusting the doses of their medications including diuretic medications during the fasting period.

The research did find that patients who adhered to their fluid and salt restrictions and took their medications correctly during fasting were more stable than those patients who did not.”