Gliclazide MR Dosing Adjustment for Ramadan
For patients on once-daily gliclazide MR, shift the entire dose from morning to evening (before the sunset meal/Iftar) without any dose reduction. 1, 2
Dosing Strategy Based on Baseline Regimen
Once-Daily Gliclazide MR (e.g., 60 mg)
- Take the full dose before the sunset meal (Iftar) with no dose reduction required 1, 2
- This simple timing shift maintains glycemic control while minimizing hypoglycemia risk 3, 4
- After Ramadan ends, immediately return to the pre-Ramadan morning schedule 2
Twice-Daily Standard Gliclazide (e.g., 80 mg twice daily)
- Take half the usual morning dose at the predawn meal (Suhur) and the full dose at the sunset meal (Iftar) 1, 2
- Example: If taking gliclazide 80 mg twice daily, adjust to 40 mg at Suhur and 80 mg at Iftar 1
Pre-Ramadan Preparation (6-8 Weeks Before)
Conduct structured risk stratification and patient education 2:
- Evaluate glycemic control (HbA1c), renal function, and hepatic status 2
- Assess for history of recurrent hypoglycemia or hypoglycemia unawareness—these patients should avoid fasting 5
- Provide education on recognizing hypoglycemia/hyperglycemia symptoms and when to break the fast 2
- Consider trial fasting to test the medication regimen before Ramadan begins 6
Critical Monitoring During Ramadan
Self-monitor blood glucose closely during the first 3-4 weeks 2, 5:
- Check glucose in the first few hours after starting the fast 2
- Check again in late afternoon before breaking fast 2
- Break the fast immediately if blood glucose drops below 70 mg/dL 6
Evidence Supporting Safety
The real-world DIA-RAMADAN study of 1,244 patients demonstrated that gliclazide MR during Ramadan resulted in only 2.2% experiencing symptomatic hypoglycemia with zero severe hypoglycemic events 4. The Bangladeshi sub-analysis specifically showed that switching gliclazide MR 60 mg from morning to evening dosing maintained glycemic control with no severe hypoglycemia 3. A controlled trial in 136 male patients confirmed that evening administration of gliclazide MR 60 mg maintained glycemic control with only 2.2% experiencing hypoglycemia during the fast 7.
Common Pitfalls to Avoid
- Do not excessively reduce the gliclazide dose—this causes rebound hyperglycemia and increases diabetic ketoacidosis risk 2
- Do not use chlorpropamide during Ramadan due to high risk of prolonged, unpredictable hypoglycemia 5
- Do not continue morning dosing—the timing shift to evening is essential for safety 1, 7
Nutritional Strategy
Distribute calories over two to three smaller meals during the non-fasting interval to prevent excessive postprandial hyperglycemia 2, 5. Ensure adequate fluid intake during non-fasting hours 1, 5.
Post-Ramadan Management
Return gliclazide to the pre-Ramadan morning schedule immediately after Ramadan ends 2. Assess overall health, complications, and glycemic control to evaluate how well the patient tolerated fasting and guide future Ramadan planning 2, 6.