The SADMANS Guide: How to Safely Manage Your Medication on Sick Days

When you’re hit with a sudden bout of food poisoning, a severe stomach flu, or a dehydrating bug, your immediate focus is usually on blankets, buckets, and resting.

But if you take regular prescription medications for long-term conditions like high blood pressure or diabetes, there is a crucial question you need to ask: Should I stop taking my pills until I'm better?

In our latest episode, Dr. Geoff Hamp and Dr. Sam McGinley break down the essential medical framework known as the "Sick Day Rules." Specifically, they walk through the clinical acronym SADMANS—a vital checklist of medications that you should temporarily pause when you are dehydrated to protect your kidneys from harm.

Why Do We Need "Sick Day Rules"?

Your kidneys are highly sensitive to dehydration. When you are losing fluids through vomiting, diarrhoea, or high fevers, the volume of blood flowing through your body drops.

Certain very common medications can either worsen dehydration or put extra stress on your kidneys when fluid levels are low. Pausing them for a day or two until you are eating and drinking normally again is a simple way to protect your body.

Decoding the Acronym: What is SADMANS?

If you take any of the following medications, Geoff and Sam recommend committing this checklist to memory (or bookmarking this page!).

Letter	Medication Type	Common Examples	Why Pause It?
S	SGLT2 Inhibitors	Canagliflozin, Dapagliflozin, Empagliflozin	Used for diabetes and heart health; can increase dehydration risk.
A	ACE Inhibitors	Ramipril, Lisinopril, Enalapril	Blood pressure medications that change how kidneys filter blood; risky during severe dehydration.
D	Diuretics	Furosemide, Bumetanide, Indapamide	Often called "water tablets"; they deliberately rid the body of fluid, which is dangerous if you're already losing it.
M	Metformin	Metformin	A staple diabetes medication; if you are severely dehydrated, it can build up in your body and cause a rare but serious side effect.
A	ARBs	Losartan, Candesartan, Valsartan	Similar to ACE inhibitors; they lower blood pressure but can reduce kidney function during a stomach bug.
N	NSAIDs	Ibuprofen, Naproxen, Diclofenac	Common anti-inflammatory painkillers that directly restrict blood flow to the kidneys.
S	Sulfonylureas	Gliclazide, Glimepiride	Diabetes tablets that encourage the pancreas to release insulin. If you can't keep food down, these can cause dangerous "hypos" (low blood sugar).

When Should You Apply the Rules?

You don't need to stop your medication for a minor sniffle or a mild headache.

The SADMANS rules apply when you are experiencing severe symptoms of dehydration, such as:

• Vomiting or diarrhoea that prevents you from keeping fluids down.

• A very high fever with shaking chills.

• Severe sweating and an inability to drink enough water to keep up.

  
  

The Golden Rule: Restarting and Reaching Out

The Doctors emphasise that these medications shouldn't be stopped indefinitely. As soon as your illness passes, you're able to eat and drink normally, and you've been symptom-free for 48 to 72 hours, you should restart your usual routine.

GPs Top Tip: If you are ever unsure whether to stop or restart a medication, do not guess. Pop a quick phone call through to your local community pharmacist—they are medication experts and can give you instant advice over the phone without you needing to book a GP appointment.

Listen to the Full Episode

Want to know how to manage your diabetes monitoring during a sick day, or what alternatives you can safely take for pain relief? Listen to the full clinical breakdown here:

[Listen to "Sick Day Rules: When your medicines call in sick" on Spotify, Apple Podcasts, Amazon Music, or right here on Coughy Break.]

Resources for Reference

• NHS Specialist Pharmacy Service: Patient Guide to Sick Day Rules

• Diabetes UK: Managing Illness and Sick Days

  
  

Contact the Show

Has your GP surgery ever given you a "Sick Day" leaflet? Let us know if this acronym helped clear things up!

• Email: hello@coughybreak.com

Legal Disclaimer: All content provided is for general informational purposes only and does not constitute medical advice. This guide outlines standard NHS framework principles valid in England (June 2026). Never stop prescribed medication long-term without consulting a medical professional.