How to Observe Ramadan with Parkinson’s disease Safely?

Personal Guide to Safe Fasting During Ramadan For Patients with Parkinson’s Disease

Ramaḍân is the month in which the Quran was revealed as a guide for humanity with clear proofs of guidance and the decisive authority. So whoever is present this month, let them fast. But whoever is ill or on a journey, then ˹let them fast˺ an equal number of days ˹after Ramaḍân˺. Allah intends ease for you, not hardship, so that you may complete the prescribed period and proclaim the greatness of Allah for guiding you, and perhaps you will be grateful.
Holy The Quran. Surah Al-Baqarah (The Cow), 2:185.

We understand that Ramadan is not merely about abstaining from food and drink. It is a time for spiritual purification, prayer, closeness to Allah, and connecting with family. We deeply appreciate your commitment to fasting during this blessed month — even when Parkinson’s disease adds significant challenges to your life.

Your faith and health are not in conflict; rather, they go hand in hand.

With this in mind, our centre has prepared this guide to help you fast safely, mindfully, and with dignity based on the research data and recomendations (Mittal, 2025).

The information provided in this article is for general informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Do not self-diagnose or self-treat, and do not start, stop, or change any medication or treatment plan without consulting a qualified healthcare professional. If you have symptoms, your condition worsens, or you have a chronic illness, seek medical advice promptly. Please discuss what you have learned from this article with your doctor, who can provide guidance tailored to your individual situation.

Is it important to take your Parkinson’s disease into consideration during Ramadan?

Patients who found fasting more difficult and whose Parkinson’s symptoms worsened during Ramadan tended to report a poorer quality of life, which may be an indirect sign of more advanced or more severe disease, or more burdensome motor and non-motor symptoms (Al‑Khammash et al., 2023). Therefore, it is very important to stay in close contact with your doctor, take your condition into account, follow evidence-based advice, and listen to how your body feels.

What do you have to be careful about during Ramadan if you have Parkinson’s disease?

Interrupting PD treatment might lead to a severe withdrawal syndrome (worsening)

Do not stop Parkinson’s medicines suddenly during Ramadan. Missing doses for several hours can be dangerous—speak to your neurologist in advance to create a safe plan.

Plan your Ramadan medication schedule before the month starts. A short pre‑Ramadan review can prevent avoidable “OFF” time and complications.

“Any sudden withdrawal of dopamine replacement drugs is associated with the risk of a life-threatening malignant hyperthermia syndrome”, — Philippe Damier, MD, PhD, MBA, FEAN and Jasem Al-Hashel, MD (2017)

Never reduce or stop levodopa or dopamine agonists abruptly without your doctor. Any changes must be gradual and supervised to avoid rare but life‑threatening reactions.

Some people may experience worsening non-movement symptoms such as pain, anxiety, depressive mood, sweating, or dyspnea!

If fasting makes you feel severe anxiety, pain, shortness of breath, or intense sweating, treat this as a warning sign, urgently contact your doctor, they could help you with advice, changing the medication. Follow your doctor’s advice!

Higher Risk of Dehydration During Ramadan (No Drinking + Hot Climate)

Condition may also be worsened by the fact that drinking is not allowed during the fasting period, and most patients who follow Ramadan live in countries with a warm climate

Avoid heat exposure and plan your day to reduce dehydration risk. If you feel dizzy, very weak, or confused, prioritize hydration and seek medical advice immediately.

What person with Parkinson’s disease should do BEFORE Ramadan

When should you start preparing for Ramadan?

Begin by starting to adapt the treatment at least 2 weeks before Ramadan to leave room for any adjustments. This will give you the time to fine‑tune doses and manage side effects safely (Philippe Damier, 2016).

Assess Your Condition. Can You Fast with Parkinson’s disease?

Not all Parkinson’s patients can fast in the same way, and this is natural.

Islam allows breaking the fast if fasting may harm your health and provides a legitimate alternative, which is fidya (feeding those in need).

Assess Your Condition (preferably in consultation with your doctor): what is Disease Stage – Can you fast? – What should you know?

Early Stage (Hoehn and Yahr I–II):

• Mild symptoms
• Independence in daily life
• Taking 1–2 medications

✅ Yes, fasting is generally possible.
Minor adjustments to medication schedules may be needed. Treatments like MRgFUS or others may significantly facilitate fasting.

Middle Stage (Hoehn and Yahr III):

• Tremor, stiffness, slowness of movement
• Taking levodopa 3–4 times daily
• Experiencing motor fluctuations (OFF periods)

⚠️ Fasting is possible but requires caution.
This stage requires reorganising treatment:

• Combining doses, using extended-release medications, or possibly adding MAO-B inhibitors (e.g., Rasagiline).

Advanced Stage (Hoehn and Yahr IV–V):

• Frequent falls, hallucinations, dementia
• Dependence on caregiving
• Continuous drug infusion therapies (LCIG, Apomorphine) or deep brain stimulation (DBS)

❌ Fasting is not recommended.
Interrupting treatment could be dangerous.
Using fidya is a valid and spiritually rewarding alternative.

✨ At our centre, we conduct individual risk assessments before Ramadan during consultations, so your decisions are based on knowledge, not fear.

What person with Parkinson’s disease should do DURING Ramadan

How Do We Adjust Medication Schedules with Parkinson’s Disease during Ramadan?

The goal is to minimise motor fluctuations (OFF periods) and avoid dyskinesia (involuntary movements) after iftar due to increased dosages.

General Principles

• Never stop medications suddenly — this can lead to serious complications.
• Separate protein intake and levodopa doses (60-minute intervals) to improve absorption.
• Hydration is essential: drink 2–3 litres of fluids between iftar and suhoor. Drink well at suhoor and iftar, rest during the day, and aim to keep your weight stable—avoid very sugary/fatty meals that can worsen energy swings and medication response.
  

Medication Recommendations (discuss with your doctor)

• Switch to extended-release medications whenever possible.
• Take main doses at suhoor and iftar.
• Add an extra dose before sleeping if needed (e.g., for night-time stiffness).
• Avoid stacking doses at iftar to prevent dyskinesia.
• Continue treatments for constipation, anxiety/depression, and sleep as prescribed (timed in non‑fasting hours). Ramadan can change symptoms—tell your clinician early if things worsen.

If you have undergone MRgFUS treatment at our centre — congratulations!
You have taken a significant step towards reducing the number and dosage of your medications.

Are there medications a patient could take not through the mouth?

Yes. You can consider with your doctor non-tablet medications.

Patches

Because the drug is delivered without entering the gastrointestinal tract, the use of a patch does not break the fast. Over the skin patch seems to be a reasonable option to consider for patients treated with low-to-moderate amount of PD medication, but heat or high humidity might make it difficult to achieve good adhesion of the patch… check regularly that the patch is correctly positioned (Philippe Damier, 2017).

Subcutaneous levodopa

VYALEV™ is the first and only treatment that delivers a levodopa-based medicine continuously under the skin, 24 hours a day, to help control motor fluctuations (ON/OFF periods) in people with advanced Parkinson’s disease (FDA, 2024).

Supporting the Body and Spirit with Parkinson’s Disease During Ramadan

Sleep

• Rest after Taraweeh prayers.
• Avoid coffee before suhoor.
• If you experience night-time symptoms, discuss extended-release levodopa or the use of patches with us.

Prayer

• Islam permits praying while sitting if illness prevents standing.
• Take breaks between rakats.
• Avoid sudden movements if feeling dizzy.

Mental Health

• Ramadan often improves mood through worship, routine, and social connection.
• If you feel anxious or stressed, talk to us — we are here for you.

What person with Parkinson’s disease should do AFTER Ramadan

Don’t “snap back” to your old schedule overnight. Arrange a post‑Ramadan review (ideally within a month) to safely return to your usual regimen and adjust if needed.

• medications should to be adjusted progressively
• a consultation is recommended 1 month after the end of Ramadan (Philippe Damier, 2016)

We Are Always With You

In Tremor.Care centres, we do not just treat tremors.
We respect your faith, choices, and strength of will.

What Do We Offer?

• Pre-Ramadan consultation (in-person or remote).
• Personalised medication schedule for the entire month.
• Direct support via WhatsApp to answer your questions at any time.

We pray that this blessed month becomes a time for both spiritual and physical renewal for you.
You are not alone.
We are with you — through science, faith, and transformation.

With care,
The Tremor.Care Team

References and Scientific Research Basis

This guide is based on the official recommendations of the Emirates Neurology Society (Mittal et al., Frontiers in Neurology, 2025), as well as the extensive clinical expertise of Parkinson’s specialists in Islamic countries and the years of experience at our centre.

1. Mittal, S.O., Krystkowiak, P., Ramberg, C.J., Sarathchandran, P., Hassan, A., Iantorno, V., Cirasanambati, M., Al Aloma, M., Maiti, T. and Al Rukn, S., 2025. Faith, fasting, and well-being: Emirates Neurology Society consensus guidelines on safe Ramadan fasting in Parkinson’s disease. Frontiers in Neurology, 16, p.1720571. https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2025.1720571/full
2. The Quran (n.d.) Surah Al-Baqarah (The Cow), 2:185. Available at: https://quran.com/2/185. (Accessed: 3 February 2026).
3. Damier, P. and Al-Hashel, J., 2017. Recommendations for the treatment of patients with Parkinson disease during Ramadan. JAMA neurology, 74(2), pp.233-237.
4. Al-Khammash, N., Al-Jabri, N., Albishi, A., Al-Onazi, A., Aseeri, S., Alotaibi, F., Almazroua, Y., Albloushi, M., Al-Jabri, N.M. and ALMAZROU, Y., 2023. Quality of life in patients with Parkinson’s disease: a cross-sectional study. Cureus, 15(1).
5. U.S. FDA Approves VYALEV™ (foscarbidopa and foslevodopa) for Adults Living with Advanced Parkinson’s Disease. Available: https://news.abbvie.com/2024-10-17-U-S-FDA-Approves-VYALEV-TM-foscarbidopa-and-foslevodopa-for-Adults-Living-with-Advanced-Parkinsons-Disease (Accessed: 3 February 2026)

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