They are used to prevent AKI (Acute Kidney Injury) in CKD Patients (especially older ones).
For patients living with Chronic Kidney Disease (CKD), a common illness like a stomach bug or a chest infection can quickly escalate into a medical emergency.
This is because certain life-saving medications, which work perfectly when you are well, can become “toxic” to the kidneys when you are dehydrated.
Following “Sick Day Rules” is a proactive way to prevent Acute Kidney Injury (AKI)—a sudden decline in kidney function that, in severe cases, can lead to the need for temporary or permanent dialysis.
When you are unwell—particularly if you have a fever, vomiting, or diarrhoea—your body loses fluids. Dehydration reduces the blood flow to your kidneys.
Many common medications for blood pressure and diabetes work by altering how the kidneys filter blood or manage fluid. While this is beneficial normally, during an illness, these drugs can “overwork” or “stress” the kidneys, causing them to shut down.
By temporarily pausing these medications, you give your kidneys a “rest” until your fluid levels return to normal.
You should consider the Sick Day Rules if you are unwell for longer than 48 hours (or sooner if symptoms are severe) with:
Vomiting or Diarrhoea: Unless it is very mild.
High Fever: Accompanied by sweats, shakes, or shivering.
Reduced Fluid Intake: If you are too unwell to drink enough to stay hydrated.
Crucial Step: If you stop your medications, you must contact your GP or pharmacist on the same day to inform them and ensure they agree with your actions.
To make these rules easier to remember, clinicians use the SSADMAN mnemonic. If you take any of the following, they should likely be paused during acute illness:
1. S – SGLT2 Inhibitors
Examples: Dapagliflozin, Empagliflozin, Canagliflozin.
Use: Often prescribed for Type 2 diabetes, heart failure, or CKD. These can increase the risk of a serious complication called ketoacidosis when you are dehydrated.
2. S – Sulphonylureas
Examples: Gliclazide, Glimepiride, Tolbutamide.
Use: Diabetes. When you aren’t eating properly due to illness, these can cause dangerously low blood sugar (hypoglycaemia).
3. A – ACE Inhibitors (ACEi)
Examples: Ramipril, Lisinopril, Enalapril.
Use: Blood pressure and kidney protection. These drugs change the pressure inside the kidney’s filters; during dehydration, this can lead to a sudden drop in kidney function.
4. D – Diuretics
Examples: Furosemide, Bumetanide, Bendroflumethiazide, Spironolactone.
Use: Known as “water tablets” for heart failure or swelling. These intentionally remove fluid from the body, which can dangerously accelerate dehydration during an illness.
5. M – Metformin
Examples: Metformin (Glucophage).
Use: Diabetes. If your kidneys aren’t working well during an illness, Metformin can build up in the blood and cause a rare but serious condition called lactic acidosis.
6. A – ARBs (Angiotensin Receptor Blockers)
Examples: Losartan, Candesartan, Irbesartan.
Use: Blood pressure. Like ACE inhibitors, these affect the internal pressure of the kidney and should be paused if you are dehydrated.
7. N – NSAIDs (Non-Steroidal Anti-Inflammatory Drugs)
Examples: Ibuprofen (Nurofen), Naproxen, Diclofenac, high-dose Aspirin.
Use: Painkillers. These drugs constrict the blood vessels leading to the kidney and are a leading cause of drug-induced AKI during illness.
Do not stay off your medications indefinitely. The goal is a temporary pause to protect your organs.
When to restart: Usually 24 to 48 hours after you are back to your “normal self”—eating and drinking well, and no longer suffering from fever, vomiting, or diarrhoea.
Consultation: Always check with your doctor or pharmacist before restarting, especially for blood pressure medications, to ensure your readings are stable.
| Medication Type | Common Name | Why Stop? |
| SGLT2i | Dapagliflozin | Risk of ketoacidosis. |
| Sulphonylureas | Gliclazide | Risk of low blood sugar (hypo). |
| ACEi / ARBs | Ramipril / Losartan | Drops kidney filtration pressure. |
| Diuretics | Furosemide | Worsens dehydration. |
| Metformin | Metformin | Risk of lactic acid build-up. |
| NSAIDs | Ibuprofen | Restricts blood flow to kidneys. |
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