Sick Day Management: What to Do With Your Medications When You're Unwell

When you're feeling sick — especially with vomiting, diarrhoea, fever, or not eating and drinking well — your body reacts in ways that can change how medications work. Some medicines may even cause harm during illness if not adjusted properly. That’s where sick day management comes in.

Sick day management (SDM) is a temporary plan to stop or adjust certain medications when you're acutely unwell, to help protect your kidneys and prevent serious side effects like low blood sugar, dehydration, or kidney injury.

Let’s break it down.

Why Sick Day Management Matters

When you're sick, especially with vomiting, diarrhoea, fever, or dehydration, your body may not handle certain medications the same way. This is especially important if you have:

• Diabetes

• Kidney problems (CKD)

• Heart disease

• Take multiple medications

• Are over 65

Without adjusting medications, you could be at risk of complications like:

• Acute kidney injury (AKI)

• Severe low blood sugar (hypoglycemia)

• Electrolyte imbalances

• Lactic acidosis

Despite being recommended in clinical guidelines, many patients and even healthcare providers don’t always know about or follow sick day rules — but they can be lifesaving.

What Happens in Your Body When You're Sick?

Acute illnesses can lead to:

• Dehydration from fever, vomiting or diarrhoea

• Poor food intake, increasing risk of low blood sugar

• Low blood pressure, reducing kidney blood flow

• Inflammation, changing how your body processes medications

These changes can turn normally safe medications into risky ones, especially if your kidneys aren’t working well.

Which Medications Are Affected? Use the SADMANS Rule

The SADMANS mnemonic helps remember which medications may need to be stopped temporarily when you're unwell:

Letter	Medication Class	Examples
S	Sulfonylureas	Gliclazide, glipizide
A	ACE inhibitors	Enalapril, ramipril
D	Diuretics	Furosemide, hydrochlorothiazide
M	Metformin	Metformin
A	ARBs (Angiotensin II blockers)	Losartan, irbesartan
N	NSAIDs (Anti-inflammatories)	Ibuprofen, naproxen
S	SGLT2 inhibitors	Empagliflozin, dapagliflozin

Let’s explore why:

1. Sulfonylureas

These medications lower your blood sugar. If you're not eating well, they can cause dangerous hypoglycemia. Stop them during illness if you're not eating properly.

2. ACE inhibitors and ARBs

These blood pressure medications can reduce kidney function during dehydration or low blood pressure. Temporarily stop them when you're very unwell.

3. Diuretics

Also known as “water pills,” these increase fluid loss. If you’re already losing fluids through vomiting or diarrhea, they can make things worse. Pause them during sick days.

4. Metformin

Usually safe, but during illness, it can build up in the body and rarely cause lactic acidosis, a serious condition. Hold this until you’re well again.

5. NSAIDs

Painkillers like ibuprofen can affect kidney function during illness, especially if you’re dehydrated. Avoid during sick days.

6. SGLT2 Inhibitors

Used for diabetes, these drugs can increase the risk of dehydration, ketosis, or even euglycemic diabetic ketoacidosis (a serious condition). Withhold during illness.

What Should You Do When You're Sick?

Here’s a simple sick day action plan:

✅ Stay hydrated – Sip water or clear fluids frequently.

✅ Monitor your symptoms – Watch for signs of worsening illness.

✅ Check your blood sugar (if diabetic) – More frequently than usual.

✅ Know your meds – Use the SADMANS list to identify medicines to pause.

✅ Seek advice early – Contact your pharmacist, GP, or nurse for support.

✅ Restart medications – Once you’re eating, drinking, and feeling better (usually 24–48 hours after recovery).

Who’s Most at Risk?

You may need a sick day plan if you:

• Are 65 years or older

• Have chronic kidney disease

• Take 5 or more medications

• Have diabetes

• Have had a previous kidney injury or hospitalization

Special Considerations

👵 Older Adults

Aging kidneys, multiple medications, and less awareness of thirst can all increase risks. Sick day plans should include help from carers or family when needed.

💉 People with Diabetes

• Monitor blood glucose every 2–4 hours if you’re unwell.

• Type 1 diabetes? Watch for diabetic ketoacidosis (DKA).

• Symptoms like nausea, fruity-smelling breath, or drowsiness require urgent medical review.

• Type 2 diabetes? Be alert for extreme thirst, urination, or confusion.

• Adjust insulin or oral medications only with medical guidance.

🧬 Chronic Kidney Disease (CKD)

Even mild illness can push vulnerable kidneys into acute kidney injury. If you have CKD, temporary medication adjustments during sick days are critical to prevent long-term damage.

When to have a Home Medication Review

Consider a home medication review if:

• You’re not sure which medications to stop

• You can’t keep fluids down for more than 24 hours

• Your blood glucose is consistently high or low

• You’re confused, drowsy, or experiencing shortness of breath

• You see reduced urine output

  
  

Being prepared with a sick day management plan can help you avoid serious health issues. Speak with your pharmacist or GP today to find out if you need one — especially if you take any of the SADMANS medications.

Knowing when to stop (and restart) your medications during illness can make all the difference.