Patients prescribed common medicines such as ibuprofen for pain relief, ramipril for high blood pressure, and metformin for managing elevated blood sugar levels are being advised to temporarily suspend their medication if they experience specific symptoms. A pharmacist has detailed the necessary precautions for those taking these drugs when signs of illness arise.
Ramipril, an ACE inhibitor prescribed primarily for high blood pressure, heart failure, and protective care after a heart attack, and metformin, used to lower high blood sugar in type 2 diabetes, are among the medications highlighted. In an exclusive interview this week, Anil Sharma, Committee Member and Regional Representative for the East of England at Community Pharmacy England, emphasised the importance of recognising certain symptoms that warrant a short pause in medication.
He explained the NHS’s recommended ‘48-hour rule’, stating: “You should temporarily pause taking these medicines if you develop a stomach bug with severe vomiting, diarrhoea, or a high fever.”
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As autumn progresses into winter, the incidence of stomach bugs such as norovirus rises, increasing the risk of dehydration due to symptoms like vomiting, diarrhoea, and fevers. These conditions, combined with sweating, shivering, and reduced fluid intake, lead to fluid loss. Some routine medications may place extra stress on the kidneys, which can be especially harmful during dehydration. Pausing these drugs until you recover fully helps prevent serious kidney damage.
While the NHS advises patients to pause certain routine medications during illnesses that cause dehydration, it is crucial to consult a healthcare professional-such as your GP, pharmacist, or NHS 111-before stopping any prescription medication. Abruptly halting some medicines may worsen underlying health conditions.
The NHS states: “Taking certain medication when you are dehydrated or very unwell can lead to more serious illness, as they increase the risk of serious side effects affecting your kidneys.”
Medications that should be temporarily withheld if you develop a dehydrating illness include:
- ACE inhibitors and ARBs (medications for high blood pressure and heart conditions), such as Lisinopril, Ramipril, Candesartan, Losartan
- Entresto (Sacubitril/Valsartan), a combination medication for heart conditions
- Diuretics (water tablets) like Furosemide, Spironolactone, Eplerenone, Bendroflumethiazide
- SGLT2 inhibitors ending in “flozin” such as Dapagliflozin, Empagliflozin, Canagliflozin, used for diabetes, kidney, or heart conditions
- Metformin, for diabetes
- Sulfonylureas like Gliclazide, Glimepiride, Glipizide, for diabetes
- GLP-1 agonists such as Tirzepatide (Mounjaro), Semaglutide (Wegovy), Liraglutide (Victoza), used in diabetes and weight loss
- NSAIDs (anti-inflammatory painkillers) including Ibuprofen, Naproxen, Diclofenac
Patients are advised to “stop these medications temporarily if you develop a dehydrating illness” and to “drink plenty of clear fluids (water or rehydration drinks) in small, frequent sips” while unwell. Once recovered-usually after 24 to 48 hours of normal eating and drinking-the medications can typically be safely restarted. It is important to continue with the usual dosing schedule and not make up for missed doses.
If symptoms persist for more than 48 hours, or if medications have been stopped for more than five days, patients should seek advice from their GP or pharmacist. Always confirm your specific medications with a healthcare professional.
If uncertain or concerned, contact your GP surgery or NHS 111 for further guidance. Medical professionals can offer advice tailored to your symptoms and medication needs.
Seek urgent medical attention or call NHS 111 if you experience:
[Further symptoms or advice to be inserted by medical authority]