Medication management on sick days

Patients may be susceptible to adverse drug events during acute illness due to comorbidities or medicine use. Acute illness should prompt careful monitoring or dose adjustment in patients prescribed certain medicines. Patient factors, severity and expected duration of illness, and class of drug should be considered to minimise the risk of adverse drug events. Some drugs may need to be temporarily suspended, such as metformin, diuretics and sodium-glucose co-transporter 2 inhibitors when there is a risk of hypovolaemia. Those with chronic kidney disease are at risk of acute kidney injury due to limits in their physiological reserve. This may be compounded by medicine use. Temporary increases in dose may be required for insulin and corticosteroids. Withdrawal syndromes may occur with controlled-release drugs, such as dopamine agonists, antidepressants and analgesics, due to malabsorption. An action plan may be needed for medicine use on sick days. Patient education around supplemental dosing of oral contraceptives to maintain efficacy after acute illness is important.