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Update 2013- Drug Therapy during Holy Month of Ramadan

Yousef A. Alomi, Bsc, Msc., BCPS, BCNSP, DiBA


yalomi@moh.gov.sa
yalomi@gmail.com

Head, National Drug Information Center


Head, General Adminstration of Pharmaceutical Care
Consultant Clinical Pharmacist
Ministery of Health

Islam was built based on five billers (the statement of Faith, prayers of five times daily, charity to poor people, and Fasting of
one Month yearly called Ramadan, and pillgrime to Mecca once in a lif). Fasting the holy Month of Ramadan is stop taking or
ingection any food or drinks from sunrise to sunset, this madate to all adults either male or female, unless tarvelers, risk dangrous of
pregrant and lactatin women, and elderly can not tolerate the fasting, and sick people

In Islam the Sick people allow them to break fasting, then postbond fasting next month if the illness is temporary. If the illnees
perment and the patinet can not fast at all she or he to pay money to poor people as subsiture of fasting for each day breaking fasting.
Not all the illnesses are allowable to break fasting, its only if the fasting affect the patients health negatively, otherwise; if the patient
can fast she or he to fast Ramadan. The problem is raising of medications for chronic disaeses , how can I switch from regular days
time to Fasting Days Times, at what time excatly, does the fasting some medication and increase or decrease their activity, is there
any changes in pharmacokinetics of medications, does the food affect absorption of medication after peoriod of fasting, all thease
question we try to answer them in the remaining of this paper

It estimated there are 1.11.5 billion Muslims worldwide, Most Muslims would like not to break fasting, even the fasting will
affect their health. Some studies showed that Muslims receiving medical treatment during Ramadan will deliberately not taken tablets
or other medicine at the prescribed time if that falls drug the day light hours, or alternatively will overdose during night to makeup for
missed day time doses. A study 1 by Aslam M, et.al , reported that 37 (45.7%) patients of 81 were found to change their drug dosage
pattern while fasting; 35 (43.2%) missed doses; 8 (9.8%)took their tablets at different times and 4 (4.9%) patients took all their
medication as one single daily dose after breaking fast in the evening. Another survey 2 of 325 outpatients in a Kuwaiti hospital
found that most of them changed their drug regimens during Ramadan. Sixty four per cent of the patients changed their therapeutic
scheme during the month; 18% took their daily medicines in a single intake, either before the first meal (sunset) or straight after the
last one (before dawn). Another hospital-based study of 334 patients conducted in during the month of Ramadan in 2006 to illustrate
thevarious characteristics including care of patients and changes in lifestyle of type 2 diabetics during Ramadan in Dhahira region,
Oman. Most of the type 2 diabetes patients in the study (93.1%) fasted 30 days during Ramadan. It was noticed that nearly 83% of the
type 2 diabetes patients in our study had poorly controlled FBS levels (83.2%). Insulin/Oral Anti Diabetic Drug (OAD) doses were
unchanged in 49.5% of diabetic patients during Ramadan. 3

Some authors reported that two patients with chronic reversible respiratory disease were admitted to an intensive care unit two
weeks after the start of Ramadan, Both patients admitted due to not having taken their treatment, including inhalers, during daylight
hours. Another study evaluated the changes in frequency of seizures during Ramadan in 124 patients with idiopathic epilepsy,
seizures occurred in 27 patients during this month; 20 of them did not use any antiepileptic drugs from dawn to sunset. The author
concluded that withdrawal of drugs was the most important cause of recurrence of epilepsy during Ramadan. 4

A recent study of wide population-based Epidemiology of Diabetes and Ramadan 1422/2001 (EPIDIAR) study, which showed (in
12,243 people with diabetes from 13 Islamic countries) 43% of patients of type 1 diabetes, and 79% of patients
with type 2 diabetes were fasting during Ramadan; with an estimation of 4050 million people with diabetes worldwide , and 3.6 -
1,9 Million in Saudi Arabia will fast during Ramadan, 5-7

Although all previous studies, with patients perception and attitude toward their medications, and dangerous impact of their diseases;
there is no consensus guideline of drug therapy during. Recommendation drug therapy regimen for the disaeses during fasting is very
difficult, due to very little experiences, and no clinical trials about drug fasting during Ramadan or pharmacokinetics of drugs during
fasting. It is not appropriate to change the drug regimen, or dose from several dose per day to two big dose once or twice daily
without scientific evidence that alternative dose is equivalence in efficacy and safety. Further, the patient should stabilized with the
new drug or dose before or during Ramadan. Here are some advices and recommendations by some authors to explore Drug Therapy
During Ramadan as following:
General Recommendation

Mark Ramadan on your office calendar, and prepare to be the one that brings up the topic for discussion. Patients are unlikely
to initiate the discussion.
Ask about the patients beliefs regarding fasting, his/her illness, and the use of oral and injectable drugs when fasting.
Inquire about current control of symptoms and comorbidities.
Inquire about past experiences during Ramadan fasts, and plans for the upcoming Ramadan.
Provide information and Medical education about his or her mental illness as medical, physically-mediated illness
Clearly communicate risks of medication changes, changes in sleeping and eating schedules, and withdrawal from substances.
Explain that decision is ultimately the patients, but you can advise him/her and help maximize chances of fasting safely.
Give general preference to medications that will allow for the easiest compliance during Ramadan, e.g. slow-release
preparations, longer elimination half-lives, and once daily dosing.
Consider a switch to slow-release or once-daily medications for the month of Ramadan. These forms may more expensive,
and may require some planning ahead, but it may be worth a switch for some patients.
Recommend dosing schedules coincident with pre-dawn (Suhoor) and sunset (Iftar) meals.
Recommend refraining from fasting according to Islamic rules for those that must take medications at a frequency of more
than twice a day.
Work to find creative compromises, balancing the patients preferences and your knowledge of the risks and benefits of
possible plans.
If a patient insists on discontinuing medications, plan a taper in advance.
Recommend tapering use of caffeine and nicotine in the weeks before Ramadan to avoid unpleasant withdrawal syndromes.
Encourage a moderate amount of physical activity; too much exertion may contribute to dehydration, but some activity is
better than a completely sedentary month.
Encourage patient to bring up the issue with their primary care doctor, to discuss which medications may be amenable to
change in dosing schedule.
Consult an imam of masijid or Shiek with help in interpreting rules, and in communicating with and reassuring the patient.
Arrange for follow-up appointments during Ramadan and when concerns arise.
Fasting and Drug dosing schedule

There are many drugs can given to the patient without affecting fasting Ramadan or nullify fasting, accoring An Islamic view
of certain contemporary medical issues that was in Morocco 1997; for instant 8
1. Eye and ear drops
2. All substances absorbed into the body through the skin,such as creams,ointments,and medicated plasters
3. Insertion into the vagina of pessaries, medical ovules, and vaginal washes
4. Injections through the skin, muscle, joints, or veins, with the exception of intravenous feeding
5. Oxygen and anaesthetic gases
6. Mouthwash, gargle, or oral spray, provided nothing is swallowed into the stomach.
7. Nose drops, nose sprays, and inhalers
8. Anal injections

Any medication can be enjection through mouth and reach to stomach break fasting. Health care provider can help mulsim patient if
he wish to fasting eith The Holy Month of Ramadan or any Holy Days throug the year, by changing admintartiom time instead of
three or fout time a day and switch to tiwce or once aday without Break-Fast. In Ramadan, instead of morning and evening, it needs
to change to dawn and sunset respectively. Twice daily dose can be taken on 04:30, and 19:00 special in this year 2013 for Riyadh
time, Saudi Arabia. Once daily dose can be taken on 04:30, or 19:00.

We attached Up-to-date 2013 suggested table1 describe type of medication, affect of food, frequency of adminstration, preferable
time of adminstration, and clinical evidence. An table 2 showed Medications, adult maintenance dose in the nornal renal function,
and frequency per day, on regular day, and Medications, adult dose, and frequency per day as alternative during Ramadan, the doses
stated for general indication, table 3 showed medications registration status at Saudi Food and Drug Authority and Ministry of
Health Drug Formulary.
The treating physcian or pharmacist should refer to other referances to doses for specific indications, and FDA or SFDA labeled
indications during conversion to other medications. Any suggestion will be highly appreciated.
Table 1
Medication During Holy Month of Ramadan 8,9
Type of Medication Adminstration Evidence Based
Anti-Epileptic Drugs Once Twice daily except Valoproic Acid General Evidence : No Evidence administration
The food: may decrease the absorption during Ramadan
Time of admin: after 1-2 of Sun set (Iftar) Specific Evidence: No Evidence of
Interchange: No, can be on specific situation Pharmacokinetics during fasting Ramadan

Anti-Psychiatrics Drugs Admin: General Evidence : No Evidence administration


Most of them Once daily, some are given Twice during Ramadan, little evidence
daily Specific Evidence: No Evidence of
The food: may decrease the absorption Pharmacokinetics during fasting Ramadan
Time of admin: pre-dawn (Suhoor)
Interchange: No, can be on specific situation
Antiplatelets and Admin: Once daily General Evidence : No Evidence administration
Anticoagulation Drugs The food: may induce ulcer at empty stomach, and during Ramadan
may reduce Warfarin Effect with vegitables Specific Evidence: No Evidence of
Be carfull of taking large a mount of vitamin K, like Pharmacokinetics during fasting Ramadan
broccoli, spinach, kale, turnip greens, cabbage, they
may decrease the effect of drugs
Aviod garlic, ginger, glucosamine, ginseng, and
ginkgo may incraese the bleeding
Time of admin: after Sun set (Iftar)
Interchange: Switch Heparin to LMWH
Drug for Lipid Disorder Admin: Once daily General Evidence : No Evidence administration
The food: No effects during Ramadan
Time of admin: after Sun set (Iftar) Specific Evidence: No Evidence of
Interchange: Switch to Statin therapy Pharmacokinetics during fasting Ramadan

Drug for Infectious Admin: Once Twice daily General Evidence : No Evidence administration
Diseases The food: Variable during Ramadan
Time of admin: after Sun set (Iftar) Specific Evidence: No Evidence of
Interchange: Switch to long acting therapy Pharmacokinetics during fasting Ramadan

Drug for Asthma Admin: variable General Evidence : No Evidence administration


The food: No effects except theophylline during Ramadan
Using Bronchodilator with caffeine (Tea or Specific Evidence: No Evidence of
Beverages) caan increase te chance of side eefctss, Pharmacokinetics during fasting Ramadan
such excitability, nervousness, and rapid heart beat
Time of admin: Any time
Interchange: Switch to long acting therapy

Drug for GIT Admin: Once daily General Evidence : No Evidence administration
The food: No effects during Ramadan
Time of admin: pre-dawn (Suhoor) Specific Evidence: No Evidence of
Interchange: Switch to long acting therapy Pharmacokinetics during fasting Ramadan

Drugs for Hypertension Admin: Once - Twice daily General Evidence : No Evidence administration
The food: No effects during Ramadan
Aviod of taking ACE Inhibitors with latge a mount Specific Evidence: No Evidence of
of Dates, Bananas, Oranges, green leafly vegetables Pharmacokinetics during fasting Ramadan

Time of admin: after Sun set (Iftar)


Interchange: Most of drugs taking once ot twice
daily, and if using short acting Switch to long acting
therapy

Drugs for Cardiac Admin: Once daily General Evidence : No Evidence administration
Arrhythmias The food: No effects during Ramadan
Time of admin: after Sun set (Iftar) Specific Evidence: No Evidence of
Interchange: Switch to long acting therapy Pharmacokinetics during fasting Ramadan

Drug for Pain Admin: Once daily General Evidence : No Evidence administration
The food: No effects during Ramadan
Time of admin: after Sun set (Iftar) Specific Evidence: No Evidence of
Interchange: Switch to long acting therapy Pharmacokinetics during fasting Ramadan
Medications During Fasting Program

I do suggest to start this program specially during fating the holy month of Ramadan

1. Assinge Resposibility of one clinical pharmacist or trained qualify pharmacist


2. Delnieate scope of services that wish you start with
3. Define type of popultion and diaseses at starting point
4. Setup protocols for each disaese drug therapy during regular and fasting days
5. Start pilot study for certain period of time
6. Collect the mearument data before and after the services
7. Evaulaute the services and impact feedback
8. Present results outcome to consern people medical and pharmacy staff
9. Expand the scope of services and evalute it periodically
References
1- Aslam M et. Al, Pharmacist, Medicines and the Fast of Ramadan, Pharm J, 259:12; 1997,973-75.
2- Aslam M, Assad A. Drug regimens and fasting during Ramadan: a survey in Kuwait. Public Health 1986;100:49-53.
3- Prakash Patel. et. al. Type 2 Diabetes and its characteristics during Ramadan in Dhahira region, Oman. Oman Medical Journal, 2007, Vol 22, No 3.
16-23
4- N Aadil, I E Houti and S Moussamih, Drug intake during Ramadan, BMJ , 2004;329;778-782
5- Al-arouj M. Et. al., Recommendations for Management of Diabetes During Ramadan, Diabetes Care, 2005, Vol 28 , No 9.
6- Salti I. et. al., A Population-Based Study of Diabetes and Its Characteristics During the Fasting Month of Ramadan in 13 Countries, Results of the
Epidemiology of Diabetes and Ramadan 1422/2001 (EPIDIAR) study, Diabetes Care, 2004, Vol 27 , No 10.
7- Al-nozha M et al, Diabetes mellitus in Saudi Arabia, Saudi Med J 2004, Nov;25(11):1603-10
8- Aadil N, Houti IE, Moussamih S, Drug intake during Ramadan, BMJ 2004;329:77882
9- Aviod Food Drug Interaction, A guide from National Consumer League and U.S. Food and Drug Adminstration; www.nclnet.org, or
www.fda.gov/drugs, Publication no. (CDER 10-1933)
10- Al Salloum H.,The New Fluoroquinolones, Pharmacy Newsletter,10:2;1420.
11- Levabuterol for Asthma, The Medical Letter on Drug and Therapeutics, 41:4,1999
12- Al-Rasheed M, Proton-Pump Inhibitor, Pharmacy Newsletter,10:1;1420.
13- Saudi National Formulary, SPS & MOH, October 1995.
14- The Sixth Report of Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, Arch Inten Med,
157:24,1997,2413-2445.
15- Drugdex, Vol 137, Exp. September 2008, Micromedex Inc.
16- eBNF, British Medical Association and The Royal Pharmaceutical Society of Great Britain, No 37, march 1999.
17- Gilbert DN et al, The Sanford Guide to Antimicrobial Therapy, 29th Edition, 1999
18- Drugs for Chronic Obstructive Pulmonary Disease, Treatment Guidelines from The Medical Letter, 2007, Volume 5 (Issue
63): 95-100
19- Antiplatelet and Anticoagulant Drugs, Treatment Guidelines from The Medical Letter, 2008, Volume 6 (Issue 69): 29-36
20- Drugs for Epilepsy, Treatment Guidelines from The Medical Letter, 2012, Volume 11 (Issue 126): 9-19
21- Treatment of Peptic Ulcers and GERD, Treatment Guidelines from The Medical Letter, 2008, Volume 6 (Issue 72): 55-59
22- Drugs for Treatment of Chronic Heart Failure, Treatment Guidelines from The Medical Letter, 2012, Volume 10 (Issue 121):
69-72
23- Drugs for Hypertension, Treatment Guidelines from The Medical Letter, 2012, Volume 10 (Issue 113): 1-10
24- Antifungal Drugs, Treatment Guidelines from The Medical Letter, 2012, Volume 10 (Issue 120): 61-68
25- Drugs for Pain, Treatment Guidelines from The Medical Letter, 2013, Volume 11 (Issue 128): 31-42
26- Drugs for Acne,Rosacea, and Psoriasis, Treatment Guidelines from The Medical Letter, 2013, Volume 11 (Issue 125): 1-8
27- Drugs for Allergy Disorders, Treatment Guidelines from The Medical Letter, 2013, Volume 11 (Issue 129): 43-52
28- Drugs for Asthma, Treatment Guidelines from The Medical Letter, 2013, Volume 10 (Issue 114): 11-18
29- Drugs for Psychiatric Disorder, Treatment Guidelines from The Medical Letter, 2013, Volume 11 (Issue 130): 53-64

Table 2
No Drug therapy during Regular days 10-29 Drug therapy during Holy Ramadan 10-29
Regular Days Doses/ Day Frequency Per day Regular Days Doses/Day Frequency Per day
1. Acebutolol 200-1200 mg Divided in 1-2 doses Acebutolol 200-1200mg Divided in 1-2 doses
2. Aliskiren 150-300 mg In 1 dose Aliskiren 150-300 mg In 1 dose
3. Amiloride HCl 5-10 mg In 1-2 diveded dose Amiloride HCl 5-10 mg In 1-2 diveded doses
4. Amitriptyline 50-150 mg In 1 dose or divided doses Amitriptyline 50-150 mg In 1 dose
5. Amlodepine besylate 2.5- 10 mg In 1 dose Amlodepine besylate 2.5- 10 mg In 1 dose
6. Amoxicillin 250- 500 mg 3 times/day Cotrimoxazole 490- 960 mg 2 times/day
7. Aspirin 100 mg (prophylactic In 1 dose Aspirin 100 mg In 1 dose
dose) (prophylactic dose)
8. Atenolol 25-100 mg In 1-2 doses Atenolol 25-100 mg In 1-2 doses
9. Atorvastatine 10-80 mg In 1 dose Atorvastatine 10-80 mg In 1 dose
10. Aripiprazol 10-30 mg In 1 dose Aripiprazol 10-30 mg In 1 dose
11. Betoxalol 5-40 mg In 1 dose Betoxalol 5-40 mg In 1 dose
12. Bisoprolol 5-20 mg In 1 dose Bisoprolol 5-20 mg In 1 dose
13. Candesartan 8 -32 mg In 1 dose Candesartan 8 -32 mg In 1 dose
14. Captopril 12.5- 150 mg Divided in 2-3 divided Enalapril 2.5 - 40 mg In 1-2 doses
doses Lisinopril 5 - 40 mg In 1 dose
Fosinopril 10-80 mg In 1-2 doses
Perindopril 4-8 mg In 1-2 doses
Quinapril 5-80 mg In 1-2 doses
Ramipril 1.25-20 mg In 1-2 doses
Trandolapril 1-8 mg In 1-2 doses
15. Carbamazepine 800 1600 mg In 2-3 divided doses Carbamazepine 800 1600 mg In 2 divided doses
(Blood Level 8-12 (Blood Level 8-12
mcg/ml) mcg/ml)
Carbamazepine SR 800 1600 mg In 2 divided doses
(Blood Level 8-12
mcg/ml)
16. Carteolol 2.5-10 mg In 1 dose Carteolol 2.5-10 mg In 1 dose
17. Carvedilol 12.5- 50 mg Divided in 2 doses Carvedilol 12.5- 50 mg Divided in 2 doses
18. Cefacolr 250- 500 mg 3 times Cefuroxim axitel 250- 500 mg 2 times
19. Celeoxib 200 mg 2 times Celeoxib 200 mg 2 times
20. Cephalexin 250 -500 mg 4 times Cefadroxil 500-1000 mg 2 times
21. Cerivastatin 0.3mg In 1 dose Cerivastatin 0.3mg In 1 dose
22. Chlorthalidone 12.5- 50 mg In 1 dose Chlorthalidone 12.5- 50 mg In 1 dose
23. Cholestyramine 12-36 mg Divided in 1- 4doses Cholestyramine 12-36 mg In 1 dose
24. Cimitidine 400 2 times Cimitidine 800 mg In 1 dose
800 mg In 1 dose
25. Ciprofloxacin 250-750 mg 2 times Ciprofloxacin 250-750 mg 2 times
26. Citalopram 20-40 mg In 1 dose Citalopram 20-40 mg In 1 dose
27. Clobazam 20-40 mg In 1-2 divided doses Clobazam 20-40 mg In 1-2 divided doses
28. Clonazepan 1.5-8 mg In 2-3 divided doses Clonazepan 1.5-8 mg In 2 divided doses
Clobazam 20-40 mg In 1-2 divided doses
29. Clopidogrel 75 mg PO daily In 1 dose Clopidogrel 75 mg PO daily In 1 dose
30. Clonidine 0.1-0.6 mg Divided in 2-3 doses Clonidine 0.1-0.6 mg Divided in 2 doses
31. Cloxacillin 250 -500 mg 4 times Cefadroxil 500-1000mg 2 times
32. Cotrimoxazole 490- 960 mg 2 times/day Cotrimoxazole 490- 960 mg 2 times/day
33. Dalteparin 5000-10,000 IU SC daily In 1-2 doses Dalteparin 5000-10,000 IU SC In 1-2 doses
or q12h daily or q12h
34. Diclofenac 50- 200mg Divided in 3-4 dses Diclofenac 75 mg 2 times
75 mg 2 times Diclofenac SR 100 mg In 1 dose
35. Diflunisal 500-1500 mg Divided in 2-3 doses Diflunisal 500-1500 mg Divided in 2-3 doses
36. Digoxin 0.125- 0.5 mg In 1 dose Digoxin 0.125- 0.5 mg In 1 dose
37. Diltiazem HCl 60-360 mg Divided in 3 doses Diltiazem SR HCl 120 -360 mg Divided in 1-2 doses
38. Doxazocin Mesylate 1-16 mg In 1 dose Doxazocin Mesylate 1-16 mg In 1 dose
39. Doxycyline 100-200 mg Divided in 1-2 doses Doxycyline 100-200 mg Divided in 1-2 doses
40. Duloxetine 60 mg In 1 dose Duloxetine 60 mg In 1 dose
41. Eplerenone 25-100 mg In 1-2 doses Eplerenone 25-100 mg In 1-2 doses
42. Eprosartan 400-800 mg In 1-2 doses Eprosartan 400-800 mg In 1-2 doses
43. Enalpril maleate 5- 40 mg Divided in 1-2 doses Enalpril maleate 5- 40 mg Divided in 1-2 doses
44. Enoxaparin 1 mg/kg bid or 1.5 mg/kg In 1-2 doses Enoxaparin 1 mg/kg bid or 1.5 In 1-2 doses
SC daily; mg/kg SC daily;
45. Erythromycin 250-500 mg 4 times Clarithroycin 250-500 mg 2 times
Azithromycin 500-1000 mg 1 time
46. Ethosuximide 750- 1250 mg Divided in 2 doses Ethosuximide 750- 1250 mg Divided in 2 doses
(blood level 40-100 (blood level 40-100
mcg/ml) mcg/ml)
47. Escitalopram 10-20 mg In 1 dose Escitalopram 10-20 mg In 1 dose
48. Esomeprazole 20-40 mg In 1 dose Esomeprazole 20-40 mg In 1 dose
49. Felodipine 2.5- 10 mg In 1 dose Felodipine 2.5- 10 mg In 1 dose
50. Flucloxacillin 250-500 mg 4 times Cefadroxil 500-1000mg 2 times
51. Fluconazole 50- 400 mg In 1 dose Fluconazole 50- 400 mg In 1 dose
52. Fluoxetine 10-20 mg In 1 dose Fluoxetine 10-20 mg In 1 dose
53. Folic acid 1- 5 mg In 1 dose Folic acid 1- 5 mg In 1 dose
54. Famotidine 20 mg 2 times Famotidine 40 mg In 1 dose
40 mg in 1 dose
55. Fosinopril sodium 10- 80 mg Divided in 1-2 doses Fosinopril sodium 10- 80 mg Divided in 1-2 doses
56. Furosemide 20- 320 mg Divided in 2 doses Furosemide 20-320 mg Divided in 2 doses
Torsemide 5-20 mg In 1 or 2 doses
57. Heparin (Unfractionated) 60-100 units/kg IV Divided in 2-3 doses Enoxaparin OR 1 mg/kg bid or 1.5 In 1-2 doses
bolus, then 12-18 mg/kg SC daily;
units/kg/hr IV; or, 5000 Daltaparin OR 5000-10,000 IU SC In 1-2 doses
units SC q8-12h daily or q12h
Tinzaparin 175 IU/kg SC daily In 1 dose
58. Hydralazine HCl 40-200 mg Divided in 2-4 doses Hydralazine HCl 40-200 mg Divided in 2 doses
59. Hydrochlorothaizide 12.5- 50 mg In 1 dose Hydrochlorothaizide 12.5- 50 mg In 1 dose
60. Ipratropium 17 mcg/inhalation 2 inhalations qid PRN Tiotropium 8 mcg In 1 dose

61. Indapamide 1.25- 5 mg In 1 dose Indapamide 1.25- 5 mg In 1 dose


62. Irbesartan 150- 300 mg In 1 dose Irbesartan 150- 300 mg In 1 dose
63. Isosorbide Dinitrate 10- 240 mg Divided in 3 doses Isosorbide Dinitrate SR 20-120 mg Divided in 2-3 doses
(at least 8 hour washout (at least 8 hour
period to avoid Nitrate washout period to
Tolerance) avoid Nitrate
Tolerance)
64. Isradipine 5-20mg Divided in 2 doses Isradipine SR 5-20 mg In 1 dose
65. Itraconazole 400 mg Divided in 2 doses Itraconazole 400 mg Divided in 2 doses
66. Ketoconazole 200- 400 mg In 1 dose Ketoconazole 200- 400 mg In 1 dose
67. Labetalol HCl 200- 1200 mg Divided in 2 doses Labetalol HCl 200- 1200 mg Divided in 2 doses
68. Lacosamide 200-400 mg Divided in 2 doses Lacosamide 200-400 mg Divided in 2 doses
69. Lamotrigine 100-500 mg Divided in 2 doses Lamotrigine 100-500 mg Divided in 2 doses
70. Lanzoprazole 15- 30 mg In 1 dose Lanzoprazole 15- 30 mg In 1 dose
71. Levetiracetam 1000-3000 mg Divided in 2 doses Levetiracetam 1000-3000 mg Divided in 2 doses
72. Levofloxacin 500 mg In 1 dose Levofloxacin 500 mg In 1 dose
73. Lisinopril 5- 40 mg In 1 dose Lisinopril 5- 40 mg In 1 dose
74. Loratadine 10 mg In 1 dose Loratadine 10 mg In 1 dose
75. Losartan potassium 25- 100 mg Divided in 1-2 doses Losartan potassium 25- 100 mg Divided in 1-2 doses
76. Mebendazole 100 mg 2 times Mebendazole 100 mg 2 times
77. Meloxicam 7.5-15 mg In 1 dose Meloxicam 7.5-15 mg In 1 dose
78. Methyldopa 250- 2000 mg In 2 divided doses methyldopa 250-2000mg In 2 divided doses
79. Metolazone 1.25-5 mg in 1 dose Metolazone 1.25-5 mg in 1 dose
80. Metopralol Succinate SR 50- 400 mg Divided in 1-2 doses Metopralol sccinate SR 50- 400 mg Divided in 1-2 doses
81. Metoprolol Tartrate 50-200 mg Divided in 1-2 doses Metoprolol 50-300 mg Divided in 1-2 doses
82. Minocycline 50-100 mg 1-2 times Minocycline 50-100 mg 1-2 times
83. Minoxidil 2,5-40 mg Divided in 1-2 doses Minoxidil 10-40 mg Divided in 1-2 doses
84. Montelukast 10 mg In 1 dose Montelukast 10 mg In 1 dose
85. Moxifloxacin 400 mg In 1 dose Moxifloxacin 400 mg In 1 dose
86. Nadolol 20-320 mg In 1 dose Nadolol 20-320 mg In 1 dose
87. Nalidixic Acid 500-1000 mg 4 times Norfloxacin Ciprofloxacin 400-800 mg 250- 2 times
750mg 2 times
88. Naproxen 500-1000mg Divided in 1-2 doses Naproxen 500-1000mg Divided in 1-2 doses
89. Nebivolol 5-40 mg In 1 dose Nebivolol 5-40 mg In 1 dose
90. Nifedipine SR 20-120 mg Divided in 1-2 doses Nifedipine SR 20-120 mg Divided in 1-2 doses
Nifedipine SR 30-90 mg In 1 dose
91. Nifedipine SR 30-90 mg In 1 dose Nifedipine SR 30-90 mg In 1 dose
92. Nifedipine 10-120 mg Divided in 3 doses Nifedipine SR 20-120 mg Divided in 1-2 doses
93. Nitrofurantoin 50-100 mg 4 times Norfloxacin 400 mg 2 times
94. Norfloxacin 400 mg 2 times Norfloxacin 400 mg 2 times
95. Ofloxacin 400 mg 2 times Ofloxacin 400 mg 2 times
96. Olmesartan 20-40 mg In 1 dose Olmesartan 20-40 mg In 1 dose
97. Olanzapine 10-20 mg In 1 dose Olanzapine 10-20 mg In 1 dose
98. Omeprazole 20-40 mg Divided in 1-2 doses Omeprazole 20-40 mg Divided in 1-2 doses
99. Oxcarbazepine 900-2400 mg Divided in 2 doses Oxcarbazepine 900-2400 mg Divided in 2 doses
100. Paliperidone 6-12 mg In 1 dose Paliperidone 6-12 mg In 1 dose
101. Pantoprazole 20-40 mg In 1 dose Pantoprazole 20-40 mg In 1 dose
102. Paroxetine 10-20 mg In 1 dose Paroxetine 10-20 mg In 1 dose
103. Phenobarbital 90-150 mg In 2-3 dose Phenobarbital 90-150 mg In 2 dose
104. Pheynetion 300-400 mg Divided in 1-3 doses Pheynetion 300-400 mg In 1 dose
(Blood Level 10-20 (Blood Level 10-20
mcg/ml) mcg/ml)
105. Pindolol 10-60 mg Divided in 2 doses Pindolol 10-60 mg Divided in 2 doses
106. Piroxicam 10-20 mg In 1 dose Piroxicam 10-20 mg In 1 dose
107. Posaconazole 400 mg 2 times Posaconazole 400 mg 2 times
108. Pravastatin 20-40 mg In 1 dose Pravastatin 20-40 mg In 1 dose
109. Prazosin HCl 1-20 mg Divided in 2-3 doses Doxazocin Mesylate 1-16 mg In 1 dose
Terazosin HCl 1-20 mg In 1 dose
110. Pregabalin 150-600 mg Divided in 2-3 doses Pregabalin 150-600 mg Divided in 2 doses
111. Perindopril 4-8 mg In 1-2 doses Perindopril 4-8 mg In 1-2 doses
112. Propranolol HCl 40-480 mg Divided in 2-3 doses Propranolol HCl (LA) 40-480 mg In 1 dose
113. Quinapril HCl 5-80 mg Divided in 1-2 doses Quinapril HCl 5-80 mg Divided in 1-2
114. Ramipril 1.25-20 mg In 1-2 doses Ramipril 1.25-20 mg In 1-2 doses
115. Ranitidine 150 mg 2 times Ranitidine 300 mg In 1 dose
300 mg In 1 dose
116. Rabeprazole 20 mg In 1 dose Rabeprazole 20 mg In 1 dose
117. Risperidone 4-8 mg In 1 dose Risperidone 4-8 mg In 1 dose
118. Salmetrol 21 Mcg/puff 2 puff 2 times Salmetrol 21 Mcg/puff 2 puff 2 times
119. Sertraline 25-100 mg In 1 dose Sertraline 25-100 mg In 1 dose
120. Simvastatin 20-40 mg In 1 dose Simvastatin 20-40 mg In 1 dose
121. Sparfloxacin 400 mg loading In 1 dose Sparfloxacin 400 mg loading In 1 dose
then 200 mg then 200 mg
122. Spironolactone 12.5-100 mg Divided in 1-2 doses Spironolactone 12.5-100 mg Divided in 2 doses
123. Sulindac 200-400 mg Divided in 2 doses Sulindac 200-400 mg Divided in 2 doses
124. Telmisartan 40-80 mg In 1 dose Termisartan 40-80 mg In 1 dose
125. Terazosin HCl 1-20 mg In 1 dose Terazosin HCl 1-20 mg In 1 dose
126. Terbinafine 250 mg In 1 dose Terbinafine 250 mg In 1 dose
127. Theophylline Plain Depend on the salt Divided in 3 doses Theophylline SR Depend on the salt Divided in 2 doses
(Blood Level 10-20) (Blood Level 5-15)
mcg/ml) mcg/ml)
128. Telmisartan 40-80 mg In 1 dose Telmisartan 40-80 mg In 1 dose
129. Tinzaparin 175 IU/kg SC daily In 1 dose Tinzaparin 175 IU/kg SC daily In 1 dose
130. Topiramate 200-400 mg Divided in 2 doses Topiramate 200-400 mg Divided in 2 doses
131. Torsemide 5-20 mg Divided in 1-2 doses Torsemide 5-20 mg Divided in 1-2 doses
132. Triameterene 50-150 mg In 1-2 diveded dose Triameterene 50-150 mg In 1-2 diveded dose
133. Trovafloxacin 200 mg In 1 dose Trovafloxacin 200 mg In 1 dose
134. Trifluoperazine 2-10 mg 2 times Trifluoperazine 2-10 mg 2 times
135. Valporic Acid 1000-3000 mg Divided in 2-3 doses Valporic Acid 1000-3000 mg Divided in 2 doses
(Blood Level 40-100 (Blood Level 40-
mcg/ml) 100 mcg/ml)
136. Valsartan 80-320 mg In 1 dose Valsartan 80-320 mg In 1 dose
137. Verpamil HCl 40-480 mg Divided in 3 doses Verpamil HCl (SR) 90-480 mg Divided in 1-2 doses
138. Vigabatran 3 GM Divided in 2 doses Vigabatran 3 GM Divided in 2 doses
139. Voriconazol 400 mg Divided in 2 doses Voriconazol 400 mg Divided in 2 doses
140. Zonisamide 100-600 mg In 1-2 dose Zonisamide 100-400 mg In 1-2 dose
Table 3

Drug therapy Registration and MOH Formulaary Status


No Drug Status Drug Status
1. Acebutolol RSFDA , MOHDF 71. Levetiracetam RSFDA , MOHDF
2. Aliskiren RSFDA 72. Levofloxacin RSFDA , MOHDF
3. Amiloride HCl RSFDA , MOHDF 73. Lisinopril RSFDA , MOHDF
4. Amitriptyline RSFDA , MOHDF 74. Loratadine RSFDA , MOHDF
5. Amlodepine besylate RSFDA , MOHDF 75. Losartan potassium RSFDA , MOHDF
6. Amoxicillin RSFDA , MOHDF 76. Mebendazole RSFDA , MOHDF
7. Aspirin RSFDA , MOHDF 77. Meloxicam RSFDA , MOHDF
8. Atenolol RSFDA , MOHDF 78. Methyldopa RSFDA , MOHDF
9. Atorvastatine RSFDA , MOHDF 79. Metolazone RSFDA , MOHDF
10. Aripiprazol RSFDA , MOHDF 80. Metopralol Succinate SR RSFDA , MOHDF
11. Betoxalol RSFDA 81. Metoprolol Tartrate RSFDA , MOHDF
12. Bisoprolol RSFDA , MOHDF 82. Minocycline RSFDA , MOHDF
13. Candesartan RSFDA , MOHDF 83. Minoxidil RSFDA
14. Captopril RSFDA , MOHDF 84. Montelukast RSFDA , MOHDF
15. Carbamazepine RSFDA , MOHDF 85. Moxifloxacin RSFDA , MOHDF
16. Carteolol RSFDA , 86. Nadolol RSFDA ,
17. Carvedilol RSFDA , MOHDF 87. Nalidixic Acid RSFDA , MOHDF
18. Cefacolr RSFDA 88. Naproxen RSFDA
19. Celeoxib RSFDA , MOHDF 89. Nebivolol RSFDA
20. Cephalexin RSFDA , MOHDF 90. Nifedipine 20mg SR RSFDA , MOHDF
21. Cerivastatin RSFDA 91. Nifedipine 30mg SR RSFDA , MOHDF
22. Chlorthalidone RSFDA , MOHDF 92. Nifedipine 10 mg RSFDA , MOHDF
23. Cholestyramine RSFDA , MOHDF 93. Nitrofurantoin RSFDA , MOHDF
24. Cimitidine RSFDA 94. Norfloxacin RSFDA , MOHDF
25. Ciprofloxacin RSFDA , MOHDF 95. Ofloxacin RSFDA , MOHDF
26. Citalopram RSFDA , MOHDF 96. Olmesartan RSFDA
27. Clobazam RSFDA 97. Olanzapine RSFDA , MOHDF
28. Clonazepan RSFDA , MOHDF 98. Omeprazole RSFDA , MOHDF
29. Clopidogrel RSFDA , MOHDF 99. Oxcarbazepine RSFDA , MOHDF
30. Clonidine RSFDA , MOHDF 100. Paliperidone RSFDA , MOHDF
31. Cloxacillin RSFDA , MOHDF 101. Pantoprazole RSFDA , MOHDF
32. Cotrimoxazole RSFDA , MOHDF 101. Paroxetine RSFDA
33. Dalteparin RSFDA , MOHDF 102. Phenobarbital RSFDA , MOHDF
34. Diclofenac RSFDA , MOHDF 103. Pheynetion RSFDA , MOHDF
35. Diflunisal RSFDA 104. Pindolol RSFDA
36. Digoxin RSFDA , MOHDF 105. Piroxicam RSFDA
37. Diltiazem HCl RSFDA , MOHDF 106. Posaconazole RSFDA
38. Doxazocin Mesylate RSFDA 107. Pravastatin RSFDA , MOHDF
39. Doxycyline RSFDA , MOHDF 108. Prazosin HCl RSFDA , MOHDF
40. Duloxetine RSFDA , MOHDF 109. Pregabalin RSFDA , MOHDF
41. Eplerenone RSFDA 110. Perindopril RSFDA , MOHDF
42. Eprosartan RSFDA 112. Propranolol HCl RSFDA , MOHDF
43. Enalpril maleate RSFDA , MOHDF 113. Quinapril HCl RSFDA
44. Enoxaparin RSFDA , MOHDF 114. Ramipril RSFDA
45. Erythromycin RSFDA , MOHDF 115. Ranitidine RSFDA , MOHDF
46. Ethosuximide RSFDA , MOHDF 116. Rabeprazole RSFDA
47. Escitalopram RSFDA , MOHDF 117. Risperidone RSFDA , MOHDF
48. Esomeprazole RSFDA , MOHDF 118. Salmetrol 21 Mcg/puff RSFDA , MOHDF
49. Felodipine RSFDA , MOHDF 119. Simvastatin RSFDA , MOHDF
50. Flucloxacillin RSFDA , MOHDF 120. Sertraline RSFDA
51. Fluconazole RSFDA , MOHDF 121. Sparfloxacin RSFDA
52. Fluoxetine RSFDA , MOHDF 122. Spironolactone RSFDA , MOHDF
53. Folic acid RSFDA , MOHDF 123. Sulindac RSFDA
54. Famotidine RSFDA 124. Telmisartan RSFDA , MOHDF
55. Fosinopril sodium RSFDA 125. Terazosin HCl RSFDA , MOHDF
56. Furosemide RSFDA , MOHDF 126. Terbinafine RSFDA , MOHDF
57. Unfractionated RSFDA , MOHDF 127. Theophylline Plain RSFDA , MOHDF
Heparin
58. Hydralazine HCl RSFDA , MOHDF 128. Telmisartan RSFDA , MOHDF
59. Hydrochlorothaizide RSFDA , MOHDF 129. Tinzaparin RSFDA , MOHDF
60. Ipratropium RSFDA , MOHDF 130. Topiramate RSFDA , MOHDF
61. Indapamide RSFDA , MOHDF 131. Torsemide RSFDA
62. Irbesartan RSFDA , MOHDF 132. Triameterene RSFDA , MOHDF
63. Isosorbide Dinitrate RSFDA , MOHDF 133. Trifluoperazine RSFDA , MOHDF
64. Isradipine RSFDA 134. Trovafloxacin RSFDA
65. Itraconazole RSFDA , MOHDF 135. Valporic Acid RSFDA , MOHDF
66. Ketoconazole RSFDA , MOHDF 136. Valsartan RSFDA , MOHDF
67. Labetalol HCl RSFDA , MOHDF 137. Verpamil HCl RSFDA , MOHDF
68. Lacosamide RSFDA 138. Vigabatran RSFDA , MOHDF
69. Lamotrigine RSFDA , MOHDF 139. Voriconazol RSFDA , MOHDF
70. Lanzoprazole RSFDA 140. Zonisamide RSFDA
RSFDA: The Drug had been registered in Saudi Food and Drug Authority
MOHDF : The Drug is Ministery of Health Drug Formulary