Discontinuance of medication

Treatment options include medication, psychotherapy (e.g., CBT preferred), or a combination of both. In some cases, pharmacotherapy will follow psychotherapy treatments when full response is not realized. Patients with panic symptoms without agoraphobia may respond to pharmacotherapy alone. Agoraphobic symptoms generally take longer to respond than panic symptoms. The acute phase of PD treatment lasts about 12 weeks and should result in marked reduction in panic attacks, ideally total elimination, and minimal anticipatory anxiety and phobic avoidance. Treatment should be continued to prevent relapse for an additional 12 to 18 months before attempting discontinuation. 6 49 Patients who relapse following discontinuation of medication should have therapy resumed.49... 

Gastroparesis can be severe and debilitating. Improved glycemic control, discontinuation of medications that slow gastric motility, and use of meto-dopramide (preferably for only a few days at a time) or erythromycin may be helpful. 

Hypomania and use with other antidepressants One case has been reported of concurrent use of hypericum with an SSRI. Gordon (1998) reported a case of a 50-year-old woman taking 600 mg/day of hypericum for chronic depression. She had discontinued taking Paxil 10 days prior to hypericum and experienced no ill effects at that time. However, she added 20 mg of paroxetine to her regimen of hypericum to improve her sleep. She presented with lethargy, nausea, and weakness, but vital signs and mental status were normal. Following discontinuation of medications, she returned to normal status the next day. 

Coadministration of beta-blockers can potentiate rebound hypertension upon discontinuation of medications, and it is therefore recommended that the beta-blocker be withdrawn before the tt2 agonist (Physicians Desk Reference, 2001). Tricyclic antidepressants may also produce changes in sinus node and AV conduction, and it is recommended that they be used cautiously in combination with tt2 agonists (Physicians Desk Reference, 2001). However, in child psychiatric practice, there has been debate about whether there are adverse interactions related to concomitant use of tricyclics and tt2 agonists. Finally, the tt2 agonists may potentiate the effects of CNS depressants (e.g., barbiturates) or other medications that produce sedation, so lower doses of each may be warranted. 

If a mild rash develops, the drug may be continued and symptomatic treatment instituted. Severe rashes require discontinuation of medication. Because the SSRIs share similar mechanisms but not similar structures, an allergy to one agent does not predict an allergy to another. 

Many of these patients derive benefit from short-term BZD therapy only. In one study, 50% of those treated with diazepam (15 to 40 mg/day) for 6 weeks maintained their improvement during subsequent placebo therapy for an additional 18 weeks ( 23). In another study, 70% treated for 4 weeks with either lorazepam or clorazepate maintained improvement during 2 weeks on placebo (24). Even the chronically anxious may benefit from brief (4 to 6 weeks) treatment ( 25). In many cases, although discontinuation of medication may eventually lead to a reemergence of anxiety, symptoms may not always be continuous, be functionally significant, or cause patients to seek further treatment (26). 

Increased skin pigmentation may occur, especially in dark-skinned women. It tends to increase with time, the incidence being about 5% at the end of the first year and about 40% after 8 years. It is thought to be exacerbated by vitamin deficiency. It is often reversible upon discontinuance of medication but may disappear very slowly. 

Hypersensitivity reactions, occasionally fatal, have been reported in 2-5% of patients receiving abacavir. Symptoms, which generally occur within the first 6 weeks of therapy, involve multiple organ systems and include fever, malaise, and gastrointestinal complaints. Skin rash may or may not be present. Laboratory abnormalities such as mildly elevated serum aminotransferase or creatine kinase levels are not specific for this reaction. Although the syndrome tends to resolve quickly with discontinuation of medication, rechallenge with abacavir following discontinuation results in return... 

Another study followed 49 outpatient TD cases for a mean of 40 weeks (range 1-59 months) after discontinuation of medication (Glazer et al., 1990). Many patients showed noticeable improvement in their movements within the first year after stopping neuroleptics, but only 2% showed complete and persistent recovery. The authors concluded, A major finding of this study is that complete reversal of TD following neuroleptic discontinuation in chronically treated patients was rare. ... 

The foimdation of exemplary patient education and reassurance is communication concerning the expected postoperative course between the ophthalmic surgeon and the optometric physician. In addition, during each postoperative visit patients should be advised of their progress and reassured or coimseled about the examination findings. Level of physical activity, use or discontinuance of medications, and any cautions regarding symptoms should be reviewed. 

Once a patient has fully recovered, the question of when to stop medication arises. Often, even if the patient is asymptomatic, an abrupt discontinuation of medications can result in either relapse or withdrawal symptoms. The matter of when to stop is highly individual and depends heavily on three factors ... 

In a review of 22 patient cohorts comparing gradual with abmpt discontinuation of medication, abmpt discontinuation resulted in a cumulative relapse rate of about 46% at six months and 56% at 24 months gradual reduction halved the six-month relapse rate. 

Phenothiazine derivatives have been observed to cause jaundice in 5% of the patients. The jaundice is accompanied by intense pruritus, fever, chills, nausea, epigastric or right upper quadrant abdominal pain, and malaise. The jaundice is not dose dependent, and develops after a typical delay of 2 to 3 weeks. With discontinuation of medication, the prognosis has been excellent. 

Phenytoin causes hypertrichosis in 5% of patienls, which occurs several months after the initiation of therapy and is either slowly reversible, or irreversible even after discontinuation of medication. Phenytoin may also cause a hypersensitivity reaction, characterized by rashes, Stevens-Johnson syndrome, lymphoid hyperplasia, blood dyscrasias, and serum sickness. If any of these reactions occur, the medications must be discontinued. 

The most prevalent or significant side effects of HMGRis are iisted beiow (7,15,21). in generai, this class of drugs is well tolerated. Gastrointestinal disturbances are the most common complaint however, these and other adverse reactions tend to be mild and transient. Elevations in hepatic transaminase ieveis can occur with aii HMGRis. These increases usually occur shortly after the initiation of therapy and resolve after the discontinuation of medication. ... 

Bell, C., Brener, S., and Gunraj, N. Association of ICU or hospital admission with unintentional discontinuation of medications for chronic diseases. JAMA 306 840-847, 2011. 

Placebo-controlled trial A randomised, placebo-controlled trial of 6 months of nasal salmon calcitonin (200 lU/day) in combination with 500 mg calcium per day for the treatment of 60 patients who underwent total hip arthroplasty found that treatment was well tolerated with no serious side effects or discontinuation of medication reported... 

Bell, C., S. Brener, and G. Gunraj. 2011. Association of ICU or Hospital Admission with Unintentional Discontinuation of Medications for Chronic Diseases, JAMA, 306 840-847. 

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