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General information.High blood pressure is one of the most common diseases in the world. There are many medical studies that have been conducted to evaluate the effect of fasting on the disease. It has been reliably concluded that there is nothing that prevents Muslims with this illness from fasting during Ramadan, especially if there are no associated complications. Here are some helpful hint and cautions to be aware of during the month of Ramadan if you have this disease.

Life Style changes in Ramadan for patient with Hypertension.Stay hydrated & drink plenty of fluids from Iftar until Suhoor. Staying hydrated and avoiding dehydration during the day helps prevent complication that may arise.Reduce salt intake as much as possible.Follow a diet adequate in terms of quality and quantity of food.Includephysicalactivityandexercisessuchasfastwalkingforhalfanhourseveraltimesaweek.Avoidfoods and liquids that contain a high percentage of fat or caffeine (coffee, soft drinks).

When to take your Medications for Hypertension during Ramadan?Many of the drugs used in the treatment of hypertension are slow release medications with long-term effects. Most are used once or maximum twice during the day, and can be taken during the evening dur-ing Iftar and at Suhoor.IfapatienttakesabetablockermedicinesuchasAtenololonceaday;itmaybetakenatIftar.If the patient is taking diuretics, it is preferable to be taken either with Iftar or about two hours following Iftar.

When to take your Medications for Hypertension during Ramadan?Patients taking more than two doses per day or diuretics, should discuss their concerns with a qualified doctor.Adoctormaybeabletochangethetreatmentplantodrugsthatcanbeusedtwiceaday.It is advisable to take your blood pressure several times a day, especially early in the month of Ramandan. The lack of food and liquids during the day can sometimes result in a fall in blood pressure (less than 120 over 80) This may lead to general weakness, dizziness or blackening around the eyes. In the event you experience any of these symptoms repeatedly, you should immediately consult with a qualified doctor to see if there can be a change in the dose or drug to better suit your situation.Patients who have been diagnosed with severe atherosclerosis, or who have history of stroke, heart at-tack or bleeding in the brain, or who suffer from severe high blood pressure are advised not to fast. Hypertensive patients who suffer from other chronic diseases such as diabetes, heart failure or kidney failure with high levels of urea and creatinine, should consult their doctor before starting to fast as this could lead to increased risk for stroke, heart attack or an acute renal failure.Patients taking more than two doses per day or diuretics, should discuss their concerns with qualified doctor.Adoctormaybeabletochangethetreatmentplantodrugsthancanbeusedtwiceaday.

HypertensionTaking your medicine during Ramadan

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General Information:Muslims with diabetes need to take special precautions during Ramadan to manage blood glucose levels and aim at avoiding hypoglycemia during the day and hyperglycemia at night. People with diabetes wishing to fast should first consult their doctor.

Life style change during Ramadan Changes to treatment

Certain diabetes medications may increase your risk of hypoglycemia while fasting. Therefore your treatment regimen may need to be altered to ensure your blood sugar levels are effectively managed during Ramadan.Speak to your healthcare professional about your current treatment / dosage and discuss any adaptations required.

Healthy eating and diet tips:Your diet during Ramadan should be healthy and balanced.Try to eat foods such as wheat, semolina and beans at Suhoor before beginning the fast, because these foods release sugar slowly. This will stabilize your blood sugar levels and help to reduce your cravings and appetite through fasting hours.At Iftar It is advisable tofirst eat foods that release sugarsquickly, such as fruits, which will rapidly increase your blood sugar levels, followed by slow-acting carbohydrates.You should avoid foods high in saturated fat and try to increase your fluid intake during non-fasting hours.

Group 1: People controlling their diabetes by diet and exercise:

If you control your diabetes by diet and exercise and you continue to be careful with your diet when breaking the fast, you can fast safely during Ramadan.If you are overweight, you can lose weight during the Holy Month, which can improve your diabetic control.Divide your food into 2 meals Suhoor and Iftar.Fill up on starchy food such as cereals, basmati rice, breads. Include fruits, vegetables, and yoghurt in your meals.Avoidoverlyfattyfriedfoods.

Stick to low calorie or diet drinks or water and drink plenty of water.You may feel tired when fasting during Ramadan, so although it is important that while you continue your daily activity and prayer, you make time to rest at some point in the day.

Group 2: People controlling their diabetes with diet, exercise and tabletsIt is important that you follow the same guidelines as Group 1 regarding diet and resting.

DiabetesTaking your medicine during Ramadan

Taking Metformin, Sitaglipti and AcarboseIf you feel unwell during the fast taking these tablets you can refer to your doctor to seek advice.If you continue to take them, the largest dose should be taken at Iftar,If you are in doubt about what to do with your tablets when fasting, discuss this with your doctor or pharmacist.Taking Gliclazide, Glipizide, Glimepiride or Glibenclamide (With or without Metformin)These tablets can cause your blood sugar to go low (hypoglycemia) when you are fasting.You can consider reducing or changing the times of taking these tablets when fasting.If you are in doubt about what to do with your tablets when fasting, discuss this with your doctor or pharmacist.

Taking Pioglitazone (with other tablets or insulin) These tablets are usually taken in the morning.

They can cause hypoglycemia (low blood sugar) so it is best to take it at Iftar.It is a good idea to check your blood sugar more often when fasting to make sure it is not rising too high or dropping too low.If you are in doubt about what to do with your tablets when fasting, discuss this with your doctor or pharmacist.

Group 3: people controlling their diabetes by taking insulin (with or without tablets)

It is important that you follow the same guidelines as Group 1 & 2 If you control your diabetes with insulin, it is vital that you know what to do when you will fast as changes in the timings of your insulin injections or alter the doses.You can refer to your diabetes educator, doctor or pharmacist for advice during fasting.It is important to check your blood sugar frequently to avoid high or low blood sugar levels.

Why is it important to prevent low blood sugar?Because it can lead to a loss of consciousness, convulsions or seizures, and require emergency treatment. Symptoms of hypoglycemia: Confusion, Dizziness, Drowsiness, Fast heartbeat, Feeling jittery, Headache, Hunger, Irritability, Sweating and Weakness.

Why is it important to prevent high blood sugar?Because it can cause loss of consciousness and coma. Hyperglycemia can be caused by excessive reduction in dosages of medications. Symptoms of hyperglycemia include: headache, weight loss, fatigue, increased thirst, loss of concentration and frequent urination.

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General information about asthma and the nature of the drugs used in treatmentAsthma is adiseaseaffecting theairways toand fromyour lungs.The typical symptomsarewheezing,cough, chest tightness, and shortness of breath. Most people with asthma are treated with inhalers and sometypesoforalmedication.Drugsdeliveredbyinhalerscanbegroupedintorelieversandpreventers;a reliever inhaler like Salbutamol and Terbutaline relaxes the muscle in the airways so they are taken as neededforrapid,short-termsymptomaticreliefduringanasthmaattack;apreventerinhaleristakenoneto two times every day to prevent symptoms from developing.

Life Style changes in Ramadan for patient with Asthma.Exposuretotobaccosmokeeitherthroughactivesmokingorbysecondhandsmokecancauseand/orexacerbate an asthma attack or asthma symptoms. It is advised quit smoking by all means (cigars, ciga-rettes and pipes). It is also preferred to avoid the places of smoke and Bukhoor.Toavoidfoodsandfruitsthatmaycauseorworsenanasthmaattacklikeeggs,strawberries,andba-nanas.Stayhydratedandremembertodrinkenoughwateratnighttime.Gettingdehydratedmaymakeyourasthma symptoms worse.Getplentyofrest.Whenyoufeeloutofbreath,orbecometired,slowdown,liedownorsitandrelax.This will help to keep your airways relaxed, and allows you to breathe easier.

When to take your Medicines for Asthma in Ramadan?In most cases, fasting during Ramadan does not pose any problem for the majority of asthma patients. If using the preventer inhaler (usually brown, orange or yellow) do so at Suhoor and at breakfast. However, if a patient is using the reliever spray (usually blue in color) patient should administer the medicine whenever a need to use it arises, even if it is during the daylight hours of Ramadan. (Patients so affected should seek theadvicefromDARElEFTAAtoreviewfastingrules.).ForpatientswhoaretakingthepillsliketheSingulairor Claritin, they will take these at bed time. This also applies to patients with allergic sinusitis.

When to take your When to seek for a medical advise for Asthma in Ramadan?Some patients independently rearrange their medication routines during Ramadan. This can lead to the exacerbationofasthma.Anattackofasthmamaybemoresevereinsomepatients.Ifso,thepatientmayneed to use the reliever inhaler more than twice a day, require the addition of cortisone to their therapy regimen or require the use of evaporators. For this groups of patients, it is recommended not to vary their medication schedule until they seek the advice from a qualified physician.

AsthmaTaking your medicine during Ramadan

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What lifestyle changes do I need to adopt during Ramadan?In addition to the spiritual benefits, Ramadan fasting can improve persons health. But if an incorrect or poor diet is followed, fasting may have negative impact on your health. Balanced food and fluid intake is important. Your diet should be simple and not too much different from your normal every day diet.Selectfoodfromdifferentgroupslikewholegrainsandseeds,greenvegetables,fruits,dairyproducts,meat & fish.Eatinmoderation.Drinklotsofwaterandfruitjuice.Avoidovereating,junkfood,deepfriedfoodsandhighsugarfoods.Avoidtoomuchofcaffeinateddrinks(tea,coffee,carbonateddrinks).Quitsmoking.Ramadanisagoodtimetocurballbadhabits.

How should I take my medications during Ramadan?IfyouareonregularmedicationsandplanningtofastduringtheHolymonthofRamadan,pleaseconsultwith your physician or pharmacist to discuss whether you require any specific changes to your therapy.Youmayrefertothedocumentsuggestedtimefortakingmedication

While fasting, I am experiencing heartburn (indigestion). How can I manage this?IfyouareonregularmedicationforindigestionlikeRanitidine,Omeprazole,Esomeprazoleetc,continuetakingthematSohour.Adoptthelifestylechangesasmentionedabove.Trysleepingwithyourheadraisedonfewpillowsandseeifthatishelpful.AnantacidlikeAluminum/Magnesiumhydroxidesuspensionmayproviderelief.Ifheartburnpersists,contactyourphysician.

I have chronic constipation. Do I need to take any special precaution? Maintaingoodhydrationwithwaterandfruitjuicesduringthefast.Increasefibrecontentoffoodwithbran,cereals,wholewheat,grainsandseeds,potatoeswiththeskin,vegetables and almost all fruit including apricots, prunes, figs, etc.Ifproblempersist,abulklaxative(likeispaghulahusk)maybeused.

When should I seek medical help?If you notice symptoms of a worsening medical condition or if you develop any new illness that causes you concern, please consult your physician. This will help in ensuring your sound health during the Holy month of Ramadan.

Gastrointestinal DisordersTaking your medicine during Ramadan

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General information.The holy month of Ramadan can be a difficult time for pregnant and breastfeeding women. Fasting be-tween dawn and sunset (Maghreb) is obligatory, but mums-to-be still need to get the essential nutrients to help their baby grow healthily

Is it safe for me to fast?If you are healthy and havent had any complications so far, you can continue your daily routine as normal. Just make sure you slow down, allow time to rest, and stay away from stress and anxiety triggers as far aspossible.Andremembertogettherightnutrientsandenoughcalorieswhenyoubreakyourfast.Forbreastfeeding women the decision to fast or postpone the fast depends on a number of things, but prob-ably the age of your baby is the main one. The decision is more difficult if your baby is tiny and gets all its nutrition only from nursing, compared with a healthy 1-year-old who is consuming other foods and only breastfeeding at night.

How can I cope if Im suffering from morning sickness?If you are in the first three months of pregnancy you may find fasting particularly difficult. This is the time when sickness and nausea are at their worst. Try to rest as much as possible and plan to spread your meals out between dusk and dawn. If fasting makes the sickness much more pronounced, do talk to your doc-tor.

Will I make enough milk?Breastfeeding women are still able to keep up milk production while fasting, but the amount of fat in the breast milk may decrease. This is not a problem in itself, but it could mean your baby gets hungry more quickly and goes to the breast more often. Preparing for fasting will help you avoid potential problems. Talk to your doctor if you are worried about your baby.

Practical ways to copeBreakyourfastgradually,byeatingonesmallmealslowly,insteadoftheonebigmealatonce.MakesureyouhavetheSuhoormeal,buttakeitaslateaspossible.Drinkplentyoffluidsaimfor8-10glassesofwatereachday.Eatdatesordrieddatestoeaseconstipation.Trytoeatanimalproteinsthatareeasytodigest,suchasredmeat,chicken,fishandeggs.Eatplentyoffreshfruitsandvegetablesincludingleafygreens.Cutbackoncarbohydratesandfattyfoods,anditmaybebesttoavoidcertainfoodslikepickles,spices,coffee, tea, carbonated water, and sweets that abound in Ramadan feasts.Rememberyouneedtoeataround400to500extracaloriesadaywhenyouarebreastfeeding.Planyour evening meal consumption accordingly.

Pregnant and breast feeding womanTaking your medicine during Ramadan

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What is Epilepsy?Epilepsyisadisorderthatresultsfromsurgesinelectricalsignalsinsidethebrain,causingrecurringsei-zures. Seizure symptoms vary. Some people with epilepsy simply stare blankly for a few seconds during a seizure, while others have full-fledged convulsions.

What are the life style changes for epileptic patients in Ramadan?EpilepticpatientsshouldconsulttheirneurologistaboutmanagementoftheirdiseasewhilefastinginRa-madan. The patient shouldnt increase or decrease his doses or frequency without consulting the physician orthepharmacistAlsoheshouldntdelayhismedicationsbecauseadelaywilltriggertheseizures.GenerallyEpilepticpatientsshouldavoidstress,fatigue,getenoughsleepandeathealthyfood.

What medication schedule should an epileptic patient follow in Ramadan?If it is a once daily medication like Phenytoin, the patient can continue to take it once in the evening after iftar.If the medication is a twice daily dose like Tegretol , then the patient can continue taking the medication at Iftar and at Sohur (Imsak time). If the medications is to be taken three or four times daily, then it is hard to fit in Ramadan schedule. It is recommended that the patient consult his neurologist to prescribe a longer acting formulation.

When to seek medical advice?If seizures increased the patient should seek medical advice.

EpilepsyTaking your medicine during Ramadan