Department of Pharmacy Practice, State University of New York at Buffalo, School of Pharmacy and Pharmaceutical Sciences, Buffalo, New York.
Department of Pharmacy, New York State Office of Mental Health, Buffalo, New York.
Int Clin Psychopharmacol. 2019 Nov;34(6):317-322. doi: 10.1097/YIC.0000000000000275.
Ramadan is a religious month dedicated to prayer, fasting and feasting. Recently, there has been an increased interest among healthcare providers regarding possible health-related complications as a consequence of religious fasting such as that seen during Ramadan. In , a 34-year-old female patient with a diagnosis of schizoaffective disorder, depressive type, was admitted for inpatient hospitalization to an inpatient psychiatric hospital in Buffalo, New York. The earliest date of initial diagnosis is unclear; however, the patient reports an increase in symptoms during her early twenties. Upon admission, the patient was continued on haloperidol, lithium and fluphenazine decanoate which had been initiated prior to this admission. Medication administration and meal times were adjusted to accommodate her observance of Ramadan. Despite efforts to mitigate the potential impact, the patient complained of dizziness and weakness following initiation and titration of clozapine. Due to psychiatric exacerbation, inpatient hospitalization and continuous monitoring, clozapine titration occurred quickly. Upon admission, the patient's blood pressure was 137/85 mmHg, which decreased to a low of 87/58 mmHg as her clozapine dose was increased, leaving the patient requesting bedrest due to significant dizziness and weakness. On the 21st day of Ramadan, the patient broke her fast due to substantial adverse effects. Five days after breaking her fast, the patient's blood pressure increased and returned to baseline. Individuals participating in Ramadan tend to have disrupted sleep cycles, including nocturnal sleep reduction and broken sleep patterns, which can impact overall health. Additional health-related complications that have been reported include dehydration and changes in blood glucose, blood pressure, lipid panel, body weight and exacerbation of psychiatric symptoms. These adverse effects can result in serious complications in fasting individuals with acute medical and psychiatric illness. Clozapine was initiated and rapidly titrated during the patient's observance of Ramadan. She exhibited signs and symptoms of hypotension, which were also subjectively reported by the patient. The significant drop in blood pressure while fasting, and rapid increase once the fast was broken, confirm that medication changes implemented during religious fasting, such as that seen during Ramadan, can increase a patient's risk of serious adverse effects.
斋月是一个宗教月份，专门用于祈祷、斋戒和盛宴。最近，医疗保健提供者对可能因宗教斋戒而产生的与健康相关的并发症产生了浓厚的兴趣，例如在斋月期间。在一个病例中，一名 34 岁的女性患者被诊断为精神分裂症谱系及相关障碍，抑郁型，因住院治疗而被收入纽约州布法罗的一家精神病院。最初诊断的最早日期尚不清楚；然而，患者报告说在她二十出头时症状加重。入院时，患者继续服用先前入院时开始服用的氟哌啶醇、锂和氟奋乃静癸酸酯。药物管理和用餐时间进行了调整，以适应她的斋月禁食。尽管努力减轻潜在影响，但患者在开始和滴定氯氮平后抱怨头晕和虚弱。由于精神科恶化，需要住院治疗和持续监测，氯氮平的滴定过程很快。入院时，患者的血压为 137/85mmHg，随着氯氮平剂量的增加，血压降至 87/58mmHg 的低值，导致患者因严重头晕和虚弱而要求卧床休息。在斋月的第 21 天，患者因严重不良反应而打破斋戒。在打破斋戒后的第五天，患者的血压升高并恢复到基线。参加斋月的人往往会打乱睡眠周期，包括夜间睡眠时间减少和睡眠模式中断，这可能会影响整体健康。此外，据报道，还存在脱水和血糖、血压、血脂谱、体重变化以及精神症状恶化等与健康相关的并发症。这些不良反应可能导致患有急性医学和精神疾病的斋戒个体出现严重并发症。氯氮平在患者禁食期间开始并迅速滴定。她表现出低血压的迹象和症状，这也被患者主观报告。在禁食期间血压显著下降，一旦斋戒结束血压迅速上升，这证实了在宗教斋戒期间（如在斋月期间）进行药物调整会增加患者出现严重不良反应的风险。
