The health professionals' right to refuse: is it good, bad or ugly?

What are the risks and benefits of temporarily discontinuing medications to prevent acute kidney injury? A systematic review and meta-analysis

“…Predominantly via community pharmacists, patients are issued with Sick-Day Rules cards, advising them to stop taking ACEIs/ARBs, NSAIDS, diuretics and metformin when they become unwell with vomiting or diarrhoea, and/or fevers sweats and shaking. 24 Under similar circumstances, guidance from the Canadian Diabetes Association Clinical Practice Guidelines for Chronic Kidney Disease in Diabetes recommends physicians and patients to withhold ACEIs, ARBs, NSAIDs, diuretics, metformin, direct renin inhibitors and sulfonylureas. 25 This guidance is based on the commonly held belief that there is an association between the use of ACEI/ARBs, diuretics and NSAIDs and the development of AKI, particularly during illness or other physiological insult.…”

“…Subsequent evidence regarding the safety of community medication cessation interventions has come from an ongoing evaluation of hospital admissions following introduction of the NHS Scotland scheme, which has shown a stabilisation or fall in hospital admissions with AKI. 24 However, a concurrent fall in heart failure admissions (which might have been expected to increase as a consequence of discontinuation of ACEIs or ARBs among patients previously stabilised on these drugs for treatment of heart failure) suggest a secular trend in hospital admissions unrelated to the introduction of the intervention, and interpretation is also limited by the absence of a control population. There remains ongoing disagreement about how the general evidence base should be interpreted to consider the balance of risks and benefits of drug-cessation interventions, particularly during acute illness.…”