If you get ill, will you follow these “Medicine Sick Day Rules”?

by Carolyn Thomas    @HeartSisters


Earlier this year, I spent a few days collapsed in bed, fighting off the death grip of some kind of horrible flu-like symptoms that included a high fever, chills, drenching sweats and uncontrollable shivers. I was miserable. But I didn’t call my family doctor because:

  • (a)  I felt too sick to leave home, never mind sit in a crowded waiting room infecting other patients, and
  • (b)  I already knew that this virus was making the rounds and, like all viral infections, there was very little my doc could order to make it better while this bug ran its course. (Antibiotics, for example, fight bacteria, not viruses – so please stop asking your doctor for an antibiotic prescription to treat a cold or other viral conditions). See also: Do Bugs Need Drugs?

Like a good little heart patient, I continued taking my regular fistful of daily prescribed cardiac medications day after day while I was deathly ill. I did this because nobody had ever told me that, while suffering the dehydrating symptoms mentioned here, many patients should consider taking a temporary holiday from certain drugs that can make dehydration worse. Dehydration means the body lacks enough fluid to function properly, and if it worsens over time, can lead to potentially serious side effects, including kidney injury. 

As always, it’s a wise idea to talk to your own physician first before stopping any prescribed meds to make sure your specific health needs are being met. Ask your doctor while you’re feeling well about Medicine Sick Day Rules and what you should do if/when you come down with any of these dehydrating symptoms.

According to experts at NHS Scotland who recently launched this campaign:

“Health professionals have been aware of the Medicine Sick Day Rules for some time, but patient awareness is low. Given how common dehydrating illnesses are, and how frequently many of the targeted medicines are prescribed, this is a significant risk.

“Most patients do not seek medical advice when they are ill, so it is vital that patients know about the Medicine Sick Day Rules in advance.”

The Scottish campaign included handy credit card-sized cards advising patients to stop taking the following medicines if they develop a dehydrating illness:

  • ACE inhibitors
  • anti-inflammatory painkillers called NSAIDs
  • diuretics (also known as water pills)
  • metformin, which is prescribed for diabetes

Medicine Sick Day Rules should be reviewed with patients by physicians whenever renewing prescriptions for the drugs listed above. Research supports these recommendations.(1, 2)

When Scotland successfully introduced this awareness campaign as a pilot project in 2013-14, pharmacists played a crucial role in reminding patients of the Medicine Sick Day Rules. Program evaluations found that patients also followed the important advice to re-start their medicines within 48 hours of recovering from the dehydrating illness.

The response from both docs and patients during this launch was positive. For example:

  • “A great resource to explain the rules. We have had two or three patients who have had acute medical admissions with acute kidney injury with diarrhea and vomiting who were taking ACE inhibitors.” (family physician)
  • “It is absolutely drummed into heart failure patients that we should never stop taking our medicines. So I would not have had the confidence to temporarily stop taking any of my medicines without having the Medicine Sick Day Rules to refer to. I’m convinced that following the advice on the list meant that I avoided a hospital admission when I was ill.” (heart patient)

San Francisco geriatrician Dr. Leslie Kernisan (who blogs at Better Health While Aging) suggests that cardiac patients, and any older person with a diagnosis of hypertension or other chronic illnesses should have a home blood pressure monitor and be sure to use it on days when they are feeling sick, adding:

“The doctor will be much better positioned to help if you can report your blood pressure and heart rate when you call.”

Particularly when you have diarrhea or vomiting, your body loses both extra water, plus the important electrolytes called sodium, potassium and chloride. Many people with diarrhea treat their dehydration with sports drinks. But sports drinks are formulated to replace electrolytes lost in sweat during strenuous exercise. The quantities of sodium and potassium are not high enough to replace those lost when you’re dehydrated. They may work, however, for those with mild diarrhea.

Meanwhile, if you do come down with one of those nasty bugs like I did, how can you tell if you’re getting dehydrated? Here are the most common signs (although by the time these symptoms show up, dehydration may be well advanced):

  • thirst
  • less frequent urination
  • dry skin
  • fatigue
  • light-headedness
  • dark colored urine

You can help reduce your risk of dehydration by drinking extra water (or oral rehydration solutions) at the first signs of illness – unless you have heart failure, in which case you may may need to limit fluid intake; ask your doctor how much fluid you’ll need to prevent dehydration when you’re sick if this is your diagnosis.

Mayo Clinic experts advise you not to wait until dehydration occurs. And although you might want to reach for traditional clear fluids such as ginger ale or other sodas, they contain too much sugar and too little sodium to replenish lost electrolytes. If you can, eat small amounts of foods that are high in water content like these fruits (watermelon, canteloupe, strawberries, oranges) or these vegetables (cucumbers, tomatoes, peppers, celery).  If you have trouble keeping anything down, try sipping very small amounts of water as frequently as possible; you can also suck on ice or frozen fruit pops. If you have a high fever as I did, remove excess clothing/blankets and use air-conditioning or an electric fan to keep your body cool and to reduce sweating.

If dehydration symptoms worsen or persist for more than two days, call your physician or seek emergency care.

More details on Medicine Sick Day Rules are available from the Scottish Patient Safety Programme.

  • 1. The Pharmaceutical Journal
  • 2. Sick Day Rules in Kidney Disease, Drug and Therapeutics Bulletin, British Medical Journal, 2015; 53:37 doi:10.1136/dtb.2015.4.0317

Q:  Have you ever discussed Medicine Sick Day Rules with your physician?

See also:

4 thoughts on “If you get ill, will you follow these “Medicine Sick Day Rules”?

  1. This was very helpful. I couldn’t find one article except this one, explaining if I should stop taking my normal meds. Blood pressure cholesterol and metformin…etc.


  2. Interesting idea, thanks for bringing up this idea. I’ve never heard of “Medicine Sick Day Rules” here in the US (other than, don’t force yourself to go to work/school). But it’s true that it can be good for people to stop certain medications while they are going through some short illnesses.

    For cardiac patients, and for any older person with a diagnosis of hypertension or other chronic illnesses, I would encourage people to have a home BP monitor and be sure to use it on days when you are feeling sick. Dehydration usually causes a higher heart rate (although fever can raise heart rate too) and lower blood pressure.

    I would also encourage people with chronic illnesses to go to their usual doctor’s office and ask to speak to the advice nurse. The clinician will be MUCH better positioned to help if you can report your blood pressure and pulse (heart rate) when you call.

    Liked by 1 person

    1. Thank you for weighing in here, Dr. K. Great advice, which I will add to the text of this post. I am often surprised by how different medical practice is from country to country e.g.
      – radial access cardiac caths are the default approach worldwide except in the U.S.
      – New Zealand physiotherapists treat costochondritis as a back issue, while North American docs continue to treat it with antibiotics/pain meds as a chest issue
      – you have Advice Nurses, and I’ve never even heard of an Advice Nurse in GP offices.

      I was surprised that in NHS Scotland, Medicine Sick Days are so entrenched in medical practice that docs actually give out wallet cards with this advice! This is why I think it’s such a good idea to discuss this recommendation with our family physicians while we are feeling well. Thanks again…


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