Ramadan and medication compliance in the muslim fasting patient
Background
Ramadan is the 9th month in the islamic lunar calendar. The lunar calendar is 10 days shorter than the Gregorian calendar so therefore Ramadan is 10 days earlier each year. For the next decade Ramadan will fall in the summer in the northern hemisphere. This year it begins mid August 2010.
Muslims observing the fast are required to fast from between dawn and sunset. The hours spent fasting vary as daylight hours vary considerably between summer and winter months in non-equatorial countries, the length of the fast (which lasts from dawn to sunset) increases in the summer (to about 16-20 hours).
Muslims are required to refrain from taking any food, drinks, oral medication and injecting fluids of nutritional value. Fasting is obligatory for all muslims except:
* children before the age of puberty
* the elderly
* the chronically ill or those taking regular medication
Those that are temporarily excluded are:
* pregnant women and breastfeeding women if deemed detrimental to mother and baby health
* those travelling long distances
* menstruating women
But the fasts should be made up at a later date
Dosage regimens and compliance
As pharmacists we need to be aware of patients who take regular medication who also wish to fast and therefore not comply with treatment regimens leading to therapeutic failure. We also need to be aware of the availability of alternative dosage forms of medication to advice doctors and patients.
Aslam et al surveyed 81 patients to determine the alterations they made to their drug regimens during the fasting period of Ramadan (1) They found that 42% of the patients adhered to their usual treatment, and 58% changed their intake pattern. Among the second group, 35 patients stopped their treatments, eight changed the administration schedule, and four took all
the daily doses in one intake
Wheatly and Shelly reported that two patients with chronic reversible respiratory disease were admitted to an intensive care
unit two weeks after the start of Ramadan. Both patients subsequently admitted to not having taken their treatment, including inhalers,during daylight hours (2)
It is also important to be aware of what routes of administration are compatible with fasting. A religious seminar held in Morocco 2007 aimed to clarify this. The participants included muslim jurists, religion experts, medical practitioners and pharmacologists agreed that the following routes do not nullify fasting (3)
* Eye and ear drops
* All substances absorbed into the body through the skin, such as creams, ointments, and medicated plasters
* Insertion into the vagina of pessaries, medical ovules, and vaginal washes
* Injections through the skin, muscle, joints,or veins with the exception of intravenous feeding
* Oxygen and anaesthetic gases
* Nitroglycerin tablets placed under the tongue for the treatment of angina
* Mouthwash, gargle, or oral spray, provided nothing is swallowed into the stomach
the article continues....
If you would like to read more( the blog is a large article i wrote) check out my blog post: Ramadan and medication compliance in the muslim fasting patient Mrs Pharmacist's Blog
Last edited by antipsychotic; 5th, August 2010 at 05:06 PM.
Reason: request from moderator
Re: Ramadan and medication compliance in the muslim fasting patient
I found the info on Mrs. Pharmacists blog very useful. I am not a follower of any religion and I consider the actions of those that do (whatever religion) to be arbitrary and irrational - but then I find this to be the case with everybody else as well. However, people will do what they will do for whatever reason and it is our function to provide the pharmaceutical services that they want to improve the quality of their lives and not to impose our own opinions on how they should live their lives. (That puts me at odds with most of you I suspect as it applies to matters such as needle exchange schemes and EHC provision.)
So being only practical can I ask Bobbin a couple of questions. (since that nice Mr. Lansley wants us to stop wantonly making dispensing errors all over the place.)
1) Dispensing errors by whom - fasting muslims or all pharmacists? (e.g. does low blood sugar in fasting muslim pharmacists affect their concentration?)
2) Errors in what - changes to medication or just an increase in the number of all errors? (e.g. changes to prescribed medication not being picked up and scripts either dispensed as repeats from the PMR when they shouldn't be and new interactions being ignored)
3) Errors affecting whom - those whose medication regime has changed or affecting those whom we assume to have changed their dosing patterns but who have not? (e.g. Metformin changed to S/R tabs for someone we assume to be a fasting muslim when this is really just an error by the receptionist picking the wrong product)
Re: Ramadan and medication compliance in the muslim fasting patient
I agree about EHC etc, I really don't think its OK for a pharmacist's personal views to negatively impact on a patient's care. If a vegetarian refused to dispense capsules because they had gelatin in them or if they refused to dispense porcine insulin because they were vegetarian/Jewish/Muslim/etc or if they refused to dispense a certain company's products because they beleived that company to be unethical or they refused to dispense any medication because they believed in faith healing being the only acceptable option then would that be ok? Of course its not ok. Pharmacists are there to ensure clinical safety and efficacy, not to pass moral judgement on a patient.
Re: Ramadan and medication compliance in the muslim fasting patient
but isn't that what signposting is all about?? surely by doing this you're not negatively impacting on a patients care..the patient is sstill able to go and get the EHC or whatever it is the pharmacist is refusing to dispense
Re: Ramadan and medication compliance in the muslim fasting patient
When I was working in the East End during 50s 60s, German cos such as Bayer and Schering just getting started again in the UK.
Their reps had a very hard time as many Drs were refugees from Nazi Germany. My own company would not permit any rep to drive a German car. Japanese cos had an even harder time later on.
Many Jewish pharmacists in the East End and they refused to stock anything of German origin.
I used to visit one Dr who told me he was only one of his family who escaped.
johnep
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