Charlotte Gurr
As Ramadan approaches each year, familiar conversations begin in community pharmacies. A patient with diabetes asks whether insulin doses can be delayed. Another admits she has stopped her antihypertensive tablets because she is unsure if they invalidate the fast. Someone with asthma uses their inhaler sparingly “just in case”.
When problems with medications arise, fasting itself is rarely the issue. More often, the difficulty is that no one initiated the conversation early enough.
Ramadan is often described as a prescribing challenge. It is better understood as a predictable, time-limited shift in behaviour. For 30 days, millions of people adjust eating patterns, sleep, activity and medication timing. Few public health interventions generate that degree of voluntary engagement.
The real question is not whether patients should fast, it is whether pharmacy anticipates that they will.
Moving from reaction to anticipation
Clinical guidance on long-term conditions is well established, yet discussions about fasting frequently occur only once symptoms emerge.
Community pharmacy is well placed to change that pattern. A pre-Ramadan medication review, a brief inhaler technique check, reinforcement of sick-day rules or a conversation about dose timing can prevent avoidable deterioration. Adjusting formulations, agreeing monitoring plans and documenting shared decisions are not complex interventions — they simply require timing.
This is medicines optimisation in its practical form
This is medicines optimisation in its practical form — adapting treatment plans to real life rather than expecting patients to adapt silently to prescriptions.
Supporting prescribing decisions
For pharmacist prescribers and clinicians managing long-term conditions, the British Islamic Medical Association Ramadan Compendium offers a useful clinical reference point. It brings together multidisciplinary guidance across a range of chronic conditions and is designed to support earlier, structured conversations about fasting.
Importantly, it is framed as informative rather than directive. Decisions about fasting are positioned as shared discussions between clinician and patient.
The compendium incorporates a three-tier risk stratification framework — ‘low or moderate risk‘, ‘high risk‘, and ‘very high risk‘ — to guide proportionate clinical decision-making. In practice, this helps clarify when optimisation and monitoring may be appropriate and when advising against fasting is necessary on safety grounds. For prescribers, that structure strengthens documentation, transparency and professional confidence.
Professional dialogue has also matured. In January 2026, the International Colloquium on Ramadan and Health, convened by the British Islamic Medical Association and endorsed by NHS England, Glaucoma UK and Diabetes UK, brought together international clinicians, academics and public health leaders to examine prescribing safety and health inequalities during Ramadan.
Ramadan health is a legitimate area of service development and clinical practice
This evolution from seasonal advice to structured national discussion signals something important: Ramadan health is a legitimate area of service development and clinical practice.
Cultural competence as patient safety
Pharmacists are often the most accessible healthcare professionals in their communities. For many Muslim patients, the pharmacy counter is the first place they seek reassurance.
Cultural competence in this context is not abstract. It means recognising that some patients will feel a strong spiritual commitment to fast even when medically exempt. It means understanding that stopping a fast because of illness can carry emotional weight. And it means asking directly, without judgement: “How are you planning to manage your medicines during Ramadan?”
Handled well, that single question can prevent harm.
Beyond the consultation
Ramadan health work does not sit solely within the consultation room. Patient and community-facing education has expanded considerably. Toolkits, webinars, mosque-based sessions, digital campaigns and multilingual resources now provide accessible guidance on medication timing, hydration, inhaler use and when not to fast.
These initiatives strengthen health literacy and counter misinformation, particularly where online advice may be inconsistent. For pharmacy teams, engagement with community education is not an optional extra, it is preventative care.
When pharmacists are visible within community spaces, collaborating with local organisations or contributing to public education, trust deepens and earlier clinical conversations follow.
A strategic opportunity for pharmacy
Ramadan presents more than a seasonal clinical consideration. It offers pharmacy a visible opportunity to lead.
Here is a defined, predictable period in which patients actively seek advice, are motivated to engage with their health and are already adjusting behaviour. Few moments in the healthcare calendar create that level of readiness.
Pharmacy can respond reactively, adjusting medicines once difficulties arise. Or it can position itself as a proactive clinical partner: initiating structured pre-Ramadan reviews, using risk stratification tools, collaborating with community organisations and embedding culturally competent care into routine practice.
Done well, this approach reduces avoidable harm, strengthens patient trust and demonstrates the clinical value of pharmacist prescribers in long-term condition management.
Ramadan is not a disruption to care. It is an opportunity for pharmacy to lead; visibly, confidently and preventatively.
