March 22, 2016
1397
Q: Can I just stop taking my prescription, or do I need to wean myself off of it?
A: The vast majority of drugs can be safely stopped on a moment’s notice but there are a number of medications that should slowly be reduced. The caveat here is that, if the reason for discontinuing the drug is especially compelling (i.e. a very significant adverse reaction to it) or if the drug has only just been started, even the drugs we’re about to talk about are sometimes stopped abruptly.
When a decision is made to slowly come off of a drug, there is no single approach that works best for every person or every drug. It really depends on the amount of drug the person is taking, how long he/she has been on it, the reason for stopping, what type of drug it is, as well as individual nuances (such as how sensitive a person is to medications, how much he/she is willing or able to put up with regarding withdrawal effects, how motivated he/she is to get off it in as short a time frame as possible, etc.).
We find we frequently encouraging patients to go slower than they would prefer when it comes to stopping a drug that they no longer need. While we are all for attempting to discontinue any medication that may no longer be necessary, we find many people put themselves through unwarranted grief and expose themselves to an increased risk of not accomplishing their goal, by going through this process far too quickly.
As we have sometimes said, come 2018, it really won’t matter if you stopped taking the drug in April, 2016, versus the end of May.
When it comes to the types of drugs that should be tapered, perhaps it is not surprising that one of the classes of drugs that should be very slowly discontinued, is the benzodiazepines (lorazepan, temazepam and all the other “...pams”). If these drugs are stopped abruptly, withdrawal effects can be varied (seizures, tremors, anxiety, sweating, muscle cramps, hallucinations), severe, and can last possibly for months.
As such, the approach to take is “low and slow”. Initially, the dose can be reduced by one-quarter every week for the first two weeks, after which it should be attempted to lower the dose by 10 per cent a week until the drug is stopped. Sometimes the medication can be changed to a liquid formulation which allows for even more finely-controlled reductions.
The sleeping pills zopiclone (Imovane) and zolpidem (Sublinox) can cause similar problems as the benzo’s when stopped although this is not common in those who take them at the normally-prescribed doses. There are a number of solutions for discontinuing these two drugs, including tapering to the lowest dose that still works and then slowly coming off of it over the next eight weeks, or switching to lorazepam and following the instructions mentioned earlier.
Beta-blockers (propranolol, atenolol, bisoprolol, metoprolol, “...ol”) are drugs used to control blood pressure, heart conditions, as well as some unusual uses, such as stage fright, tremors and migraines. They may have withdrawal effects such as anxiety, a racing heartbeat, a sudden increase in blood pressure and perhaps the potential for angina or a heart attack. As such, these drugs should be stopped gradually over a one- or two-week period, unless you’re being put on another type of beta-blocker.
Clonidine is a medication used to treat hot-flashes, high blood pressure and ADHD. When stopped abruptly, a sudden rise in blood pressure, headaches, sweating, anxiety, restlessness, hiccups, nausea and a host of other symptoms may occur. Now, this is usually only seen at higher doses - greater than 1.2 milligrams (mg) per day. It's not as commonly seen today as it was years ago but it is still wise to reduce the dose by 0.1 mg every three to seven days until the patient is off.
Prednisone is also a drug for which it is critical (potentially even life-threatening) that it be slowly reduced when it has been taken for longer than two weeks (Note: most patients who require this drug for allergic reactions or airway inflammation are only on it for a few days). For those who have been on it longer, depending on the reason for use of the drug, a slowly-descending schedule can be provided.
Proton Pump inhibitors (PPIs), which include omeprazole, pantoprazole, rabeprazole, the “...azole”s, are medications that reduce stomach acid and are, therefore, used for conditions such as heartburn, ulcers and the like. Sudden discontinuation of this class of drugs can frequently lead to rebound acid secretion which can cause the sufferer to continue taking the drug for a longer period of time than might have been necessary.
With these drugs, the dose should be reduced every week or two, until the lowest dose that is manufactured is reached. At this point, the drug should be taken every second day (rather than daily) and eventually every third day. The whole process should take four to six weeks.
Lastly, the anti-depressants as a class are a group of drugs that have been associated with withdrawal symptoms such as insomnia, flu-like symptoms, imbalance, hyperarousal and sensory disturbances. These symptoms are usually mild, begin and peak within one week of stopping the agent, and can last anywhere from one day to upwards of three weeks.
Paroxetine (Paxil) and venlafaxine (Effexor), and possibly Pristiq which is based upon venlafaxine, are most commonly associated with withdrawal symptoms whereas Prozac (fluoxetine) is not, due to its naturally slow elimination from the body. The schedule for reduction of these drugs is very specific depending on which particular drug you are talking about as well as the indication for use (i.e. different schedules are recommended for those who take them for depression as opposed to panic disorder or acute bipolar) so it is best to consult with a health professional prior to making the decision to get off of these drugs.
This list is far from complete as to the drugs that should be slowly tapered off, so do not hesitate to ask before executing your decision. It may turn out to make your next few weeks much easier and your decision more likely to be a successful one.
For more information about this or any other health-related questions, contact the pharmacists at Gordon Pharmasave, Your Health and Wellness Destination.
Related Stories
No related stories.