Ramadan and ADHD Medication FAQ

What is Ramadan?

Ramadan is a holy month for Muslims around the world where Muslims will fast from dawn to dusk for a whole month. No food or drink is allowed during fasting hours, not even sips of water. At this time yearly, many individuals that are required to take medications for chronic conditions wonder how they will manage these medications while fasting. This also applies to individuals treating their ADHD symptoms with long-acting psychostimulants such as Vyvanse, Concerta, Adderall XR etc.

Should I continue to take my long-acting psychostimulant while fasting the month of Ramadan?

This is a personal choice that can be made in consultation with your ADHD clinician. You will need to weigh the potential benefits of the medication against the risks and/or consider alternative treatments during this month. You may opt to withhold your long-acting stimulant during this month and resume when Ramadan has ended if side effects are not tolerable while fasting. If you decide on continuing with your current medication regimen, adjustments to the timing of your dosing and/or dosing may be required.

What are the main health concerns with taking a long-acting stimulant while fasting?

Fasting may exacerbate the side effects of long-acting psychostimulants such as increased dehydration which can further worsen dry mouth brought on by long-acting psychostimulants. You may feel more fatigued and dizzy as a result as well. Given the nature of fasting, weight loss may be expected for some individuals due to calorie restrictions. Given that weight loss may also occur due to appetite reduction from long-acting psychostimulants, it is crucial to monitor for any major weight loss and notify your clinician to determine if withholding the medication is required until Ramadan has ended.

How does fasting affect ADHD symptoms?

While this will be different for each individual, you may notice that your ADHD symptoms are worsening due to not being able to fully engage in lifestyle measures that are supportive of ADHD symptoms. These include following a healthy, well-balanced diet, ensuring adequate sleep, and establishing regular physical activity. Concentration may be more difficult due to low blood sugar levels as well. If you opted to temporarily withhold medication during Ramadan, you may also notice your ADHD symptoms returning to baseline.

I have decided to continue with my long-acting psychostimulant to manage my ADHD symptoms while fasting Ramadan. What are the general recommendations?

• As diet and nutrition are crucial aspects of your ADHD care, it is highly recommended that you wake up each morning for Suhoor which is the meal consumed before dawn prior to commencing your fast each day. Choosing a nutrient-dense meal, rich in protein is imperative to help sustain not only your fast, but also your ADHD symptoms. Also, ensuring sufficient hydration during this meal will help lessen the extent of dehydration during the day. It is recommended that you take your long-acting psychostimulant during your Suhoor prior to beginning your fast daily.

• After Suhoor, you may opt to attempt to go back to sleep for a couple hours prior to beginning your day. By the time you wake up, your medication will have started to work. If you are unable to go back to sleep due to the effects of the medication, it is recommended that you try to be as productive as possible while your body is still well nourished and rested. 

• If you missed waking up for Suhoor or did not have enough time to consume an adequate meal, it may be best to skip your medication that day to avoid becoming overly dehydrated.

• Upon breaking your fast daily during “Iftar” dinner, it is recommended to choose nutrient-dense foods such as lean proteins, whole grains, fruits, vegetables, and healthy fats (including Omega-3s). Ensure to replenish your hydration needs by consuming sufficient water and other hydrating beverages. It is best to avoid or minimize consumption of excessive sweets/sugar, caffeine, and high-fat foods.

• Ensure sufficient total calories are consumed daily between your Suhoor and Iftar meals to avoid excessive weight loss.

• If side effects are unbearable despite following the above recommendations, it is recommended discussing this with your ADHD clinician to determine whether a temporary dose decrease may be tried to help with side effects or whether to hold medication until Ramadan has ended.

I am on a split-dosing regimen with my long-acting psychostimulant that requires me to take my medication more than once daily. How will I manage this while fasting?

As you will be fasting during the time your second dose is usually taken, you will need to skip this dose (assuming you are continuing with your fast). In essence, this will result in a dose decrease as you are eliminating one of your doses. You may discuss with your ADHD clinician regarding adjusting your initial dose taken during Suhoor to help mitigate any implications from this dose decrease. However, you may opt for a dose decrease temporarily during Ramadan to help better tolerate side effects of the long-acting psychostimulant while fasting. It is not recommended to take your second dose during Iftar dinner as this will hinder your ability to sleep which will likely negatively impact your ADHD symptoms the next day.

I am still in the titration phase for my long-acting psychostimulant. Can I continue this process while fasting?

Accurately assessing the side effects and the response to your long-acting psychostimulant can be difficult while fasting as fasting may possibly worsen your ADHD symptoms in general as well as exacerbate common side effects of these medications. It is recommended to reserve any further dose increases until after Ramadan and fasting have ended to better assess and avoid negative outcomes. Your ADHD clinician will help formulate a care plan with you in more detail to know what to expect.

I am not required to fast during my menstrual period. Can I resume my long-acting psychostimulant during this period if I chose to hold my medication while fasting?

The short answer is yes. However, the dose that you resume will be dependent on the length of the interval between your last dose of medication and your menstrual period. If too many days have passed since your last dose and you were on a higher stable dose prior to Ramadan, you may need to decrease your dose temporarily to help your body readjust to side effects. Aim to discuss this with your ADHD clinician to have a plan in place prior to Ramadan starting. It will be helpful to try to track your menstrual cycle to give your clinician an idea when you will be next menstruating if able. It is also recommended to resume a regular meal schedule during your menstrual period to help replenish your body’s nutritional stores and hydration status in preparation for your next fasting day once your menstrual period ends. 

I opted to withhold my long-acting psychostimulant during Ramadan. Can I resume my stable dose once Ramadan is over?

Depending on what your stable dose was, you may be required to titrate back up to your dose over a couple weeks to help build tolerance to the common side effects once again and assess efficacy.

This FAQ serves as a guide to help answer common questions regarding fasting and taking a long-acting psychostimulant concurrently for ADHD symptom management. Discussing your specific case with your ADHD clinician is recommended to formulate a patient-centered plan that meets your own needs while ensuring safety with any comorbid medical conditions.