Understanding What Is the Sick Day Medication Policy for Chronic Conditions

October 13, 2025 •

3 min read

Acute illnesses like the flu or gastroenteritis can significantly increase the risk of adverse drug events for people with chronic conditions, making what is the sick day medication policy a crucial piece of patient education. This involves temporarily withholding or adjusting specific medications to prevent complications, particularly those related to dehydration.

Quick Summary

Sick day medication policies provide essential guidance for adjusting medications during acute illness to prevent complications. Some drugs, particularly for diabetes, kidney, and heart disease, should be temporarily stopped to avoid risks like dehydration and organ injury. Other medications may need dosage adjustments under medical supervision.

Key Points

Identify Sick Day Triggers: Initiating sick day medication guidance is triggered by symptoms like vomiting, diarrhea, or reduced fluid intake, which cause volume depletion.
Know the SADMANS List: Temporarily withhold SGLT2 inhibitors, ACE inhibitors, Diuretics, Metformin, ARBs, NSAIDs, and Sulfonylureas to prevent organ damage.
Adjust Insulin Carefully: Insulin doses may need to be adjusted up or down based on blood sugar levels, requiring frequent monitoring and potentially ketone checks.
Prioritize Hydration: Drinking plenty of non-caffeinated fluids is crucial to prevent dehydration during illness.
Consult a Healthcare Provider: Always contact your doctor or pharmacist before making changes to your medication plan and know when to seek emergency care.
Have a Sick Day Plan: Keeping an updated medication list, important contact numbers, and supplies like ketone strips can help you manage illness effectively.
Resume Meds Post-Recovery: Once symptoms resolve and eating/drinking returns to normal, typically within 24-48 hours, resume your regular medication doses.

During an acute illness, such as a cold, the flu, or gastroenteritis, your body undergoes significant physiological changes. Fever, vomiting, and diarrhea can lead to dehydration and affect your blood pressure and kidney function. For individuals taking medications for chronic conditions like diabetes, cardiovascular disease, or kidney disease, these changes can alter how the body processes drugs, turning a typically safe medicine into a potential hazard. Understanding sick day medication guidance (SDMG) is essential for patient safety and preventing serious health complications. A panel of international clinical experts reached a consensus on 42 specific recommendations for SDMG, emphasizing the temporary withholding of certain medications.

The SADMANS Mnemonic: Medications to Withhold

A widely used mnemonic, SADMANS, helps remember which medications to temporarily stop during illness causing volume depletion like vomiting or diarrhea. This is primarily to prevent acute kidney injury (AKI) exacerbated by dehydration. The list includes SGLT2 inhibitors, ACE inhibitors, Diuretics, Metformin, ARBs, NSAIDs, and Sulfonylureas, each with specific risks when unwell.

Special Considerations for Specific Conditions

Diabetes Management During Illness

Managing diabetes during illness requires close monitoring. Insulin should not be stopped unless advised, and dosage may need adjustment based on blood sugar. Frequent blood sugar and ketone checks (if blood sugar is high) are recommended. Maintaining hydration is important, using a mix of sugar-free and sugary fluids if solids aren't tolerated.

Heart Failure and Kidney Disease

Patients with heart failure and kidney disease face increased risks during acute illness. Temporarily stopping diuretics, ACE inhibitors, and ARBs is crucial to prevent hypotension or further kidney damage. These patients require medical supervision.

How to Safely Implement Sick Day Rules

Following a sick day action plan can reduce adverse events:

Stay Hydrated: Drink plenty of non-caffeinated fluids.
Monitor Symptoms and Vitals: Track symptoms, blood sugar, blood pressure, and weight.
Know When to Call for Help: Contact a healthcare provider for fever over 24 hours, inability to keep fluids down, confusion, or consistently high blood sugar. Seek emergency care for severe symptoms.
Do Not Make Unilateral Changes: Always consult your doctor or pharmacist before changing medications.
Maintain an Updated Medication List: Keep a current list of all medications and consider a medical alert ID.

Resuming Your Medications After Illness

Resume medications at usual doses within 24 to 48 hours after symptoms resolve and normal eating/drinking resumes. Follow up with your healthcare provider.

Sick Day Medication Rules Comparison Table


Medication Type	Sick Day Action	Reason
Diabetes: Metformin, SGLT2i	Stop temporarily if vomiting, diarrhea, or not eating/drinking well.	Dehydration increases risk of lactic acidosis or ketoacidosis.
Diabetes: Insulin	Adjust based on blood glucose readings. May need more or less.	Illness can cause blood sugar to rise or fall unpredictably.
Blood Pressure: ACEi, ARBs	Stop temporarily during illness causing dehydration.	Risk of acute kidney injury and hypotension increases.
Heart Failure: Diuretics	Stop temporarily during illness causing dehydration.	Can worsen dehydration and affect kidney function.
Pain Relief: NSAIDs	Stop temporarily, especially if dehydrated.	Can impair kidney function and cause damage.
Other Chronic Meds	Continue unless advised otherwise by your doctor.	Many chronic medications are unaffected by minor illness.

Conclusion

Understanding your sick day medication policy is crucial for managing chronic conditions during illness. Temporarily stopping certain medications, like those in the SADMANS group, helps prevent complications like dehydration and kidney issues. These adjustments are short-term. Always seek personalized advice from your healthcare provider and know when to get emergency care. A written plan can be helpful during sick days. More information can be found in this resource from the {Link: Canadian Journal of Diabetes https://www.canadianjournalofdiabetes.com/article/S1499-2671(24)00045-5/fulltext}.

Frequently Asked Questions

A 'sick day' refers to any acute illness, such as the flu, a viral infection, or gastroenteritis, especially when accompanied by vomiting, diarrhea, fever, or an inability to eat and drink normally.

Using the SADMANS mnemonic, you should temporarily stop SGLT2 inhibitors, ACE inhibitors, Diuretics, Metformin, ARBs, NSAIDs, and Sulfonylureas, especially if you are dehydrated or not eating well.

Stopping certain medications prevents complications that can be exacerbated by illness. For example, some drugs can worsen dehydration or increase the risk of acute kidney injury when you're unwell.

Do not stop insulin without medical advice. You may need to increase your dose if blood sugar is high or decrease it if low. Monitor your blood glucose and ketones frequently and call your doctor if levels are consistently high.

You should typically resume your medications within 24 to 48 hours after your symptoms have resolved and you can maintain normal food and fluid intake.

Contact your provider if you cannot keep fluids down, have a fever for more than 24 hours, experience symptoms of severe dehydration, or have persistently high blood sugar levels.

No, NSAIDs like ibuprofen are included in the SADMANS list and should be temporarily stopped during a sick day, especially if dehydrated, as they can harm your kidneys. Consider acetaminophen (Tylenol) for fever and pain relief instead, if safe for you.