Injections, Inhalers and Saline While Fasting: Does Treatment Break the Fast?

When people fall ill in Ramadan, the first worry is usually this: will an injection while fasting break my fast? The same question comes up for inhalers, saline drips, blood tests, endoscopy and dental work. Some people delay treatment they urgently need; others take treatment that really does break the fast without knowing it.

This guide brings the common modern treatments together in one place. Its main basis is Resolution No. 93 of the International Islamic Fiqh Academy (an OIC body; 10th session, Jeddah, 1997), where scholars and doctors from many countries reviewed medical treatment and fasting together. Where scholars disagree, we say so clearly.

Medical treatment while fasting: the basic principle

The fast is broken mainly by eating, drinking, intercourse and anything that works like food or drink. So for any treatment, scholars ask two questions:

1. Does it pass through the mouth or nose, past the throat, into the stomach? If so, it usually breaks the fast.
2. Does it work as food or nourishment? A nutritional saline or glucose drip replaces food, so it breaks the fast.

Medicine given through the skin, veins, eyes or ears, which is not food and is not swallowed, usually does not break the fast.

Treatments that do not break the fast

According to the Fiqh Academy resolution, the following do not break the fast. IslamQA and other reliable fatwa sources say the same.

Injections, insulin and vaccines

Medical injections under the skin, into a muscle or into a vein do not break the fast. Insulin for diabetes, painkiller injections, antibiotics and vaccines all fall in this group. The only condition is that the injection is not for nutrition.

Eye, ear and nose drops

Eye drops or kohl, ear drops, and nasal drops or sprays do not break the fast, provided nothing reaching the throat is swallowed. Use nasal drops in small amounts without tilting your head far back, and spit out anything you taste in your throat.

Oxygen and anaesthetic gases

Oxygen given in hospital does not break the fast. Anaesthesia by gas during surgery does not break it either, as long as no nutritious fluids are given with it.

Endoscopy, angiography and other tests

• Endoscopy or gastroscopy: does not break the fast if no fluid or substance is given through the tube.
• Angiography: a catheter into the heart's blood vessels does not break the fast.
• Laparoscopy and biopsy: examining the abdomen through a small opening or taking a liver or organ sample (without added fluids) does not break the fast.
• Urinary catheter or cystoscopy: does not break the fast.
• Ultrasound, X-ray, ECG: nothing enters the body, so the question does not arise.

Under-the-tongue tablets, creams and patches

Tablets placed under the tongue for chest pain (such as nitroglycerin) do not break the fast if nothing is swallowed. Creams, ointments, oil and medicated patches on the skin do not break it either.

Dental treatment and mouthwash

Tooth extraction, cleaning, miswak or brushing, gargling and mouthwash do not break the fast if nothing is swallowed. In the Hanafi school, however, using toothpaste is disliked (makruh) because its taste may reach the throat. Wearing dentures does not affect the fast.

Involuntary vomiting

If you vomit on your own because of illness or treatment, the fast is not broken. Deliberate vomiting has a different ruling.

Treatments that break the fast

• Nutritional saline and glucose drips: saline, glucose or vitamin and mineral fluids given into a vein work as food. The Fiqh Academy left them out of its list of things that do not break the fast, and most scholars say they break it.
• Oral medicine: swallowing a tablet, syrup or capsule breaks the fast.
• Medicine that reaches the throat through the nose or mouth: drops or sprays that are swallowed break the fast.
• Tube feeding through the nose: this is food, so it breaks the fast.

In these cases you only need to make up the fast later (one day for one day). No expiation (kaffarah) is due, because the reason is illness.

Where scholars disagree

The Fiqh Academy postponed its ruling on the following for further study. Here, follow a trusted local scholar.

Using an inhaler while fasting

An asthma inhaler delivers very fine particles of medicine mainly to the lungs. For this reason many scholars, including the ruling published in Prothom Alo, say it does not break the fast. On the other hand, many Hanafi fatwa books in South Asia say a spray in the mouth reaches the throat and therefore breaks the fast. Practical advice: ask your doctor whether doses can be moved to suhoor and iftar, or whether a longer-acting medicine is possible. If you become breathless during the day, use your inhaler without delay. Saving your life comes first.

Giving blood, blood tests and cupping

Sahih al-Bukhari 1938 reports that the Prophet (peace be upon him) was cupped (hijama) while fasting. For this reason the Hanafi school and many others hold that drawing blood does not break the fast, while the Hanbali school holds that cupping does. Almost all agree that a small blood sample for tests, or a finger-prick sugar check, does not break the fast. If giving a large amount of blood may leave you weak, donate after iftar.

Dialysis and rectal medicine

Scholars also differ on kidney dialysis and on suppositories or other medicine given rectally. In the Hanafi school, medicine given through the rectum (such as an enema or suppository) breaks the fast. For patients who need regular dialysis, fasting is often medically risky in any case.

At a glance: which treatments break the fast

Should you fast when you are ill?

Islam does not place hardship on the sick. Surah Al-Baqarah 2:184 says that whoever is ill or travelling should make up the same number of days later. So if fasting could worsen your illness or slow your recovery, the rule is not to fast and to make the days up later. A person permanently unable to fast has the option of fidya.

The Fiqh Academy also advised doctors to postpone a fasting patient's treatment until iftar when the delay causes no harm.

Extra care for people with diabetes

Diabetes UK says that checking your blood sugar does not break the fast, so keep checking while fasting. If your sugar falls below 4 mmol/L (about 72 mg/dL), break the fast at once and take something sugary. If it rises above the limit your doctor has set, break the fast, drink water and seek medical advice. Agree your insulin or tablet doses and timings with your doctor before Ramadan begins.

What to do before Ramadan

1. Talk to your doctor early: ask whether daily doses can be moved to suhoor and iftar.
2. List your medicines: note which are oral, which are injections and which are drops.
3. Book routine procedures after iftar: blood donation, dental work or endoscopy can usually wait for the evening.
4. Ask a scholar about disputed issues: especially inhalers and dialysis.
5. Never delay in an emergency: saving life is an obligation, and the fast can be made up later.

Final word

In short, an injection while fasting, insulin, vaccines, eye and ear drops, oxygen, endoscopy and blood tests do not break the fast; nutritional saline, glucose and oral medicine do. On inhalers, blood donation and dialysis scholars differ, so follow your own scholar. For other things that break the fast, read our guide What Breaks the Fast in Ramadan?.

This article is general religious information. For your own condition, medicine doses and whether fasting is safe for you, please consult your doctor.