DRUG INTAKE DURING RAMADAM

DISEA DRUG SPECIFICATION RECOMMENDATION

SE CATEGORY

Beta- Blockers
Bisoprolol OD Take after Suhoor
. Metoprolol OD Take after Suhoor
. Atenolol OD Take after Iftar and Suhoor
Propranolol BID/TID Take after Iftar and Suhoor
Labetolol BID/TID/QID Calculate the TDD and give BID after
Methyldopa BID/TID/QID Iftar(2/3) and Suhoor(1/3)
Clonidine BID/TID
Carvedilol BID Take with fatty meal (dinner) to avoid abrupt
fall in BP

ACEs OD - Monitor for postural Take after Ishaa praying

Avoid taking with large hypotension e.g. dizziness
amounts of dates, bananas, BID/TID – Shift to long-acting
oranges, green leafy Lisinopril OD - Monitor for Take after Ishaa praying
vegetables postural hypotension e.g. dizziness
Enalapril 5mg

ARBs Valsartan OD/BID Take after Ishaa prayer

Losasartan OD Take after Iftar and Suhoor

CCBs
Dihydropyridine e.g.
amlodipine or nifedipine OD/ BID Take after Iftar or Suhoor
Non–dihydropyridine e.g. Take after Iftar and Suhoor
verapamil and diltiazem OD/BID/TID

Thiazide diuretic
Hydrochlorothiazide OD - might cause dehydration Take after Ishaa prayer
Metalazone Avoid taking suhoor time

Loop diuretic. OD - might cause dehydration

- furosemide BID- TID – Change to OD or BID Take after Ishaa prayer
For HTN OD Avoid Suhoor time
For HF depends on patients Take after Iftar (larger dose) and midnight
clinical condition – OD/BID (dose)

Carbonic Anhydrase Acetazolamide 250mg OD/BID For OD take after iftar

Inhibitors For BID take after Iftar and midnight

Amiloride 5mg/ OD
Spironolactone OD – HF-depends on patient Take after iftar prayer
clinical condition Liver cirrhosis – fasting not advisable
BID /TID – Liver cirrhosis

Hydralazine Every 6 or 8 hours Option 1:

Take the total dose in two divided doses,
monitor blood pressure
Option 2:
Change the drug if possible to longer acting
 Alpha blocker; OD –
- Tamsulosin - BPH Monitor for postural hypotension
- Alfasulosin - BPH e.g. dizziness Take after Iftar
- Terazosin - HTN BD/TID/QID – change to
- Prazosin - HTN extended-release OD
Monitor for postural hypotension

DISEASE DRUG SPECIFICATION RECOMMENDATION

CATEGORY

Antiplatelet e.g. OD - Aspirin and clopidogrel OD: take after the full Iftar meal (preferably
aspirin, Increased resistance in diabetic 8pm):
clopidogrel and patients during fasting Combination : take after the full Iftar meal
dyrypidimole (preferably 8pm):
Combination of aspirin and
1-To achieve the full synergistic effect next
clopidogrel
day morning 10 am where platelet
aggregation is at highest rate induced by
both drugs
2-After meal to avoid the stomach irritation.
Strict adherence is recommend

Antiplatelet e.g. BID After Iftar and Suhoor Interval between

ticagrelor doses should not be less than 8 hours

Contrast media Increase risk of contrast induced Advise not to fast

after angioplasty nephropathy due to dehydration

Nitrates (MR) e.g. OD Take after Ishaa Iftar

Isosorbide Monitor for postural hypotension
Monotrate

Nitrates (IR) e.g. BID/TID Option 1: Convert to long acting

Isosorbide
dinitrate Option 2: Give Bid the same dose and to be
taken 2 hours after Iftar and 30 min before
Suhoor.

Fasting reduces Sympathetic Nervous

System where the possibility of angina
attacks will be low.

Seek clinical judgment

Contrast media Increase risk of contrast induced Advise not to fast

after angioplasty nephropathy dehydration

GTN spray/tablet PRN Does not invalidate fast

Anytime as needed
 Beta-Blockers As stated Above

Calcium Channel As stated Above

Blockers

DISEASE DRUG SPECIFICATION RECOMMENDATION

CATEGORY

Amiodarone Patient are sensitive to Take after full Iftar meal.

electrolyte
disturbance

Flecainide BID Take after Iftar and Suhoor Interval between doses
should not be less than 8 hours

Oral electrolyte OD Preferred after Suhoor

replacement BID Take after Iftar and Suhoor

Sotolol 80mg OD -Take after iftar

BID -After Iftar and Suhoor

Loop Diuretics - Alone OD - Take after Ishaa prayer

- Combined - Advise not to fast. Monitor for significant dehydration
with Thiazide and electrolyte disturbance
Spironolactone OD Take after Iftar or Suhoor
Advise not to fast if symptomatic
Digoxin OD - Take after Suhoor
Monitor for toxicity Or
secondary to Seek clinical judgement and advise not to fast if
hypokalemia and symptomatic
dehydration
ACEs & ARBs OD - Monitor for Take after Ishaa praying
Lisinopril postural hypotension Advise not to fast if unstable and symptomatic
Valsartan e.g. dizziness
Beta Blockers: BID Take with fatty meals, with Iftar and Suhoor
Carvedilol Risk of abrupt Take after Suhoor
hypotension Take after Suhoor
Bisoprolol OD Take after Iftar and Suhoor
Metoprolol BD/BID Advise not to fast if unstable and symptomatic

DISEASE DRUG SPECIFICATION RECOMMENDATION

CATEGORY
 Warfarin OD – Take after main Iftar Monitor INR frequently
Take the dose in the same time Avoid large amount of vitamin K food like
every day broccoli, spinach, green leafy vegetables,
cabbage - may decrease the drug effect
Avoid garlic, ginger, glucosamine, ginseng and
gingko may increase bleeding.

If co-prescribed with aspirin To be taken separate timings. Aspirin at 8pm and

warfarin at 10pm both after meals or with large
amount of liquid

If co-prescribed with other To be taken separate timings. Aspirin at 8pm and

drugs known to cause GIT
disturbance such as NSAID or
Corticosteroid
Rivaroxaban 20mg OD
If co-prescribed with other
drugs known to cause GIT
disturbance such as aspirin
NSAID or Corticosteroid
NSAID and steroid after suhoor both after meals
or with large amount of liquid
Always advice the patient to monitor sign and
symptoms of bleeding
Seek clinical judgment
Take after full Iftar meal
To be taken separate timings. Aspirin at 8pm and
NSAID and steroid after suhoor both after meals
or with large amount of liquid

Dabigatran BID - Might increase GI Take after full Iftar and Suhoor Interval should
disturbance be ≥ 8 hours

Apixaban BID Take after full Iftar and Suhoor Interval should
be ≥ 8 hours

Atorvastatin and OD Take after Iftar or Suhoor

Rosuvastatin To be taken the same time daily
(Long acting)
Simvastatin and OD Take before bedtime preferably at 10pm
Pravastatin (short To be taken same time daily
acting)
Fibrates During fasting, risk of Take after full Iftar or Suhoor
rhabdomyolysis might increase With Statins:
if used in combination with Statins to be taken at night and fibrates after
Statins due to dehydration suhoor
during fasting
EZETIMIBE OD Take after or Suhoor
To be taken the same time daily

DISEASE DRUG SPECIFICATION RECOMMENDATION

CATEGORY
 Carbamazepine (IR) Should be taken at least twice Option 1:
daily convert to CR formula
Option 2:
Redistribute total daily dose into BID dose and
take larger dose with Iftar and lower dose with
Suhoor
Clinical judgment : Advice not to fast if
clinically unstable
Carbamazepine Initiation OD Take after Iftar or Suhoor (same time daily)
(MR) Maintenance BID Take after Iftar and Suhoor (same time daily)

Benzodiazepines
Diazepam OD /BID/ PRN doses Take after Iftar (preferred after Ishaa pray)
Lorazepam OD Clinical judgment : Advice not to fast if
Bromazepam OD clinically unstable
Sodium Valproate Regular formulation – Take after Iftar and Suhoor
BID/TID Chrono – OD or BID
Food may decrease absorption take 1-2 hour after
Iftar or 1 hour before suhoor
Oxcarbazepine BID Take after Iftar and Suhoor

Topiramate BID Take after Iftar and Suhoor

Pregabalin BID Take after Iftar and Suhoor

Gabapentin BID If TID, Redistribute total daily dose into BID
dose and take with Iftar and with Suhoor
Levetiracetam BID Take after Iftar and Suhoor

Lamotrigine (IR) Initiation OD or BID Clinical judgment. Take after Iftar and/or suhoor
Same time daily

Lamotrigine (MR) OD Take after Iftar and Suhoor (same time daily)

Phenytoin BID Take after Iftar and Suhoor

TID Clinical judgment; Redistribute total daily dose
into BID dose and take with Iftar and with
Suhoor

DISEASE DRUG SPECIFICATION RECOMMENDATION

CATEGORY
 Inhalers Advise to avoid food that can No dose change,
trigger asthma symptoms such Does NOT invalidate the fast,
as peanuts, milk, eggs, and Stay hydrated
wheat

Vaporizers/ PRN/TID/QID No dose change,

Nebulising soln. invalidate fasting

Nasal spray Take as usual as instructed – does not invalidate

fast
Powder/Capsule No dose change,
e.g. invalidate fasting since the powder contains
Relvar OD lactose
Turbo haler BID Take After Iftar
DISKUS Take After Iftar and Suhoor
Liquid MIST
(Tiotropium) Contains liquid invalidate fasting
Theophylline ER formula – OD Take at night 1 hour before or 2 hour after meal

Montelukast OD To be taken after iftar or suhoor (same time

daily)
During exercise: to be taken 2 hours before
exercise
Pulmonary -to be taken with iftar to avoid stomach
hypertension discomfort take after food
(pirfenidrone
200mg)
Antihistamine OD/BID -to be taken aftar iftar or suhoor food
Loratidine 10mg

Chlorpheramine OD/BID/TID/QID OD: to be after iftar

40mg BID: After iftar and midnight
TID/QID: Give BID dose
Hydroxyzine OD/BID/TID BID: After iftar and midnight
TID/QID: Give BID dose
Levothyroxine OD Should be taken on empty stomach I hour
before suhoor to get the benefit of circadian
HYPO- rhythm
THYRIODISM
& Carbimazole BID Take with Iftar meal and Suhoor
HYPER-
THYROIDISM TID TID- Change to BID. 2/3 Iftar and 1/3 Suhoor

Methimazole OD Take with main Iftar meal or Suhoor

(same time daily

Propylthiouracil TID Clinical judgment,

Maintenance Change to BID. 2/3 Iftar and 1/3 Suhoor

Desmopressin OD - to be taken 1 hour before suhoor or 2 hours

0.2mg after iftar (same time daily)

Prednisone OD - to be taken after suhoor meal to get the

benefit of circadian rhythm and avoid
 stomach discomfort

Fludrocortisone OD - to be taken after suhoor

0.1mg

Hydrocortisone OD -to be taken after iftar, drink plenty of fluids to

10mg BID facilitate absorption
After iftar and suhoor
Dexamethsone OD/BD/QID - to be taken preferably with iftar to avoid
0.5/2/4 mg stomach discomfort

DISEASE DRUG SPECIFICATION RECOMMENDATION

CATEGORY

Metformin (IR) - OD: Daily dose remains - Take after Iftar

unchanged
- BID: Daily dose - 500MG BID:Take after Iftar and Suhoor
remains unchanged -1G BID : Take after Iftar and Suhoor
- TID: Daily dose 1G TID : Give 1G BID Take after Iftar and
remains unchanged Suhoor

- 500mg TID: Morning dose (500mg) after

Suhoor, combine afternoon & evening dose at
Iftar (1g dose)
Metformin (MR) MR - Daily dose remains Take after Iftar
unchanged

Acarbose No dose modifications

Pioglitazone, OD No dose modifications.

Rosiglitazone Dose can be taken with Iftar or Suhoor

Repaglinide TID Reduce TID dose to BID

Exenatide & Maintenance OD No dose modification is needed

Liraglutide Take usual timings as do not invalidate fast and
does not cause hypoglycaemia
However, advice to take during night
Sulfonyl Ureas e.g. OD * If prescriber insists to give the same then:
Glibenclamide*, Glibenclamide OD/BID 5mg OD: Give after iftar
Gliclazide, and best to be avoided and 5mg BID: 5mg after iftar and 2 hours before
Glimepiride Switch to newer shorter suhoor to avoid daytime hypoglycaemia
acting SU patients with good glycemic control
(Gliclazide, Glimepiride) * Advice to monitor BG as stated below
Short – Acting Gliclazide MR: OD To be taken after iftar (if good glycaemic control
Sulphonylureas advice to take half the dose)

Gliclazide IR: BID Take after iftar and 2 hours before suhoor to
avoid daytime hypoglycaemia ( if good
glycaemic control, advice to reduce the suhoor
dose by 50%)
 Glimepiride OD 2mg – 4mg OD: To be taken after iftar
Max. 8mg 6mg OD : Reduce to 4mg and give after iftar
Above 6mg give into 8mg OD: Give 4mg BID, 4mg after iftar and
divided doses BID reduce the 2nd dose to 2mg and give 2 hours
before suhoor.

*Advice to monitor BG as stated below

SGLT-2 Inhibitors OD – -Advice not to fast
Dapagliflozin, Risk of severe -If insists on fasting then:
Empaglifozin dehydration and Genito- Give with Iftar
Canagliflozin urinary infections No dose modifications
Advice the patient to drink plenty of fluid to
avoid dehydration and urinary infections
Avoid in the elderly with renal impairment,
hypotensive individuals or patient taking
diuretics.
Calcitrol 0.25mg - To be taken after directly after suhoor meal

Alphacacidol 0.2µg - To be taken directly after suhoor meal

Vitamin D3 10,000 IU -To be taken with iftar (preferable fatty meal to

50,000 IU once weekly facilitate absorption )

Sevelamir BID/TID -CKD: clinical judgment: best not to fast if insists

Calcium carbonate OD /BID/TID to be taken BID with iftar and suhoor
Calcium + vit D OD/BID -BID doses: To be taken after iftar and suhoor
Calcium gluconate OD/BID/TID -Calcium carbonate and gluconate if taken as
Magnesium chelate OD phosphate binder then give with meals, if given
Pyridoxine (vit b6) OD as supplement give on empty stomach
Folic acid OD -Advice the patient to drink plenty of fluid to
Ferrous sulphate OD
avoid daytime dehydration and electrolyte
Riboflavin OD
disturbance.
Potassium chloride OD/BID/TID
Sodium chloride OD/BID/TID -In case of CKD plenty of fluid is restricted; best
Thiamine OD to avoid fasting but if insists advice to monitor
Vitamin E OD symptoms of dehydration
Biotin OD -Other vitamins may be taken anytime during
Cod Liver Oil OD the evening time but same time daily.

DISEASE DRUG SPECIFIC- RECOMMENDATION

CATEGORY ATION

Long- or intermediate
acting basal insulin OD Take at Iftar.
e.g. Glargine /Degludec Reduce dose by 15–30% if good glycaemic
(Tresiba)l Detemir control

intermediate - Take usual morning dose at Iftar immediately

 NPH/Detemir/ BID Reduce evening dose by 25 to 50% and take 30
min before Suhoor.
If good glycaemic control reduce the dose by
50%

Rapid- or short-acting
prandial/bolus insulin -Take normal dose at Iftar Omit lunch time
e.g. Lispro TID dose
Aspart -Reduce Suhoor dose by 25–50% based on
Actrapid patients glycaemic status.
If good glycaemic control reduce the dose by
50%

Premixed insulin BID -Take normal dose at Iftar immediately

Mixtard 30/70 -Take usual morning dose at Iftar Reduce
Humalog Mix 50 evening dose by 25–50% based on glycaemic
status and advice to take at 30 min before
suhoor for Mixtard and 5 to 15 min before
suhoor for Humalog Mix
If good glycaemic control reduce the suhoor
dose by 50%

Monitor Blood Glucose levels 6 times per day:

1- Pre-dawn meal (suhoor)

2- Morning (10 am)
3- Midday (12pm)
4- Mid-afternoon (3 pm)
5- Pre-sunset meal - Iftar ( 6pm)
6- 2-hours after Iftar
7- At any time when there are symptoms of hypoglycaemia/hyperglycemia or feeling unwell

Break the fast if:

∑ Blood glucose level is < 3.3 mmol/L

∑ Blood glucose level reaches 3.9 mmol/L after first few hours of fasting
∑ Blood glucose level is > 16.6 mmol/L
∑ At any time when there are symptoms of hypoglycaemia/hyperglycemia or feeling unwell

Patients with frequent hypo and hyperglycemia are not advised to fast.
Patients with major diabetic complications are not advised to fast.

DISEASE DRUG CATEGORY SPECIFICA- RECOMMENDATION

TION
 Penicillins (oral route) - Change to
Penicillin V 500mg QID Clarithromycin 250 -500mg BID
(every 12 hours) x 5 days if possible

-Option 1:
Give Augmentin 1g formula every 12
URTIs Amoxicillin 250mg – TID hourly if available
5oomg Option 2:
TID Change to Clarithromycin BID x 5 days
Augmentin 375mg - 625mg or
Azithromycin OD x 3 days

Option 1:
Soft tissue Change to cefadroxil 500-100mg BID x
infections QID 5 days
Cloxacillin 250mg -5oomg -Do not fast till completion of course
Amoxicillin 250mg – TID Option 1:
LRTIs 5oomg Give Augmentin 1g formula every 12
TID hourly if available
Augmentin 375mg - 625mg Option 2:
Change to Clarithromycin BID x 5 days
or
Azithromycin 250 -500mg OD x 3 to 5
days or
Levofloxacin OD or BID x 5 days

Option 1:
Amoxicillin 250mg – TID Give Augmentin 1g formula every 12
5oomg hourly if available
TID Option 2:
Community- Augmentin 375mg - 625mg Change to Clarithromycin BID x 5 days
Acquired or
Pneumonia Azithromycin 250 -500mg OD x 3 to 5
days or
Levofloxacin OD or BID x 5 days

Give Augmentin 1g formula every 12

hourly if available OR
If combination of TID Advice to change Augmentin TID to :
Amoxicillin 500mg or TID Cefuroxime 250 – 500mg BID
Augmentin 375 – 625mg
prescribed with BID
Clarithromycin 500mg
 Amoxicillin 250mg – 5oomg TID Option 1:
Give Augmentin 1g formula every 12 hourly
Augmentin 375mg - 625mg TID if available
Option 2:
Hospital – Change to Clarithromycin BID x 5 days or
Acquired Azithromycin 250 -500mg OD x 3 to 5 days
Pneumonia or
Levofloxacin OD or BID x 5 days OR
Co-trimoxazole 960mg BD

If combination of Give Augmentin 1g formula every 12 hourly

Amoxicillin 500mg or if available OR
Augmentin 375 – 625mg Advice to change Augmentin TID to :
prescribed with TID Cefuroxime 250 – 500mg BID or
Clarithromycin 500mg TID Levofloxacin 250 -500mg OD

BID

Erthyromycin 250mg QID - change to Clarithromycin BID

to be taken with food to avoid stomach
discomfort
Doxycycline 100mg BD - to be taken on empty stomach 1hour
before food or after food by 2 hours, should
be taken with glass full of water while
sitting or standing. don’t lay down after
taken the medication to avoid throat
irritation
Phenomethylpencilin 250mg BD/QID -change to BID
to be taken on empty stomach, 30 minutes
before the meal or 2 hours after it
Cotrimaxizole 800mg BD - to be taken with or after food to avoid
stomach discomfort, nausea and diarrhea
Ciprofloxacin 250mg BD - to be taken with or without food, try to
drink plenty of water
Other Antibiotics
Levofloxacin 250mg BD to be taken with or without food, in case of
liquid levofloxacin it should be taken 1 hour
before food or after food by 2 hours on an
empty stomach
Cephalexin 20mg BD/QID -to be taken with or without food
Cefurexime 250mg BD - other cephalosporins are on an empty
stomach , but only cefurexime is better
absorbed with food
Nitrofurine 100mg OD/BD - to be taken with food or milk , which
(Sustain release ) would lessen the stomach upset and
promote absorption
Moxifloxacin 400mg OD -to be taken with or without food , but
avoid taken medicines containing iron or
zinc during the two hours before taken
moxifloxacin or after taken moxifloxacin by
two hours
 Advice to Change to:
Nitrofurantion QID Ciprofloxacin
UTIs (immediate- release) 250 – 500 BID or
Co-trimoxazole 960 BD if possible
otherwise advice not to fast

-vorticonazole 200mg BD - To be taken on empty stomach one

hour before suhoor or two hours
-fluconazole 150mg OD after a meal iftar
- To be taken before or after a suhoor
Fungal infections -itraconazole 100mg BD - To be taken after iftar. But oral
solution to be taken on empty
stomach. Swish the liquid in your
mouth before swallowing for several
seconds

For other antibiotics

Advice for Once or Twice daily
OD or BID formulations if available otherwise advice
Other Infections
preferable patient not to fast till the completion of
antibiotic course

Viral infections Oseltamivir 30/75mg OD/BD - To be taken with or without food.

After iftar or before suhoor But with
food may lessen the stomach upset
Valganciclovir 450mg - Whenever possible to be taken with
OD
food. After iftar
Valaciclovir 500mg BD - Taken with meals or on empty
stomach. After iftar or before suhoor

May fast if willing with careful monitoring

due avoid
Abacavir -300mg
Risk of treatment failure and resistant.

- To be taken before or after iftar/suhoor

HIV -Emtricitabine -300mg BD To be taken after iftar and after suhoor (fatty
meal)
Nucleoside
reverse -Lamivudine -200mg OD - To be taken before or after suhoor
transcriptase
inhibitors
(NRTIs) -Stavudine -50/100/150mg - To be taken before or after suhoor

-Tenofovir alafenamide -25mg -to be taken with iftar or suhoor

 - Tenofovir disoproxil -300mg QD -to be taken with iftar or suhoor(fatty meal)

-Zidovudine - to be taken before or after iftar/suhoor,

preferable after iftar or suhoor to reduce
nausea
Non-Nucleoside -efavirenz -100/200mg -to be taken before iftar or suhoor (fatty
reverse meal)
transcriptase -Etravirine -
- to be taken with iftar or suhoor
inhibitors
-Doravirine -100mg OD
(NNRTIs) - to be taken before or after iftar/suhoor
- Nevirapine -200mgs
- to be taken with iftar or suhoor(fatty meal)
-atazanavir - 300mg - to be taken before or after
iftar/suhoor(fatty meal)
(PIs) - Ritonavir - 100mg
- to be taken before or after iftar/suhoor
(fatty meal), preferable after iftar or suhoor
to reduce nausea (fatty meal)
-Raltegravir -100/400mg - to be taken before or after
iftar/suhoor(fatty meal)
(INSTIs) -Dolutegravir -50mg
- to be taken before or after
iftar/suhoor(fatty meal), preferable after iftar
or suhoor in case of integrase inhibitors
resistance
Combinations - efavirenz + emtricitabine + - 600 mg/200 -to be taken before suhoor
tenofavir mg/245 mg

- Dolutegravir + abacavir + - 50 /600 -to be taken before or after iftar/suhoor,

lamuvidine /300mg preferable before food and with food in case
of intake of supplements containing calcium
or iron

-lopinavir + Ritonavir - 200/50mg BD - to be taken with iftar and suhoor

- Lamivadine + Zidovidine -150/300mg -to be taken before or after iftar/suhoor,

preferable after iftar or suhoor to reduce
- emtricitabine + tenofavir nausea
disoproxil fumarate -200/300mg -to be taken with or after food(fatty meal)

- Lamivadine + Zidovidine
+ efavirenz - -to be taken with or without food, efavirenz
150/300/600mg to be taken 2 hours before suhoor
- bictegravir, emtricitabine, OD
tenofovir alafenamide
-50/200/25mg -to be taken with or without food(fatty meal)
- Favipiravir -200mg - to be taken after iftar or suhoor
OD/BD

Fusion Inhibitors Not available in the local

& Entry Inhibitor medical stores
& PK Enhancer
 Hepatiti Entrecavir 0.5mg OD/BD - To be taken on empty stomach 2
s hours after iftar or 1 hour before
suhoor
Sofomavir OD - Taken with or without food. After
iftar or suhoor

Sofosbuvir OD - To be taken with or without food.

400mg+ After iftar or suhoor
velpatsvir 100mg

Ledipasvir OD - Taken with or without food

90mg+ - After iftar or suhoor
Sofosbuvir
400mg

Daclatasvir 60mg OD - To be taken with or without food

- After iftar or before suhoor

Anti Rifampicin 150/300mg OD - To be taken before food to enhance

tubercul absorption. Directly after iftar
osis
Isonizid 100/300mg TID/OD - To be taken on empty stomach
- 2 hours after iftar or 1 hour before
suhoor
pyrizihamide 500mg OD/BD - To be taken with or without food
- 2 hours after iftar or 1 hour before
suhoor
-
-
Dapsone 100mg OD/BD - To be taken with or without food
but with food may decrease stomach
upset. Advised to drink a full glass
of water with each dose.
- After iftar

DISEA - DRUG SPECIFICATION RECOMMENDATION

SE CATEGORY

Anti-Psychiatric OD To be taken after iftar

& To be taken after iftar and Suhoor

Antidepressants BID

Paroxetine 20mg OD

Flouxetine 20mg OD to be taken before or after iftar or suhoor

Citalopram 20mg OD - to be taken before or after iftar or suhoor,

preferably with food in case of GI upset
 Sertraline 50mg OD

Fluoxerine 20mg OD

Maprotiline 50mg -to be taken usual timings at night

Amitryptiline 25mg

Drugs for GIT e.g. Omeprazole To be taken 30min before suhoor

Esmeprazole
OD -To be taken after 2 hours after Iftar and 30 min
BID before Suhoor

Domperidone TID
Metoclopramide TID -To be taken BID
Mebeverine TID -2 hours after Iftar and 30 min before Suhoor

Salfasalazine 500mg BID

Ulcerative colitis -To be taken after iftar and suhoor
TID -2 tab after iftar and 1 tab after suhoor
and crohn's disease

Meselazamine 500mg BD
-To be taken 2 hours after iftar and 1 hour before
suhoor

(Salofak) 0.5g TID - (2 tab) 2 hours after iftar and (2tab)1 hour
before suhoor
1g TID
-(3 tab) 2 hours after suhoor and ( 3 tab) 1 hour
before suhoor
(Pentasa) 4g BID -(2tab) after iftar and (2tab) after suhoor
2g OD -(2tab) after iftar

Biologic Agents Sc inj.

Do not invalidate fast.
To be taken usual timings
Ursodeoxychloric acid 250mg

Analgesics Paracetamol TID/QID

NSAIDs Ibuprofen TID
Mefenamic acid TID To be given twice after Iftar and Suhoor or once
celocoxib OD/BID after iftar
Diclofenac Na OD/BID

Mycophenolate Mofetil 250 – BD dose:

500mg BID (cellcept)
Mycophenolate Sodium 360-720mg
BID (Myfortic)
Tacrolimus 0.5-1mg BID
Tacrolimus ER 0.75mg – 1mg OD
To be taken 2 hours after iftar and 1 hour before
suhoor
To be taken after Iftar and suhoor
To be Given 2 hours after Iftar and 1 hour before
suhoor
1 hour before suhoor
Renal Transplant - Azathioprine OD To be taken 1 hour before suhoor
Prednisolone OD
Immunopressants Everolimus 0.25mg - 0.75mg OD To be taken after suhoor

Sirolimus 1mg OD
To be taken after suhoor
Ciclosporin 25mg – 50mg – 100mg
BID To be taken with iftar and with suhoor

Urology Tamosulsin 400mg BD -to be taken after iftar or suhoor

Finasteride 5mg OD -to be taken with or without food

Tolteradine 2mg BD -to be taken before or after iftar or suhoor

Solfencin 5mg OD - to be taken before or after iftar or suhoor

Salfasalazine 500mg BID

TID
Please refer to GIT section.
Meselazamine 500mg BD
TID
1g TID
Rheumatology To be taken after iftar
Methotrexate once weekly

-To be taken after iftar

Hydroxychloroquine OD -To be taken after iftar or suhoor
Leflunomide OD -To be taken after iftar or suhoor
Tofacitinib OD
Do not invalidate fast.
Biologic Agents Sc injections To be taken usual timings

One hour before suhoor (empty stomach) with

Alendorate sodium 75mg plenty of water – remain standing or in a sitting
position or walk for 30 min to prevent severe
esophagitis

Chronic Kidney Clinical judgment

Disease.
Doses should be modified to twice
daily regimen if possible
-Stable patients with CKD 1 - 3 may fast if
wishing. Otherwise are exempted
-Stage 3 – 4 Unstable Patients (high risk ) not
advisable to fast (if insisting to fast may be done
under close supervision and monitoring)
-HD patients if wishing to fast may only fast
during non-dialysis days

In General:

Patient Education and Awareness is of paramount with regards appropriate use of medication during
this holy month of Ramadan.
Try to switch to longer –acting (Extended-release form that requires to be given once or twice daily)

Always seek Advice for clinical judgment

Patients with chronic unstable medical conditions should be advised not to fast.

Patients may be reminded about conditions that exempted from fasting according to Islamic scholars
rules if possible.

Choice of fasting is entirely left on patient to decide, we as healthcare professional are involved in
advising, education and informing the patient about potential harm of fasting (high risk patient willing
to fast) and the precautionary measures to be taken in case of any complication that might occur during
or after the period of fasting.

Special attention must give to elderly patients and patients with chronic co-mordities (multiple medical
conditions) who are on polypharmacy that may further pose their health at risk.

For further queries and information please call Drug Information (DIC) and Training Centre

Dect Phone: 5549, DIC; 9400, WhatsApp: 95056028, Mobile: 95056028

Email: malbalushi73@gmail.com

Ph. Maqbool Al Balushi

Drug Information and Training Centre
Pharmaceutical care department
Royal Hospital