Drug ‘holidays

Sleep disturbance Use drug holiday or different medication if severe growth delay Give dose earlier in the day ... 

Allowing dose reductions or drug holidays will possibly keep patients in a trial and avoid them dropping out, in addition to providing a closer model to what will actually happen in practice in real life. Continued follow-up for patients who withdraw from medication should also be considered (sometimes referred to as partial withdrawal) and this will give much more flexibility when it comes to analysing the data once the trial is complete. 

The effects of stimulant medication generally cease upon discontinuation of the treatment. One double-blind study, however, did not find this to be necessarily true for DEX (Gillberg et ah, 1997). Many patients favor a period off the medication, a drug holiday, to deal with the partial suppression of weight gain, worries about long-term effects, or to assess the need for staying on medication. This type of trial is best done when the child is not scheduled for important school tests or social activities (e.g., summer camp). 

Our advice to clinicians is to make the best decision that they can, based on the evidence, while opting for agents with the best side effect profiles and that are supported, when possible, with other appropriate therapies. Because of the experimental nature of pharmacotherapy in this population, practitioners should endeavor to confirm the utility of treatment with hard data. Where possible, periodic drug holidays are recommended to determine if continued therapy is needed. Until far more drug research is available on young people with MR, this will continue to be one of the more challenging populations in which to practice psychopharmacology. 

A drug holiday (discontinuance of the drug for 3-21 days) may temporarily improve responsiveness to levodopa and alleviate some of its adverse effects but is usually of little help in the management of the on-off phenomenon. Furthermore, a drug holiday carries the risks of aspiration pneumonia, venous thrombosis, pulmonary embolism, and depression resulting from the immobility accompanying severe parkinsonism. For these reasons and because of the temporary nature of any benefit, drug holidays are not recommended. 

Drug holidays are sometimes used in the patient who has become refractory to the beneficial effects of levodopa or has had a sudden increase in adverse side... 

Despite these potential benefits, drug holidays are no longer used routinely because of their potential risk to the patient. Considering that these patients are in the advanced stages of Parkinson disease, discontinuing the anti-Parkinson medications even temporarily results in severe immobility, which can lead to problems such as venous thrombosis, pulmonary embolism, pneumonia, and other impairments that could increase morbidity and mortality.3 Hence, drug holidays may still be used on a limited basis in a few select patients with Parkinson disease, but this intervention is not used routinely at the present time. 

Drug holiday A period of several days to several weeks in which medications are withdrawn from the patient to allow recovery from drug tolerance or tox-... 

The most frequent noncompliance behaviors are deviations from the amount of dose (this includes leaving out doses), the timing of administration, and the duration of treatment. Thus, noncompliances range from short-time deviation from the administration time over randomly omitted doses up to so-called drug holidays where the patient takes a break from medication. The worst case is discontinuation of the medication, which is discussed in Section 17.8.3. 

There are insufficient data to support the use of drug holidays in detecting the risk of tardive dyskinesia, but they may help to diagnose the covert type by unmasking dyskinesia (245). 

A third conservative approach is the drug holiday. Anticipating planned sexual activity, the patient temporarily discontinues the drug, say, for a day or so. The sharp reduction in antidepressant blood levels sometimes results in temporary disappearance or at least reduction of the sexual dysfunction. This method has several limitations as well it precludes spontaneous sexual activity it may lead to relapse of depressive symptoms it may produce antidepressant withdrawal symptoms (see Table 3.13), which can be severe enough to squelch the desire of even the most passionate of lovers and it is restricted to patients on antidepressants with a short half-life (blood levels of long half-life compounds such as fluoxetine [Prozac] would not drop quickly enough to create the planned holiday). 

Parents will talk with their physician about dose amounts and intervals and whether the child should be given a drug holiday, in which... 

May be able to give drug holidays over the summer in order to reassess therapeutic utility and effects on growth and to allow catch-up from any growth suppression as well as to assess any other side effects and the need to reinstitute stimulant treatment for the next school term... 

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