Drug Intake

During
Ramadan
Prepared by Online Download

Ph. Maqbool Al Balushi

Royal Hospital

Designed by
A.Ph: Abdullah Al-Kaabi
Shinas EHC
 Hypertension
Disease
Beta- Blockers SPECIFICATION RECOMMENDATION

Bisoprolol OD Take after Suhoor OR after iftar

Metoprolol OD Take after Suhoor OR after iftar

Atenolol OD Take after Suhoor OR after iftar

Propranolol BID/TID Take after Iftar and Suhoor

Labetalol BID/TID/QID Take after Iftar andSuhoor

Calculate the TDD and give BID

Methyldopa BID/TID/QID after Iftar(2/3) and Suhoor(1/3)
Calculate the TDD and give BID
Clonidine BID/TID after Iftar(2/3) and Suhoor(1/3)

Carvedilol OD Take after iftar

BID Take after iftar and after suhoor

Take with fatty meal (dinner) to avoid abrupt fall in BP

ACEIs SPECIFICATION RECOMMENDATION

OD - Monitor for postural hypotension e.g. dizziness
BID/TID – Shift to long-acting
Take after Ishaa prayer

Lisinopril
Monitor for postural hypotension e.g. dizziness
OD Take after Ishaa prayer

Enalapril 5mg OD Take after Ishaa prayer

Avoid taking with large amounts of dates, bananas, oranges, green leafy vegetables

ARBs SPECIFICATION RECOMMENDATION

Valsartan OD Take after Ishaa prayer
BID Take after iftar and suhoor

Losartan OD Take after Iftar and suhoor

 Hypertension
Disease
CCBs SPECIFICATION RECOMMENDATION

Dihydropyridine e.g. OD Take after Iftar or Suhoor

amlodipine or nifedipine BID Take after Iftar and Suhoor
Non–dihydropyridine OD/BID/TID Take after Iftar and Suhoor
e.g. verapamil and For TID; HTN: change to BID dosing Angina &
Arrythmias: change to sustain release BID or Extended
diltiazem release OD, if not possible advice not to fast

Thiazide diuretic SPECIFICATION RECOMMENDATION

Take after Ishaa prayer
Hydrochlorothiazide OD - might cause dehydration Avoid taking suhoor time
Take after Ishaa prayer
Metolazone OD - might cause dehydration Avoid taking suhoor time

Loop diuretic SPECIFICATION RECOMMENDATION

Furosemide OD - might cause dehydration
BID- TID – Change to OD or BID
For HTN OD
For HF depends on patients clinical
condition – OD/BID
Carbonic Anhydrase Inhibitors SPECIFICATION
Take after Ishaa prayer
Avoid Suhoor time
Take after Iftar (larger dose) and
midnight (lower dose)
RECOMMENDATION

Acetazolamide 250mg OD For OD take after iftar

BID BID take after Iftar and midnight
SPECIFICATION RECOMMENDATION

Amiloride5mg/ OD Take after Iftar

Spironolactone OD – HF-depends on patient HF stage 3-4 – fasting not
clinical condition advisable
BID /TID – Liver cirrhosis Liver cirrhosis – fasting not
advisable
SPECIFICATION RECOMMENDATION

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 SPECIFICATION RECOMMENDATION

Tamsulosin - BPH OD – Take after Iftar

Alfasulosin - BPH Monitor for postural hypotension e.g.
dizziness
Terazosin - HTN BD/TID/QID – change to extended-release OD
Prazosin - HTN Monitor for postural hypotension
 Coronary Artery
Disease
Antiplatelet SPECIFICATION RECOMMENDATION

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

Ticagrelor BID After Iftar and Suhoor Interval

between doses should not be
less than 8 hours

SPECIFICATION RECOMMENDATION

Contrast media after Increase risk of contrast Advise not to fast

angioplasty induced nephropathy
due to dehydration

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

Isosorbide Mononitrate Monitor for postural
hypotension

Nitrates (IR) e.g. BID/TID/QID 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

GTN spray/tablet PRN Does not invalidate fast

Anytime as needed

Beta-Blockers Refer to Hypertension As stated Above

section

Calcium Channel Refer to Hypertension As stated Above

Blockers section
 Arrythmia
Disease

SPECIFICATION RECOMMENDATION
Amiodarone OD Take after Iftar with full meal
Patient are sensitive to (At initiation of treatment
electrolyte disturbance where the patients starts
with tid for the first week
then bid for the 2nd week,
advise not to fast)

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

SPECIFICATION RECOMMENDATION
Verapamil OD Preferred after Suhoor
BID Take after Iftar and Suhoor
TID If possible change to SR
OD/BD or advise not to fast

SPECIFICATION RECOMMENDATION
Sotalol 80mg OD Take after iftar
BID After Iftar and Suhoor
 Heart Failure
Disease
Loop Diuretics SPECIFICATION RECOMMENDATION
Frusemide - Alone OD - Take after Ishaa prayer
-Combined with Thiazide - Advise not to fast. Monitor
Spironolactone OD for significant dehydration
and electrolyte disturbance
Take after Iftar or Suhoor
Advise not to fast if
symptomatic

SPECIFICATION RECOMMENDATION
Digoxin OD - Take after Suhoor
Monitor for toxicity Or
secondary to hypokalemia Seek clinical judgement and
and dehydration advise not to fast if
symptomatic

ACEs & ARBs SPECIFICATION RECOMMENDATION

Lisinopril OD - Monitor for postural Take after Ishaa praying
Valsartan hypotension e.g. dizziness Advise not to fast if
unstable and symptomatic

Entresto-(Sacubitril BD Take after Iftar and Suhoor

+valsartan) If clinically unstable, advise not to
fast

Beta Blockers SPECIFICATION RECOMMENDATION

Carvedilol BID Take with fatty meals, with
Iftar and Suhoor

Bisoprolol OD Take after Suhoor

Metoprolol OD Take after Suhoor

BID Take after Iftar and Suhoor
Advise not to fast if
unstable and symptomatic

Risk of abrupt hypotension

 Anti-Coagulants
SPECIFICATION RECOMMENDATION
Warfarin OD – Take after main Iftar Monitor INR
Take the dose in the same frequently
time every day Avoid large amount of vitamin K
food like 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 To be taken separate timings.

aspirin Aspirin at 8pm and warfarin at
10pm both after meals or with
large amount of liquid

If co-prescribed with To be taken separate timings.

other drugs known to Aspirin at 8pm and NSAID and
cause GIT disturbance steroid after suhoor both after
such as NSAID or meals or with large amount of
Corticosteroid liquid

Always advice the patient to monitor sign and symptoms of bleeding

Seek clinical judgment
SPECIFICATION RECOMMENDATION
Rivaroxaban 10mg/20mg OD Take after full Iftar meal

If co-prescribed with other To be taken separate timings.

drugs known to cause GIT Aspirin at 8pm and NSAID and
disturbance such as aspirin steroid after suhoor both after
NSAID or Corticosteroid meals or with large amount of
liquid

15mg bid Take after Iftar and suhoor

SPECIFICATION RECOMMENDATION
Dabigatran BID - Might increase GI Take after full Iftar and Suhoor
disturbance Interval should be ≥ 8 hours
SPECIFICATION RECOMMENDATION
Apixaban BID Take after full Iftar and Suhoor
Interval should be ≥ 8 hours
 Hyper-Lipidimia
Disease

SPECIFICATION RECOMMENDATION
Atorvastatin and OD Take after Iftar or Suhoor
Rosuvastatin (Long acting) To be taken the same time daily

SPECIFICATION RECOMMENDATION
Simvastatin and OD Take before bedtime preferably
Pravastatin (short acting) at 10pm
To be taken same time daily

SPECIFICATION
Fibrates During fasting, risk of
rhabdomyolysis might
increase if used in
combination with Statins
due to dehydration during
fasting
RECOMMENDATION
Take after full Iftar or Suhoor
With Statins:
Statins to be taken at night
and fibrates after suhoor

SPECIFICATION RECOMMENDATION
EZETIMIBE OD Take after Iftar or Suhoor
To be taken the same time daily
 Epilepsy
Disease
SPECIFICATION RECOMMENDATION

Carbamazepine (IR) Should be taken at least Option 1: convert to CR formula

twice daily 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 (MR) Initiation OD Take after Iftar or Suhoor

Maintenance BID (same time daily)
Take after Iftar and Suhoor
(same time daily)

Benzodiazepines OD /BID/ PRN doses Take after Iftar (preferred after Ishaa
Diazepam OD pray)
Clinical judgment : Advice not to fast
Lorazepam OD if clinically unstable
Bromazepam

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
 Asthma & COPD
Disease
SPECIFICATION RECOMMENDATION

Inhalers Advise to avoid food that can No dose change,

MDIs/Evohalers trigger asthma symptoms Does NOT invalidate the fast,
such as peanuts, milk, eggs, Stay hydrated
and wheat

Vaporizers/ PRN/TID/QID No dose change,

Nebulizing soln. Does NOT invalidate fasting

Nasal spray PRN/TID/QID Take as usual as instructed –

does not invalidate fast

Powder/Capsule e.g. OD No dose change,

Relvar BID invalidate fasting since the powder
Turbo haler contains lactose
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

SR formula - BD hour after meal
Take 2 hours after Iftar and
one hour before suhoor

Montelukast OD To be taken after Iftar or

suhoor
(same time daily)
During exercise: to be taken 2
hours before exercise

Idiopathic Pulmonary TID Advise not fast

fibrosis (pirfenidone)
Antihistamine SPECIFICATION RECOMMENDATION

Loratidine 10mg OD/BID To be taken after Iftar or suhoor food

Chlorpheramine 4mg OD/BID/TID/QID OD: To be taken after Iftar

BID: After Iftar and midnight
TID/QID: Give BID dose

Hydroxyzine OD/BID/TID/QID OD
BID: After Iftar and midnight
TID/QID: Give BID dose
 hypo-Thyriodism & hyper-Thyroidism
Disease

SPECIFICATION RECOMMENDATION

Levothyroxine OD Should be taken on empty

stomach I hour before suhoor to
get the benefit of circadian rhythm

Carbimazole BID Take with Iftar meal and Suhoor

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 0.2mg OD To be taken 1 hour before

suhoor or 2 hours after Iftar
(same time daily)

Prednisolone OD To be taken after suhoor meal to

get the benefit of circadian rhythm
and avoid stomach discomfort

Fludrocortisone 0.1mg OD To be taken after suhoor

Hydrocortisone 10mg OD To be taken after Iftar, drink plenty

BID of fluids to facilitate absorption
After Iftar and suhoor

Dexamethasone OD/BD/QID To be taken preferably with

0.5/2/4 mg Iftar to avoid stomach
discomfort
 Oral Anti-diabetics & Non-Insulin
Diabetes Disease
SPECIFICATION RECOMMENDATION

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

remains unchanged - 500MG BID: Take after Iftar and
- BID: Daily dose Suhoor
remains unchanged -1G BID : Take after Iftar and Suhoor
- TID: Daily dose 1G TID : Give 1G BID Take after Iftar
and Suhoor
remains unchanged
- 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 & Liraglutide Maintenance OD No dose modification is needed

Take usual timings as do not
invalidate fast and does not
cause hypoglycaemia
However, advice to take during
night

Sulfonyl Ureas e.g. OD * To be avoided in elderly patients

Glibenclamide*, Glibenclamide OD/BID above 65 years
Gliclazide, and best to be avoided and If prescriber insists to give the
same then:
Glimepiride Switch to newer shorter
5mg OD: Give after Iftar
acting SU 5mg BID: 5mg after Iftar and 2.5mg
(Gliclazide, Glimepiride) 2 hours before suhoor to avoid
daytime hypoglycaemia
patients with good glycemic
control
* Advice to monitor BG as stated
below
 Oral Anti-diabetics & Non-Insulin
Diabetes Disease

SPECIFICATION RECOMMENDATION

Short – Acting Gliclazide MR: OD To be taken after Iftar (if good

Sulphonyureas glycemic control advice to
reduce the dose by 50%)

Gliclazide IR: BID Take after Iftar and 2 hours

before suhoor to avoid
daytime hypoglycaemia (if
good glycemic control, advice
to reduce the suhoor dose by
50%)

Glimepiride OD 2mg – 4mg OD: To be taken after

Max. 8mg Iftar
Above 6mg give into 6mg OD : Reduce to 4mg and
divided doses BID give after Iftar
8mg OD: Give 4mg BID, 4mg
after Iftar and 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 dehydration -If insists on fasting then:
Empaglifozin and Genito-urinary Give with Iftar
Canagliflozin 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.
 Phosphate binders,
Vitamins and minerals

SPECIFICATION RECOMMENDATION

Calcitriol 0.25mcg - To be taken after directly

after suhoor meal

Alphacacidol 0.25mcg -0.5mcg To be taken directly after

suhoor meal

Vitamin D3 5,000 IU daily To be taken with Iftar

10,000 IU daily (preferable fatty meal to
50,000 IU once weekly facilitate absorption )
50,000 IU once monthly

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

Calcium carbonate OD /BID/TID fast if insists to be taken BID with
Iftar and suhoor
Calcium + vit D OD/BID
-BID doses: To be taken after Iftar
Calcium gluconate OD/BID/TID and suhoor
Magnesium chelate OD -Calcium carbonate and gluconate if
Pyridoxine (vit b6) OD taken as phosphate binder then give
Folic acid OD with meals, if given as supplement
give on empty stomach
Ferrous sulphate OD -Advice the patient to drink plenty of
Riboflavin OD fluid to avoid daytime dehydration
Potassium chloride OD/BID/TID and electrolyte disturbance.
Sodium chloride OD/BID/TID -In case of CKD plenty of fluid is
restricted; best to avoid fasting but if
Thiamine OD insists advice to monitor symptoms
Vitamin E OD of dehydration
Biotin OD -Other vitamins may be taken
Cod Liver Oil OD anytime during the evening time but
same time daily.
Multivitamins OD
- Amino acids may be taken after
Amino acids OD/BD Iftar and suhoor without any changes
in doses
 Insulin
Diabetes Disease
SPECIFICATION RECOMMENDATION

Long- or intermediate acting OD Take at Iftar.

basal insulin Reduce dose by 15–30% if
e.g. Glargine /Degludec good glycemic control
(Tresiba)l Detemir

intermediate - BID Take usual morning dose at Iftar

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

Rapid- or short-acting TID -Take normal dose at Iftar Omit

prandial/bolus insulin lunch time dose
e.g. Lispro -Reduce Suhoor dose by 25–50%
Aspart based on patients glycemic status.
Actrapid If good glycemic 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
glycemic status and advice to take at 30
min before suhoor for Mixtard and 5 to 15
min before suhoor for Humalog Mix
If good glycemic control reduce the
suhoor dose by 50%

Break the fast if:

Monitor Blood Glucose levels 6 times per day: Blood glucose level is < 3.3 mmol/L
1-Pre-dawn meal (suhoor) Blood glucose level reaches 3.9 mmol/L after
2- Morning (10 am) first few hours of fasting
3- Midday(12pm) Blood glucose level is > 16.6 mmol/L
4-Mid-afternoon (3 pm) At any time when there are symptoms of
5-Pre-sunset meal - Iftar ( 6pm) hypoglycaemia/hyperglycemia or feeling
6- 2-hours after Iftar unwell
At any time when there are symptoms of Patients with frequent hypo and hyperglycemia are
hypoglycaemia/hyperglycemia or feeling unwell not advised to fast.
Patients with major diabetic complications are not
advised to fast.
 Anti-infectives
URTIs SPECIFICATION RECOMMENDATION

Penicillin (oral route) QID - Change to

Penicillin V 500mg Clarithromycin 250 -500mg BID
(every 12 hours) x 5 days if possible

Amoxicillin 250mg – 5oomg TID -Option 1:

Augmentin 375mg - 625mg
Soft tissue infections
TID Give Augmentin 1g formula every 12
hourly if available
Option 2:
Change to Clarithromycin BID x 5
days or Azithromycin OD x 3 days
SPECIFICATION RECOMMENDATION

Cloxacillin 250mg -5oomg QID Option 1:

Change to cefadroxil 500-100mg BID
x 5 days
-Do not fast till completion of course
LRTIs SPECIFICATION RECOMMENDATION

Amoxicillin 250mg – 5oomg TID Option 1:

Augmentin 375mg - 625mg TID Give Augmentin 1g formula every 12
hourly if available
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
Community-Acquired Pneumonia SPECIFICATION RECOMMENDATION

Amoxicillin 250mg – 5oomg TID Option 1:

Augmentin 375mg - 625mg
If combination of
Amoxicillin 500mg or
Augmentin 375 – 625mg
prescribed with
Clarithromycin 500mg
TID Give Augmentin 1g formula every 12
hourly if available
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
TID Give Augmentin 1g formula every
TID 12 hourly if available OR
BID Advice to change Augmentin TID
to :
Cefuroxime 250 – 500mg BID
 Anti-infectives
Hospital – Acquired Pneumonia
Amoxicillin 250mg – 5oomg
Augmentin 375mg - 625mg
If combination of
Amoxicillin 500mg or
Augmentin 375 – 625mg
prescribed with
Clarithromycin 500mg
Other Antibiotics
Erythromycin 250mg
Doxycycline 100mg
Phenoxymethylpenicillin
250mg
Cotrimoxazole 800mg DS
Ciprofloxacin 250mg
SPECIFICATION RECOMMENDATION
TID Option 1:
TID Give Augmentin 1g formula every 12
hourly if available
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 OR
Co-trimoxazole 960mg BD
TID Give Augmentin 1g formula every 12
TID hourly if available OR
BID Advice to change Augmentin TID to :
Cefuroxime 250 – 500mg BID or
Levofloxacin 250 -500mg OD
SPECIFICATION RECOMMENDATION
QID - change to Clarithromycin BID
to be taken with Iftar and suhoor to
avoid stomach discomfort
BD - to be taken on empty stomach
1hour before Suhoor and 2 hours
after Iftar, should be taken with glass
full of water while sitting or standing.
don’t lay down after taken the
medication to avoid throat irritation
BD/QID -change to BID , after Iftar and suhoor
to be taken on empty stomach, 30
minutes before the meal or 2 hours
after it
BD - to be taken with or after Iftar and
suhoor to avoid stomach discomfort,
nausea and diarrhea
BD - to be taken with or without food, try
to drink plenty of water, after Iftar
and suhoor
 Anti-infectives
Other Antibiotics SPECIFICATION RECOMMENDATION

Levofloxacin 250mg OD/BD To be taken with or without food,

in case of BD levofloxacin it
should be taken 1 hour before
suhoor and 2 hours on after Iftar
Cephalexin 250mg BD/QID Give BD after Iftar and suhoor

Cefuroxime 250mg BD Give BD after Iftar and suhoor

Nitrofurantoin 100mg OD/BD To be taken with Iftar and suhoor

(Sustain release )

Moxifloxacin 400mg OD To be taken after iftar, but avoid

taken medicines containing iron or
zinc during the two hours before
taken moxifloxacin or after taken
moxifloxacin by two hours

UTIs SPECIFICATION RECOMMENDATION

Nitrofurantoin QID Advice to Change to either SR form

(immediate- release) If SR not available then change to
Ciprofloxacin
250 – 500 BID or
Co-trimoxazole 960 BD if possible
otherwise advice not to fast

Fungal infections SPECIFICATION RECOMMENDATION

voriconazole 200mg BD To be taken on empty stomach one

hour before suhoor or two hours
after Iftar

fluconazole 150mg OD To be taken before or after

suhoor

Iitraconazole 100mg BD To be taken after Iftar. But oral

solution to be taken on empty
stomach.

Other Infections OD or BID preferable For other antibiotics

Advice for Once or Twice daily
formulations if available
otherwise advice patient not to
fast till the completion of
antibiotic course
 Anti-infectives
Viral infections SPECIFICATION RECOMMENDATION

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

After Iftar or before suhoor

Valganciclovir 450mg OD Whenever possible to be taken with

food after Iftar

Valaciclovir 500mg BD Whenever possible to be taken with

food after Iftar

HIV (NRTIs) SPECIFICATION RECOMMENDATION

Abacavir 300mg May fast if willing with careful

monitoring to avoid risk of treatment
failure and resistant.
- To be taken before or after
Iftar/suhoor

Emtricitabine 300mg BD To be taken after Iftar and after

suhoor (fatty meal)

Lamivudine 200mg OD To be taken before or after suhoor

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

HIV (NNRTIs) SPECIFICATION RECOMMENDATION

Efavirenz -100/200mg To be taken before Iftar or suhoor

(fatty meal)

Etravirine - To be taken with Iftar or suhoor

Doravirine 100mg OD To be taken before or after

Iftar/suhoor

Nevirapine 200mgs to be taken with Iftar or suhoor(fatty

meal)
 Anti-infectives
PIs SPECIFICATION RECOMMENDATION

Atazanavir 300mg To be taken before or after

Iftar/suhoor(fatty meal)

Ritonavir 100mg To be taken before or after

Iftar/suhoor (fatty meal), preferable
after Iftar or suhoor to reduce
nausea (fatty meal)

INSTIs SPECIFICATION RECOMMENDATION

Raltegravir 100/400mg To be taken before or after

Iftar/suhoor(fatty meal)

Dolutegravir 50mg To be taken before or after

Iftar/suhoor(fatty meal), preferable
after Iftar or suhoor in case of
integrase inhibitors resistance

Combinations SPECIFICATION RECOMMENDATION

Efavirenz+emtricitabine 600 mg/200 mg/245 mg To be taken before suhoor

+tenofavir

Dolutegravir+abacavir+l 50 /600 /300mg To be taken before or after

amuvidine Iftar/suhoor, 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

Lamivudine+Zidovidine 150/300mg To be taken before or after

Iftar/suhoor, preferable after Iftar or
suhoor to reduce nausea

Emtricitabine+tenofavir 200/300mg To be taken with or after Iftar (fatty

disoproxil fumarate meal)

Lamivudine+Zidovidine+ 150/300/600mg OD To be taken with Iftar, efavirenz to be

efavirenz taken 2 hours before suhoor

Bictegravir, emtricitabine, 50/200/25mg To be taken with Iftar (fatty meal)

tenofovir alafenamide

Favipiravir 200mg OD/BD To be taken after Iftar or suhoor

Fusion Inhibitors & Entry Inhibitor & PK Enhancer Not available in the local medical stores
 Hepatitis Disease
& Anti-tuberculosis

Hepatitis SPECIFICATION RECOMMENDATION

Entrecavir 0.5mg OD/BD To be taken on empty stomach 2

hours after Iftar or 1 hour before
suhoor

Sofomavir OD Taken with or without food. After

Iftar or suhoor

Sofosbuvir 400mg+ OD To be taken with or without food.

velpatsvir 100mg After Iftar or suhoor

Ledipasvir 90mg+ OD Taken with or without food

Sofosbuvir 400mg After Iftar or suhoor

Daclatasvir 60mg OD To be taken with or without food

After Iftar or before suhoor

Anti-tuberculosis SPECIFICATION RECOMMENDATION

Rifampicin 150/300mg To be taken on empty to enhance

OD absorption. 2 hours after Iftar

Isoniazid 100/300mg -To be taken on empty stomach

TID/OD -2 hours after Iftar or 1 hour
before suhoor

Pyrazinamide 500mg -To be taken with or without food

OD/BD - 2 hours after Iftar or 1 hour
before suhoor

Dapsone 100mg -To be taken with or without food

OD/BD but with food to decrease
stomach upset. Advised to drink
a full glass of water with each
dose.
-After Iftar and suhoor
 Anti-Psychiatric &
Antidepressants

Anti-Psychiatric & Antidepressants SPECIFICATION RECOMMENDATION

Paroxetine 20mg OD To be taken after Iftar

Flouxetine20mg OD To be taken after Iftar

Citalopram 20mg OD To be taken after Iftar

Sertraline 50mg OD To be taken after Iftar

Escitalopram 10mg OD To be taken after Iftar

Venlafaxine XR 75mg To be taken after Iftar

Maprotiline 50mg To be taken after Iftar

Amitryptiline 25mg To be taken usual timings at night

 GIT, Ulcerative colitis &
crohn's disease

GIT SPECIFICATION RECOMMENDATION

Omeprazole OD OD: To be taken 30min before

BD suhoor
BD: To be taken 2 hours after Iftar
and 30 min before Suhoor

Esmeprazole OD OD: To be taken 30min before

BD suhoor
BD: To be taken 2 hours after Iftar
and 30 min before Suhoor

Domperidone TID To be taken BID

Metoclopramide TID -2 hours after Iftar and 30 min
Mebeverine TID before Suhoor

Ulcerative colitis and crohn's disease SPECIFICATION RECOMMENDATION

Salfasalazine 500mg BID To be taken after Iftar and suhoor

TID 2 tab after Iftar and 1 tab after suhoor

Meselamine500mg BD To be taken 2 hours after Iftar

and 1 hour before suhoor

Salofak 0.5g TID (2 tab) 2 hours after Iftar and (1tab)1

hour before suhoor
1g TID (3 tab) 2 hours after suhoor & ( 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.

Ursodeoxychloric acid BID After iftar and suhoor

250mg TID 2/3 dose after iftar and 1/3 after suhoor
 Analgesics NSAIDs &
Renal Transplant -
Immunopressants

Analgesics NSAIDs SPECIFICATION RECOMMENDATION

Paracetamol TID/QID To be given twice after Iftar and

Suhoor or once after iftar
Ibuprofen TID To be given twice after Iftar and
Suhoor or once after iftar

Mefenamic acid TID To be given twice after Iftar and

Suhoor or once after iftar

Celecoxib OD/BID To be given twice after Iftar and

Suhoor or once after iftar

Etoricoxib OD/BD To be given twice after Iftar and

Suhoor or once after iftar

Diclofenac Na OD/BID To be given twice after Iftar and

Suhoor or once after iftar
Renal Transplant - Immunopressants SPECIFICATION RECOMMENDATION

Mycophenolate Mofetil BID BD dose:To be taken 2 hours after iftar

250 – 500mg (cellcept) and 1 hour before suhoor
Mycophenolate Sodium BID To be taken after Iftar and suhoor
360-720mg (Myfortic)

Tacrolimus 0.5-1mg BID To be Given 2 hours after Iftar

and 1 hour before suhoor

Tacrolimus ER 0.75mg – 1mg OD 1 hour before suhoor

Azathioprine OD To be taken 1 hour before suhoor

Prednisolone OD To be taken after suhoor

Everolimus0.25mg - 0.75mg OD To be taken after suhoor

Sirolimus 1mg OD To be taken after suhoor

Ciclosporin 25mg – 50mg – BID To be taken with iftar and with

100mg suhoor
 Urology, Rheumatology &
Chronic Kidney Disease

Urology SPECIFICATION RECOMMENDATION

Tamsulosin 400mcg OD To be taken after iftar

Finasteride 5mg OD To be taken after iftar

Tolteradine 2mg BD To be taken after iftar and suhoor

Solifenacin 5mg OD To be taken after iftar

Rheumatology SPECIFICATION RECOMMENDATION

Sulfasalazine 500mg BID/TID Please refer to GIT section

Meselamine 500mg BD/TID Please refer to GIT section

Meselamine 1g TID Please refer to GIT section

Methotrexate once weekly To be taken after iftar

Hydroxychloroquine OD/BD To be taken after iftar/after iftar

and suhoor

Leflunomide OD To be taken after iftar or suhoor

Tofacitinib OD To be taken after iftar or suhoor

Biologic Agents Sc. Do not invalidate fast. To be taken usual timings

injections

Alendronate sodium once weekly One hour before suhoor (empty

70mg stomach) with plenty of water –
remain standing or in a sitting
position or walk for 30 min to
prevent severe esophagitis
Chronic Kidney Disease SPECIFICATION RECOMMENDATION

Doses should be modified to twice Clinical judgment

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-morbidities (multiple medical conditions) who are on polypharmacy
that may further pose their health at risk.
 For further queries and information please call Drug Information Specialist

WhatsApp: 95056028, Mobile: 95056028

Email: malbalushi73@gmail.com , maqbool2balushi@gmail.com

Ph. Maqbool Al Balushi

Consultant Clinical Pharmacist / Senior Lecturer National University
Medicines Information, Education and Training Centre
Pharmaceutical care department
Royal Hospital