Choosing wisely in practice: How sick day rules help prevent medication-related complications

Sick Day Rules represent a practical multidisciplinary procedure for temporarily adjusting or suspending certain medications during an acute illness to prevent drug-related complications, especially acute kidney injury. This article aims to introduce the international concept of Sick Day Rules and proposes its application in Czech clinical practice.

Literature search and analysis in the PubMed and Google Scholar databases using keywords focused on Sick Day Rules, prevention of medication-related complications, and medicine re-initiation during acute illness. Resources used included consensus documents, clinical reviews, and national methodological frameworks within the Choosing Wisely initiative.

Situations suitable for applying Sick Day Rules were identified: recurrent vomiting or diarrhea with fluid loss, significantly reduced fluid intake, and orthostatic problems. Concurrently, specific conditions requiring immediate contact with a healthcare professional were determined. Under these conditions, the following self-monitoring steps are also recommended: more frequent monitoring of blood glucose and urine ketones, adequate hydration, and appropriate nutrition. Temporary suspension is particularly advisable for selected drug classes: SGLT2 inhibitors (gliflozins), metformin, drugs acting on the renin-angiotensin system (including combinations with sacubitril), diuretics, non-steroidal anti-inflammatory drugs (NSAIDs), and aliskiren. Insulin and insulin secretagogues are not universally discontinued; the approach is guided by current blood glucose levels (temporarily reduce and supplement with carbohydrates at low values, or appropriately increase the insulin dose at high values). Rules for the safe resumption of treatment after symptoms subside (usually within 24-48 hours) were also established, and the importance of interdisciplinary cooperation, clear communication, and educational materials for patients was emphasized. For Czech implementation, it is advisable to adopt internationally shared and proven elements and integrate them into practice.

Sick Day Rules provide a unified and applicable framework that can reduce drug-related complications and increase treatment safety in clearly defined situations. Systematic implementation in the Czech environment is feasible and beneficial if accompanied by education and clear instructions for resuming medications. Published literature shows that patients prefer physician-led recommendations.