From the Guidelines
You should break your Ramadan fast to take your prescribed medications, including pantoprazole, gabapentin, and Keppra (levetiracetam), if you forgot to take them before fasting began, as consistent medication adherence is crucial for maintaining therapeutic blood levels and preventing potential complications. Keppra is an anti-seizure medication, and missing doses can potentially trigger seizures in people with epilepsy 1. Gabapentin is also used for seizures and nerve pain, while pantoprazole treats acid-related stomach conditions. These medications generally need to be taken consistently to maintain therapeutic blood levels. From an Islamic perspective, many scholars permit breaking the fast for necessary medications, as health preservation is a priority in Islam 1. You can make up the missed fast day later when your health allows. If this situation happens frequently, consult both your doctor and religious advisor about possibly adjusting your medication schedule to accommodate fasting, or whether you qualify for an exemption from fasting due to medical necessity. Some key considerations for individuals with medical conditions who wish to fast include:
- Assessing and optimizing treatment plans in advance of religious fasting to reduce risks 1
- Using technology, such as monitoring devices, to enhance safety during fasting 1
- Providing fasting-focused education to minimize risks 1 Remember that Islam provides exemptions for those whose health would be compromised by fasting. It is essential to prioritize your health and well-being while also respecting your religious beliefs and practices. Consulting with your healthcare provider and a religious advisor can help you make informed decisions about managing your medications during Ramadan.
From the Research
Medication Management During Fasting
- There is no direct evidence to suggest that breaking the Ramadan fast to take prescribed medications, including pantoprazole, gabapentin, and Keppra (levetiracetam), is necessary if they were forgotten before fasting began 2.
- However, studies suggest that patients should be advised on how to manage their medications during fasting periods to avoid any potential harm 2, 3.
- In general, patient information leaflets and summaries of product characteristics often lack specific advice on what to do if a dose is missed, which can lead to confusion and potential harm 3.
Pharmacokinetic Considerations
- From a pharmacokinetic perspective, taking a late dose of medication can have varying effects depending on the specific drug and individual patient factors 4, 5.
- For example, studies have investigated the effects of taking late doses of levothyroxine, atorvastatin, and lamotrigine, and have proposed general principles and strategies for dealing with dosing irregularities 4.
- Population pharmacokinetic modeling and simulation can be used to develop remedial dosing regimens and minimize unintended clinical consequences in the event of delayed or missed doses 5.
Specific Medications
- Gabapentin and Keppra (levetiracetam) are both antiepileptic medications that have been shown to have better tolerability profiles and lower interaction potential compared to older generation antiepileptics 6.
- However, they can still cause side effects such as dizziness, drowsiness, and mental slowing, and it is essential to consider these potential effects when managing medication during fasting periods 6.