Sick Day Rules in the context of chronic medication

Drug-related complications during acute intercurrent illnesses represent a significant clinical problem particularly in multimorbid patients. The Sick Day Rules concept provides a simple and effective framework for healthcare professionals to safely implement temporary witholding of medications that affect renal haemodynamics and glycaemic control. However, several commonly used high-risk drug classes, specifically statins, anticoagulants, and methotrexate, cannot be included in these simplified recommendations, as their management requires individualised clinical assessment. This article summarizes the pharmacological and clinical rationale for excluding these agents from this concept and proposes an argument-based framework to support clinical decision-making in routine practice, with the aim of minimising risks associatied with both inappropriate continuation and unjustified interruption of therapy.