During vomiting, diarrhoea or fever with poor fluid intake, several common drugs can worsen or complicate acute kidney injury. Standard advice is to pause ACE inhibitors and ARBs, diuretics, metformin, SGLT2 inhibitors and NSAIDs until the patient is eating and drinking normally, and to restart them afterwards.
The restart is as important as the pause. Many patients stop a protective drug during an illness and never resume it.
- Give written sick-day advice to patients on ACE inhibitors, ARBs, diuretics, metformin or SGLT2 inhibitors.
- Advise avoiding NSAIDs during dehydrating illness.
- Specify when to restart — usually after 24–48 hours of normal eating and drinking.
- Check creatinine and potassium if the illness is prolonged or severe.
Why it matters
Most drug-associated AKI in the community happens during intercurrent illness.
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