Use of Orally Dissolving and Sublingual Medications While Fasting

Question: Do orally dissolving or sublingual medications like ondansetron and lorazepam break the fast? 


Bismihi Ta’ala

Orally dissolving tablets (ODT) and sublingual (SL) routes allow for mucosal absorption of medications. This is particularly beneficial in patients with difficulty swallowing (dysphagia). It also bypasses gastric and enteral breakdown and liver first-pass metabolism. The medication must first be diluted into saliva before absorption into the mucosa. The patient must avoid eating, drinking, smoking, and possibly talking to keep the tablet in place to dissolve and give time to transfer from the saliva into the mucosa. This time is variable depending on drug and patient characteristics. 

In the case of ondansetron ODT and lorazepam SL, bioavailability is about 56% and 94% respectively indicating some portion of the drug remains in the saliva. This is likely the case even more so for the delivery (filling) agents. This is also reflected in the package insert administration instructions: 

  • Ondansetron ODT: “Immediately place the Zofran ODT tablet on top of the tongue where it will dissolve in seconds, then swallow with saliva.” 
  • Lorazepam SL: “The sublingual tablet, when placed under the tongue, will dissolve in approximately 20 seconds. The patients should not swallow for at least 2 minutes to allow sufficient time for absorption.” 

If the package insert is followed for Ondansetron ODT and the medication is swallowed, the fast is broken, and it will need to be repeated (qaā). If there was a medical necessity for taking it, there is no penalty (kaffārah). Otherwise, there is a penalty. 

If the package insert is followed for lorazepam SL, it presents us with two scenarios: 

  1. The drug is not necessary while fasting. Taking the medication is impermissible (makrūh taḥrīmī) because the chances of it entering the posterior pharynx is high and thus, unnecessarily risks one’s fast. If one were to take it, one would incur the sin. Additionally, if any portion of saliva or drug is swallowed unintentionally, the fast breaks, and it will need to be repeated (qaḍā’) without a penalty (kaffārah). If it is swallowed intentionally, then a penalty would also be due. 
  2. The drug is necessary. Taking the medication via the orally dissolving or sublingual route is permissible. The saliva should not be swallowed, and any traces of the drug should be washed out of the mouth. If any portion of saliva or drug is swallowed either intentionally or unintentionally, the fast breaks, and it will need to be repeated (qaḍā’) without a penalty (kaffārah).

And Allah knows best

Shaykh Mateen Khan, MD

Mufti Adil Farooki, MD

Dr Ramzan Judge, PharmD

Dr Samad Tirmizi, Pharm D


Sublingual route for systemic drug delivery, 

Orally Disintegrating Tablets: A Review, 

Pharmacokinetic Comparison of Sublingual Lorazepam with Intravenous, Intramuscular, and Oral Lorazepam, 

Efficacy of orally disintegrating ondansetron in preventing postoperative nausea and vomiting after laparoscopic cholecystectomy, 

حاشية الطحطاوي على مراقي الفلاح شرح نور الإيضاح، دار الكتب العلمية بيروت، 679 

قوله: “لما فيه من تعريض الصوم للفساد” لأن الجاذبة قوية فلا يؤمن أن تجذب منه شيئا إلى الباطن عناية 

الفتاوى الهندية، دار الفكر، 1:199 

وَكُرِهَ ذَوْقُ شَيْءٍ، وَمَضْغُهُ بِلَا عُذْرٍ كَذَا فِي الْكَنْزِ. وَمِنْ الْعُذْرِ فِي الْأَوَّلِ مَا لَوْ كَانَ زَوْجُ الْمَرْأَةِ وَسَيِّدُهَا سَيِّئَ الْخُلُقِ فَذَاقَتْ الْمَرَقَةَ، وَمِنْ الْعُذْرِ فِي الثَّانِي أَنْ لَا تَجِدَ مَنْ يَمْضُغُ الطَّعَامَ لِصَبِيِّهَا مِنْ حَائِضٍ أَوْ نُفَسَاءَ أَوْ غَيْرِهِمَا مِمَّنْ لَا يَصُومُ، وَلَمْ تَجِدْ طَبِيخًا، وَلَا لَبَنًا حَلِيبًا كَذَا فِي النَّهْرِ الْفَائِقِ وَذَكَرَ فِي التَّجْنِيسِ أَنَّ كَرَاهَةَ الذَّوْقِ فِي صَوْمِ الْفَرْضِ، وَأَمَّا التَّطَوُّعُ فَلَا بَأْسَ كَذَا فِي النِّهَايَةِ. وَيُكْرَهُ لِلصَّائِمِ أَنْ يَذُوقَ الْعَسَلَ أَوْ الدُّهْنَ لِيَعْرِفَ الْجَيِّدَ مِنْ الرَّدِيءِ عِنْدَ الشِّرَاءِ كَذَا فِي فَتَاوَى قَاضِي خَانْ. وَقِيلَ لَا بَأْسَ بِهِ إذَا لَمْ يَجِدْ بُدًّا مِنْ شِرَائِهِ أَوْ يَخَافُ الْغَبْنَ كَذَا فِي الزَّاهِدِيِّ. 

الفتاوى الهندية، دار الفكر، 1:202 

لَوْ أَكَلَ مُكْرَهًا أَوْ مُخْطِئًا عَلَيْهِ الْقَضَاءُ دُونَ الْكَفَّارَةِ كَذَا فِي فَتَاوَى قَاضِي خَانْ. الْمُخْطِئُ هُوَ الذَّاكِرُ لِلصَّوْمِ غَيْرُ الْقَاصِدِ لِلْفِطْرِ إذَا أَكَلَ أَوْ شَرِبَ هَكَذَا فِي النَّهْرِ الْفَائِقِ. وَالنَّاسِي عَكْسُهُ، هَكَذَا فِي النِّهَايَةِ وَالْبَحْرِ الرَّائِقِ. 

الهداية في شرح بداية المبتدي، دار احياء التراث العربي، 1: 122-123 

ولو أكل أو شرب ما يتغذى به أو ما يداوى به فعليه القضاء والكفارة 

ومن كان مريضا في رمضان فخاف إن صام ازداد مرضه أفطر وقضى 

Jadīd Fiqhī Masā’il, 1:128-129 

Kitāb al-Nawāzil, Muftiī Muḥammad Salmān Mansūrpūrī 6:385 

Islamic Permissibility of Tamiflu


Muslims should avoid consuming Tamiflu capsules and must instead either use the suspension form or open the capsule and consume the contents of the capsule without ingesting the capsule itself. 


Are Tamiflu capsules permissible for Muslims to use?


Bismihi Ta’ala

Tamiflu, and its generic equivalent oseltamivir, is an influenza neuraminidase inhibitor that is used for the treatment and prevention of influenza infections[i].  The medication is available in capsule and suspension forms. The suspension does not contain any Islamically unlawful ingredients and is therefore permissible for Muslims to use[ii].  The capsule form contains porcine gelatin in the capsule, which is considered Islamically unlawful to consume by most Islamic scholars[iii].   According to Islamic jurisprudence, medications with unlawful ingredients are not permissible to use unless certain conditions are met. A Muslim patient can only use impermissible medication when instructed to do so by an experienced doctor (thereby making him certain that a cure can be expected from the medication), and when an alternative permissible medication is not available[iv].

In the case of Tamiflu capsules, permissible alternatives exits.  As stated above, the suspension form is permissible to use as it lacks unlawful ingredients.  Even if the capsule form has to be used due to lack of availability or tolerance for the suspension, the capsule can be opened and the contents within the capsule can be consumed, thereby avoiding the impermissible pork gelatin used in the capsule.  As per the FDA[v]:

“If liquid Tamiflu is not available and you have capsules that give the right dose (30 mg, 45 mg or 75 mg), you may pull open the Tamiflu capsules and mix the powder with a small amount of sweetened liquid such as regular or sugar-free chocolate syrup. You don’t have to use chocolate syrup but thick, sweet liquids work best at covering up the taste of the medicine.”

Therefore, Muslims should avoid consuming Tamiflu capsules and must instead either use the suspension form or open the capsule and consume the contents of the capsule without ingesting the capsule itself. 

And Allah Knows Best

Mufti Adil Farooki, MD

Approved by Mufti Abdul Muqtadir Sikander

[i] BMJ. 2003;326(7401):1235


[iii] for a discussion of porcine gelatin, see the following:

[iv] For a detailed discussion on medications with unlawful ingredients, see the following:


Opioid Medications

Question:  Is the use of opioid drugs such as oxycodone and codeine for medicinal purposes permissible?


Bismihi Ta’ala

Opioid drugs are those that are derived from opium.  These drugs are used for various medicinal purposes, such as relief of pain or cough. Common side effects of opioid medications include constipation, nausea, vomiting, sedation, impaired psychomotor function, and urinary retention. 

In general, the consumption of intoxicating substances is impermissible according to the shariah.  Intoxication is defined in shariah as a state in which a person is insane and this can be as extreme as not being able to differentiate the sky from the ground. At a minimum, a person is considered to be intoxicated if the majority of his speech is non-sensical.[i][ii]

A state of delirium that would fit the criteria of intoxication as defined above is not an expected or common side effect of these medications when used in prescribed amounts.[iii]

If a person is using a small amount of an opioid substance, such as the amount used for medicinal purposes, then this is considered permissible[iv]. However, If he is using a larger amount of it simply for the purpose of intoxication, euphoria or entertainment, then this is not permissible[v].  Therefore, drugs of abuse such as cocaine and heroine are not permissible to use because they are not used for medicinal purposes, but rather to achieve an altered mental state and euphoria.  It would not be unexpected for a person using these drugs of abuse to reach a state of intoxication as defined above.

In conclusion, opioid medications such as oxycodone and codeine are considered permissible to use if prescribed by a doctor for medical treatment. 

And Allah knows best

Mufti Adil Farooki, MD

Checked and approved by Mufti Abdul Muqtadir Sikander

[i]رد المحتار على الدر المختار – دار الفكر – 3:239

قَوْلُهُ أَوْ سَكْرَانَ) السُّكْرُ: سُرُورٌ يُزِيلُ الْعَقْلَ فَلَا يَعْرِفُ بِهِ السَّمَاءَ مِنْ الْأَرْضِ. وَقَالَ: بَلْ يَغْلِبُ عَلَى الْعَقْلِ فَيَهْذِي فِي كَلَامِهِ، وَرَجَّحُوا قَوْلَهُمَا فِي الطَّهَارَةِ وَالْأَيْمَانِ وَالْحُدُودِ

[ii] بدائع الصنائع في ترتيب الشرائع – دار الكتب العلمية – 5:118

قَوْلِهِمَا: شَهَادَةُ الْعُرْفِ وَالْعَادَةِ فَإِنَّ السَّكْرَانَ فِي مُتَعَارَفِ النَّاسِ اسْمٌ لِمَنْ هَذَى وَإِلَيْهِ أَشَارَ سَيِّدُنَا عَلِيٌّ – رَضِيَ اللَّهُ عَنْهُ – بِقَوْلِهِ: إذَا سَكِرَ هَذَى، وَإِذَا هَذَى افْتَرَى


[iv] رد المحتار على الدر المختار – دار الفكر – 3:240

قَوْلُهُ أَوْ أَفْيُونٍ أَوْ بَنْجٍ) الْأَفْيُونُ: مَا يَخْرُجُ مِنْ الْخَشْخَاشِ. الْبَنْجُ: بِالْفَتْحِ نَبْتٌ مُنْبَتٌ. وَصَرَّحَ فِي الْبَدَائِعِ وَغَيْرِهَا بِعَدَمِ وُقُوعِ الطَّلَاقِ بِأَكْلِهِ مُعَلِّلًا بِأَنَّ زَوَالَ عَقْلِهِ لَمْ يَكُنْ بِسَبَبٍ هُوَ مَعْصِيَةٌ. وَالْحَقُّ التَّفْصِيلُ، وَهُوَ إنْ كَانَ لِلتَّدَاوِي لَمْ يَقَعْ لِعَدَمِ الْمَعْصِيَةِ، وَإِنْ لِلَّهْوِ وَإِدْخَالِ الْآفَةِ قَصْدًا فَيَنْبَغِي أَنْ لَا يَتَرَدَّدَ فِي الْوُقُوعِ

فَقَدْ فَرَّقَ بَيْنَ مَا إذَا كَانَ بِطَرِيقٍ مُحَرَّمٍ وَغَيْرِ مُحَرَّمٍ كَمَا تَرَى فَتَأَمَّلْ (قَوْلُهُ أَوْ بِمُبَاحٍ) كَمَا إذَا سَكِرَ مِنْ وَرَقِ الرُّمَّانِ فَإِنَّهُ لَا يَقَعُ طَلَاقُهُ وَلَا عَتَاقُهُ وَنَقَلَ الْإِجْمَاعَ عَلَى ذَلِكَ صَاحِبُ التَّهْذِيبِ كَذَا فِي الْهِنْدِيَّةِ ط. قُلْت: وَكَذَا لَوْ سَكِرَ بِبَنْجٍ أَوْ أَفْيُونٍ تَنَاوَلَهُ لَا عَلَى وَجْهِ الْمَعْصِيَةِ بَلْ التَّدَاوِي كَمَا مَرَّ

[v] رد المحتار على الدر المختار – دار الفكر – 4:42

وَفِي كَافِي الْحَاكِمِ مِنْ الْأَشْرِبَةِ: أَلَا تَرَى أَنَّ الْبَنْجَ لَا بَأْسَ بِتَدَاوِيهِ، وَإِذَا أَرَادَ أَنْ يَذْهَبَ عَقْلُهُ لَا يَنْبَغِي أَنْ يَفْعَلَ ذَلِكَ. اهـ.

وَبِهِ عُلِمَ أَنَّ الْمُرَادَ الْأَشْرِبَةُ الْمَائِعَةُ، وَأَنَّ الْبَنْجَ وَنَحْوَهُ مِنْ الْجَامِدَاتِ إنَّمَا يَحْرُمُ إذَا أَرَادَ بِهِ السُّكْرَ وَهُوَ الْكَثِيرُ مِنْهُ، دُونَ الْقَلِيلِ الْمُرَادُ بِهِ التَّدَاوِي وَنَحْوُهُ كَالتَّطَيُّبِ بِالْعَنْبَرِ وَجَوْزَةِ الطِّيبِ، وَنَظِيرُ ذَلِكَ مَا كَانَ سُمَيًّا قِتَالًا كَالْمَحْمُودَةِ وَهِيَ السَّقَمُونْيَا وَنَحْوُهَا مِنْ الْأَدْوِيَةِ السُّمِّيَّةِ فَإِنَّ اسْتِعْمَالَ الْقَلِيلِ مِنْهَا جَائِزٌ، بِخِلَافِ الْقَدْرِ الْمُضِرِّ فَإِنَّهُ يَحْرُمُ، فَافْهَمْ وَاغْتَنِمْ هَذَا التَّحْرِيرَ