Ramadan Medication Adherence Program in Saudi Arabia: What Pharma Teams Should Plan Before the Month Starts
A Ramadan adherence program helps patients keep taking chronic medicines safely when meal and sleep patterns change. In Saudi Arabia, pharma teams should plan it before the month starts: equip clinicians and pharmacists with prompts, give patients clear timing and warning-sign information approved by their doctor, and review how the month went afterwards.
Clinical content note: This article describes programme design, not medical advice. Decisions about fasting and any change to medicines must be made by the patient with their treating clinician.
Key takeaways
- In a mixed-methods study at a diabetes centre in Makkah, 54% of 95 patients changed how they took their medicines during Ramadan and 15% stopped at least one; 43% said their doctor gave no advice about fasting.
- Interviewed patients described difficulty adjusting medication timing in the first days of Ramadan and little advice, particularly from pharmacists.
- The programme's role is to prompt and support the clinician conversation, not to replace it.
- Ramadan follows the lunar calendar, so confirm the expected start date and work back about eight weeks for content approval and enrolment.
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What the Saudi evidence shows
Alluqmani and colleagues studied patients with diabetes at the Diabetes Center of a large governmental hospital in Makkah between December 2017 and March 2018 (International Journal of Environmental Research and Public Health, 2019). Twenty patients were interviewed, then 95 completed a questionnaire. Of the 95, 54% said they changed how they took their medicines during Ramadan, for example by changing doses, and 15% stopped at least one medicine while fasting. Forty-one per cent reported health problems such as hypoglycaemia, hyperglycaemia, fatigue, sweating or gastrointestinal disturbance. Seventy-seven per cent fasted the whole month, and 95% planned to fast the next Ramadan. On advice, 51% said their doctor told them they could fast, 43% said their doctor gave no advice about fasting, and 4.2% were told not to fast. In the interviews, patients described difficulty adjusting the timing of their medicines in the first days and said they received limited advice from healthcare providers, particularly pharmacists.
The authors list their own limits: no power calculation, a convenience sample at one hospital, and questionnaire data collected six months after Ramadan, which may affect recall. The sample was 97% Saudi nationals and all had diabetes. It describes patients' reported behaviour, not clinical outcomes, and it should not be read as a national figure. For a pharma team, the value is the pattern: a large share of patients change how they take medicines, and many report not being advised.
Why Ramadan is a distinct adherence window
Most medicine schedules are built around daytime meals and a normal sleep pattern. During Ramadan both shift, and patients decide for themselves how to adapt unless a clinician has given them a plan. In the Makkah study 80% of patients believed changes in eating habits affected their diabetes control. The programme opportunity is not to tell patients what to do. It is to make sure that every patient who intends to fast has had a conversation with a clinician or pharmacist about their medicines before the month begins, and that the plan they leave with is written down in plain Arabic. Whether any patient should fast is an individual medical decision, and the programme must stay neutral on it.
A four-part Ramadan programme
1. Before Ramadan: prompt the clinician conversation
Invite enrolled patients, a few weeks ahead, to book a pre-Ramadan review with their physician or pharmacist, and give the clinician a short structured prompt covering whether the patient intends to fast, which medicines they take and whether the schedule needs to change. The clinical content belongs to the treating team and the sponsor's medical affairs function; the programme supplies the prompt and the booking path.
2. During Ramadan: re-timed support
Once the clinician has agreed a schedule, reminders can follow that schedule rather than the usual one. Keep check-ins short, in Arabic, in the channel the patient prefers, and give a clear route to the clinic or an emergency service for the warning signs the clinician has named. Reminders must never replace urgent advice.
3. Education that fits the patient
In the Makkah study, patients with no formal education reported more health problems during fasting (p = 0.04), although the sample was small and this was the only significant association. Our suggestion, not a finding of the study: use audio and short video in Arabic as well as text, and invite a family member into the conversation if the patient wishes. Have educators or pharmacists review all material.
4. After Ramadan: review and reset
Prompt a post-Ramadan check: what changed, any problems, and a return to the usual schedule agreed with the clinician. Pass what patients report back to the treating team, and record it in the programme for the next year.
Roles: where pharmacists and nurse educators come in
Patients in the study singled out the lack of advice from pharmacists. A programme can close part of that gap by offering a scripted pharmacist or nurse educator touchpoint before the month, using the same Arabic checklist. See our overview of patient educator management software for how to schedule and track these contacts.
Compliance guardrails for pharma teams
A Ramadan programme should be non-promotional, with no product claims in patient material. Any adverse event or product complaint reported by a patient must flow to your pharmacovigilance process; see our article on SFDA pharmacovigilance and digital PSP adverse-event reporting. Enrolment, consent and data handling follow your PDPL-aligned PSP design. Confirm with your regulatory and legal teams how Saudi Food and Drug Authority rules and company policy apply to programme materials before launch.
Measuring the programme
Use operational indicators the programme controls: patients enrolled before Ramadan, pre-Ramadan reviews prompted and completed, check-in response, self-reported changes to medicine-taking (categorised, not interpreted clinically) and post-Ramadan reviews completed. Do not present these as clinical outcomes. For how to combine self-report, engagement and refill data, read our guide to measuring medication adherence in a PSP.
An illustrative timeline (not a client case)
About eight weeks before the expected start of Ramadan the sponsor's medical affairs team approves Arabic materials and the clinician prompt. Four weeks before, enrolled patients are invited to a pre-Ramadan review and pharmacists receive the checklist. During the month patients receive short check-ins on the schedule their clinician agreed, with a clear contact route for warning signs. In the two weeks after Eid, patients are prompted to review how the month went, and the programme team compiles the categorised, self-reported changes for the sponsor and the treating teams.
Where CareSync fits
CareSync PSP Connect is a white-label platform for pharma patient support programmes, supporting enrolment, consent, reminders and follow-up in Arabic and English. The clinical content, timing rules and escalation routes in a Ramadan programme come from your medical team and treating clinicians; the platform's role is to deliver and record them consistently.
Frequently asked questions
Do Saudi patients change how they take their medicines during Ramadan?
In a Makkah diabetes-centre study of 95 patients, 54% reported changing how they took their medicines and 15% stopped at least one. The study was small, single-centre and based on recall, so it shows a pattern rather than a national rate.
Should a pharma company give dosing advice during Ramadan?
No. Dosing and fasting decisions belong to the patient and their treating clinician. A programme can prompt the conversation, supply clinician-approved Arabic material and support reminders on the agreed schedule.
When should a Ramadan adherence programme start?
Ramadan follows the lunar calendar, so confirm the expected start date and work back: about eight weeks for content approval, and enrolment and pre-Ramadan reviews in the weeks before. The eight-week figure is our planning suggestion, not a regulatory requirement.
Which patients does the Makkah study cover?
Patients with diabetes at a governmental hospital's diabetes centre in Makkah, 97% Saudi nationals. It does not cover other conditions, so do not extend its figures to them.
How should adverse events reported during a Ramadan programme be handled?
Route them to your pharmacovigilance process under your company procedures and SFDA requirements, and make sure programme staff are trained to recognise and escalate them.