Top 6 Safety Tips for Stopping Your Meds
Stopping your medication abruptly may not only adversely affect your condition, it can be flat out dangerous.
1. Talk to Your Doctor First
Many factors need to be considered before you stop any medication that has been prescribed for you, that’s why it is so important to talk to your doctor first.
Discontinuing a medication abruptly can often be associated with unpleasant side effects and worsening of symptoms based on your drug treatment, its chemistry profile, and how your drug is broken down (metabolized) and excreted from your body.
Ideally, talk to your doctor about how, when (and if) to stop a drug when it is first prescribed.
2. Discuss Your Medications With Your Doctor
Roughly 40 percent of people over the age of 60 take at least five prescription drugs, including medications they no longer need. Some medications -- like sleeping pills -- should only be used short-term. How about allergy medications that are only needed in the spring or fall? Did you lose those few extra pounds? If so, maybe your blood pressure has dropped back into the normal range and you don’t need as much medication to manage your hypertension. Should you continue with your stronger painkiller, or can you back down to a milder NSAID?
Any of these can be reasons to discontinue your medication, if okayed by your doctor. You may save on monthly health care costs, too. But you need to have that conversation with your doctor first, and you may need to start that conversation.
3. Stop for the Right Reason
According to a report from CVS Caremark, half of patients taking maintenance medications for chronic conditions will stop taking them within the first year of starting therapy. This non-adherence results in roughly a $300 million charge to health care costs per year. Non-adherence can lead to worsening of chronic conditions, increased hospitalizations, and overall worsened outcomes.
If you feel better after taking a medication, say an antidepressant or arthritis medication, your symptoms can return when you stop taking the medication. In addition, some conditions, like hypertension and high cholesterol, have no real symptoms at all, lessening the chance you’ll stick with your meds. Many people think they can stop their treatment when they feel better, but this is usually not the case. Not only will your condition worsen, you may experience side effects from abrupt medication withdrawal.
If you read or hear news from the media about your medication that is concerning to you, do not stop your medication before you speak to your healthcare provider. The new reports, including those from social media, may be unfounded, or the particular concern may not be relative to your condition.
4. Ask Your Doctor How to Best Stop Your Medication.
Some drugs can be stopped immediately without a special discontinuation schedule, but many medications require a taper, which is a slow reduction in dose or frequency over a longer period of time, usually 2 to 6 weeks.
Slow tapers help to avoid disagreeable side effects that you might experience if you stopped the drug quickly.
If you are stopping several medications, you may want to taper them one at a time to avoid added side effects -- check with your doctor.
5. Learn Your Medicine Side Effects if You Quickly Stop.
For example, abruptly stopping some selective serotonin reuptake inhibitors (SSRI) antidepressants prescribed to boost your mood -- like Paxil (paroxetine) or Zoloft (sertraline) -- can lead to a host of disturbing side effects, such as anxiety, dizziness, upset stomach, or fatigue. This is called antidepressant discontinuation syndrome. Not everyone experiences this antidepressant discontinuation syndrome, only about 1 in 5 people. It is not usually dangerous, and will usually subside in a few days depending upon your drug, but there are ways to lessen its effect.
Antidepressant discontinuation syndrome may be more common with certain antidepressants that stay in your body for a shorter period of time, although longer-acting antidepressants may cause withdrawal, as well. Antidepressant discontinuation syndrome can occur with many antidepressants, not just the SSRIs.
Examples of common antidepressants that can lead to antidepressant discontinuation syndrome include:
- Cymbalta (duloxetine)
- Effexor (venlafaxine)
- Lexapro (escitalopram)
- Paxil (paroxetine)
- Zoloft (sertraline)
6. Chart Your Discontinuation Plan
If you are started on a new medication, you should ask several questions of your doctor and record the responses for future reference, including:
- Your dose and schedule
- Your expected outcomes
- Common side effects, including if the drug is abruptly stopped
- Cost of your drug and generic availability
- How long are you are going to take the medication?
You may need to switch drugs due to side effects or lack of effectiveness. If you are switching from one medication to another in the same class, you can usually switch drugs immediately or start the new drug at a lower dose while slowly tapering off of the first drug. However, this is not always the case, so you must consult with your prescribing doctor, especially if the drugs are from different classes.
Table 1: Important Classes to Avoid Abrupt Withdrawal
|Drug Class or Drug||Example Drugs||Side Effect Risks|
|Antidepressants||Paroxetine (Paxil), Sertraline (Zoloft), Venlafaxine (Effexor)||Panic, agitation, worsened depression, nightmares, confusion insomnia,|
|Antipsychotics||Aripiprazole (Abilify), clozapine (Clozaril), olanzapine (Zyprexa), quetiapine (Seroquel)||Severe relapse of symptoms, anxiety, withdrawal dyskinesia or dystonia (involuntary muscle movement), parkinsonian symptoms, neuroleptic malignant syndrome|
|Benzodiazepines||Alprazolam (Xanax), oxazepam, temazepam (Restoril), triazolam (Halcion)||Abrupt discontinuation can be serious; seizures, anxiety, rebound insomnia, tremors, nausea, heart palpitations, hallucinations|
|Corticosteroids||Cortisol, Prednisone||Pain, fatigue, low blood pressure, anxiety, insomnia, irritability, depression, nausea, vomiting|
|HMG Co-A Reductase Inhibitors (Statins)||Atorvastatin (Lipitor), lovastatin (Mevacor), rosuvastatin (Crestor), simvastatin (Zocor)||Possible rapid rise in C reactive protein (CRP) and LDL cholesterol levels; worsening of heart disease risks|
|Insomnia Medications (for sleep)||eszopiclone (Lunesta), zaleplon (Sonata), zolpidem (Ambien),||Anxiety, rebound insomnia, muscle cramps, nausea, seizures|
|Lithium||Lithium||Mood instability, manic relapse|
|Proton Pump Inhibitors (PPIs)||Esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec),||Rebound heartburn|
|Hormone therapy||Estrogen (Premarin), estrogen with progestin (Prempro)||Menopausal symptoms, hot flashes, flushing, sweating|
|Nonsteroidal Antiinflammatory Drugs NSAIDs||aspirin, celecoxib (Celebrex), ibuprofen (Advil, Motrin), naproxen (Aleve)||Increased risk of heart attack due to blood clotting (aspirin); rebound headaches (NSAIDs)|
|Opioids||codeine, hydrocodone, oxycodone, tramadol||Agitation, irritation, chills, shivering, cramps, diarrhea, insomnia, muscle pain|
Table 1 adapted from “When (and how) to stop taking a drug” Consumers Reports, November 2010
Learn More: Managing Antidepressant Side Effects
- Consumers Reports, November 2010 “When (and how) to stop taking a drug”. http://www.consumerreports.org/cro/2012/04/when-and-how-to-stop-taking-a-drug/index.htm
- Tartakovsky M. Discontinuing Psychiatric Medications: What You Need to Know. PsychCentral http://psychcentral.com/lib/discontinuing-psychiatric-medications-what-you-need-to-know/0005742
- Howland RH. Potential adverse effects of discontinuing psychotropic drugs. Part 3: Antipsychotic, dopaminergic, and mood-stabilizing drugs. J Psychosoc Nurs Ment Health Serv. 2010;48:11-4. http://www.ncbi.nlm.nih.gov/pubmed/20669865
- van der Harst P1, Asselbergs FW, Hillege HL, et al. Effect of withdrawal of pravastatin therapy on C-reactive protein and low-density lipoprotein cholesterol. Am J Cardiol. 2007;100:1548-51.