Ramadan is the 9th month of the Islamic lunar calendar and shifts forward by about 10-12 days each year because the lunar calendar is shorter than the Gregorian calendar. This year, it lasts from 17th of February to 19th of March 2026.
The beginning of the month is traditionally determined by the sighting of the new crescent moon, which is why Ramadan can last 29 or 30 days. During this month, observant Muslims fast daily from dawn until sunset. The fast begins with the end of the last meal before dawn (Suhoor) and ends with breaking the fast at sunset (“Iftar”). Depending on geographical location, the daily fasting period lasts approximately 12-18 hours, as the length of daylight varies considerably from region to region.
During Ramadan, people mainly fast from food and drink, including water, as well as alcohol and tobacco.
It is a time of purification, compassion for those in need, and strengthening one’s relationship with God.
Who needs to fast during Ramadan?
Fasting is obligatory for all healthy, adult Muslims and is one of the fundamental religious duties. However, people with health or physical limitations are exempt from this obligation. This includes, among others, travelers, the seriously ill, the elderly, pregnant and breastfeeding women if fasting could harm them or their child, as well as people with physical or mental disabilities. Missed fasting days should generally be made up later, provided the person is able to do so. If this is permanently impossible – for example, due to a chronic illness – a substitute can be provided in the form of “Fidya,” which is the provision of meals to those in need.
Special regulations apply to women: Fasting is expressly forbidden during menstruation or the postpartum period. These days must be made up later, once the body has returned to normal. The obligation to fast can also be waived during pregnancy and breastfeeding if a risk to the mother or child is suspected; the missed fasting days are either made up later or, in certain cases, compensated for by Fidya.
The handling of medication is also of particular importance during Ramadan. Oral medications and nutritional infusions break the fast, which is why medication intake often has to be postponed until the time between sunset and dawn. Patients with chronic illnesses can often adjust their therapy using alternatives such as long-acting medications or altered administration times. At the same time, the following also applies: If fasting could endanger one’s health, the person is exempt from the obligation to fast and may take medication during the day without violating religious obligations. Medical consultation is particularly recommended for people with complex medical conditions such as diabetes, cardiovascular disease or Parkinson’s to avoid risks such as hypoglycemia, dehydration or typical motor or non-motor symptoms in Parkinson’s.
So how to treat Parkinson’s best during Ramadan, when multiple intake times of oral medication is not feasible during this time?
In patients who are already treated with Apomorphine continuously, is monotherapy with Apomorphine advisable during Ramadan?
In many cases, switching to continuous dopaminergic therapy – including Apomorphine – during Ramadan can be beneficial, but only with careful patient selection.
Background from literature:
⚪ Guidelines for Parkinson’s disease and Ramadan emphasize that patients in the early stages
(Hoehn & Yahr 1–2) can often fast with less complex therapies. In moderate to advanced Parkinson’s disease, the risk from therapy interruptions is significantly higher.
⚪ The JAMA Neurology analysis recommends switching to dopaminergic therapies that can be administered once daily or transdermally during Ramadan to avoid taking medication during the fasting period.
⚪ is an established treatment option for motor fluctuations despite optimized oral therapy and provides reliable continuous stimulation (a s a pump) that is independent of meals or absorption.
Interpretation for Ramadan
Since oral medications are considered breaking the fast during a fast, and many Parkinson’s patients require levodopa several times a day, in early stages of the disease an Apomorphine pen could be considered to bridge off-phases, while continuous dopaminergic stimulation (e.g., an Apomorphine pump) is a particularly suitable approach to:
– Maintain stable dopamine levels
– Avoid jeopardizing the fast
– Prevent motor fluctuations
– Prevent withdrawal symptoms caused by interrupting therapy
Advantages of continuous Apomorphine infusion during Ramadan are:
– No oral administration → Fasting remains valid (similar to non-oral therapies in other recommendations)
– Continuous dopaminergic stimulation → Stabilization of OFF phases, which would be exacerbated by the absence of tablets.
– Avoidance of meal-related absorption problems with levodopa during disrupted eating patterns (Suhoor/Iftar)
→ Yes, (temporary or permanent) monotherapy with Apomorphine can be beneficial during Ramadan if multiple oral doses would be problematic. However, this should be decided on an individual basis.
How can Apomorphine Pump Therapy be managed during Ramadan?
A pre-Ramadan planning is useful. Guidelines recommend preventive risk management, including an individual assessment of the stage of the disease, medication, dyskinesias, and fluctuations. This means:
⚪Adjust the treatment plan 4–6 weeks before Ramadan
⚪Stabilize the Apomorphine dose titration before Ramadan
⚪Educate the patient and their family members
Practical Management of continuous Apomorphine Infusion during Ramadan
1 – Pump Settings
Adjust the basal rate to accommodate daily fluctuations
Consider administering bolus doses for predictable off-times until “Iftar”
2 – Management During Fasting
Keep the pump running → avoid breaking the fast.
Ensure adequate hydration during Iftar and Suhoor (avoid hypotension)
3 – Reconsider Combination Therapies
If the patient has required many doses of oral dopamine agonists/levodopa:
→ Consider reducing or pausing oral therapies in favor of stable apomorphine monotherapy.
This aligns with the recommendation to switch to simpler forms of therapy.
4 – Special attention to Patient Selection
Good candidates:
– Early to moderate stage
– Patients with significant OFF phases despite taking tablets
Poor candidates:
– Very advanced Parkinson’s disease
(high risk, fasting difficult, fasting not recommended according to guidelines)
– Patients with apomorphine intolerance (nausea, hypotension)
Safety Information for Apomorphine Treatment
⚪Orthostatic hypotension is possible with Apomorphine → exacerbated by dehydration during Ramadan
⚪ Antiemetics (e.g., domperidone) may need to be optimally adjusted before Ramadan
⚪Patients should be instructed to break their fast in case of pronounced OFF phases, syncope, dyskinesia, or
marked somnolence (medically and religiously permissible)
Conclusion
Ramadan is a time of intense spiritual reflection, self-discipline, and social responsibility. Fasting is central, but it is always interpreted with consideration for health, life circumstances, and individual needs. The religion allows for clear exceptions and exemptions, so no one has to harm themselves to fulfill their religious obligation.
Apomorphine therapy bypasses the gastrointestinal tract because it is administered subcutaneously. Therefore, it can be one of the best options for Parkinson’s patients who wish to fast during Ramadan. Monotherapy with the continuous apomorphine pump is particularly useful when multiple oral doses are not possible or contraindicated. Management includes:
– Early planning
– Possible reduction of concomitant oral medication
– Stable pump settings
– Monitoring of side effects
– Individual risk assessment
→ The decision should always be made in an interdisciplinary manner:
neurology + Ramadan counselling + if necessary, an imam/religious scholar.
Ramadan begins this year (2026) between February 17th and 19th, depending on the regional lunar phases. The fasting month lasts 29 to 30 days, with the end also determined by the sighting of the new crescent moon. Accordingly, Ramadan is expected to end between March 18th and 20th, 2026.
“Ramadan Mubarak”. May this month bring blessings and peace to all who observe it.
Further links:
🔗www.islamicfinder.org
🔗www.muslimpro.com
🔗www.sop.washington.edu
🔗www.parkinsons.org.uk
🔗www.d-minecare.com
