Stopping treatment

Antineoplastic drugs are potentially toxic and their administration is often associated with many serious adverse reactions. At times, some of these adverse effects are allowed because the only alternative is to stop treatment of the malignancy. A treatment plan is developed that will prevent, lessen, or treat most or all of the symptoms of a specific adverse reaction. An example of prevention is giving an antiemetic before administering an antineoplastic drug known to cause severe nausea and vomiting. An example of treatment of the symptoms of an adverse reaction is the administration of an antiemetic and intravenous (IV) fluids and electrolytes when severe vomiting occurs. 

Drugs were given for 2 weeks and eradication checked 1 month after stopping treatment with rapid urease test and histology on biopsy samples taken from the antrum and the corpus. ... 

Side-effects of corbamazepine include blood disorders such as thrombocytopenia, leucopenia, aplastic anaemia and agranulocytosis. Patients ore therefore advised to stop treatment and contact a healthcare provider if they develop symptoms of sore throat, fever, rash, mouth ulcers, bleeding or bruising. 

Ophthalmologic effects Optic neuropathy or neuritis may occur at any time following initiation of therapy, in some cases, visual impairment has progressed to permanent blindness. Corneal microdeposits appear in virtually all adults treated with amiodarone. They give rise to symptoms such as visual halos or blurred vision in as many as 10% of patients. Corneal microdeposits are reversible upon reduction of dose or drug discontinuation. Asymptomatic microdeposits are not a reason to reduce dose or stop treatment. Some patients develop photophobia and dry eyes. Vision is rarely affected and drug discontinuation is rarely needed. 

Bronchospasm Tiotropium is not indicated for the initial treatment of acute episodes of bronchospasm (ie, rescue therapy). Inhaled medicines, including tiotropium, may cause paradoxical bronchospasm. If this occurs, stop treatment with tiotropium and consider other treatments. 

Reducing dosage and stopping treatment - Make the decision to discontinue therapy with buprenorphine or buprenorphine/naloxone after a period of maintenance or brief stabilization as part of a comprehensive treatment plan. Gradual and abrupt discontinuation have been used but there is not a best method of tapering the dose at the end of treatment. 

X ULN Stop treatment. Monitor the patient closely for signs and symptoms associated with hepatitis and follow transaminase levels until within normal limits (see Rechallenae). 

Patients who are successfully abstinent on the nasal spray should be treated at the selected dosage for up to 8 weeks, following which use of the spray should be discontinued over the next 4 to 6 weeks. Some patients may not reguire gradual reduction of dosage and may abruptly stop treatment successfully. Treatment with the nasal spray for longer periods has not been shown to improve outcome, and the safety of use for periods longer than 6 months has not been established. 

Monitoring Monitor liver function in patients with pre-existing hepatic function abnormalities or those who have experienced liver toxicity with other medications consider monitoring in all patients. Stop treatment immediately and conduct liver function testing in patients who develop signs and symptoms suggestive of liver... 

Sudden deterioration of respiratory function has been associated with initiation of aerosolized ribavirin use in infants. Carefully monitor respiratory function during treatment. If initiation of aerosolized ribavirin treatment appears to produce sudden deterioration of respiratory function, stop treatment and reinstitute only with extreme caution, continuous monitoring, and consideration of concomitant administration of bronchodilators (see Warnings). 

Posttreatment exacerbations of hepatitis Clinical and laboratory evidence of exacerbations of hepatitis have occurred after discontinuation of lamivudine (these have been primarily detected by serum ALT elevations in addition to the re-emergence of HBV DMA commonly observed after stopping treatment). Although most events appear to have been self-limited, fatalities have been reported in some cases. Closely monitor patients with clinical and laboratory follow-up for at least... 

Posttreatment exacerbation of hepatitis Patients with HIV should be tested for the presence of chronic hepatitis B virus (HBV) before initiating antiretroviral therapy. Patients coinfected with HIV and HBV should be closely monitored for at least several months after stopping treatment. 

Upon stopping treatment with cyclosporine, relapse will occur in approximately 6 weeks (50% of patients) to 16 weeks (75% of patients). In the majority of patients, rebound does not occur after cessation of treatment with cyclosporine. Continuous treatment for extended periods longer than 1 year is not recommended. Consider alternation with other forms of treatment in the long-term management of patients with this disease. 

For auto-immune hepatitis relatively low doses of oral corticosteroids are effective, and concurrent azathioprin (2 mg/kg) is steroid sparing. Those in remission for two years can stop treatment, but relapse is common. 

Antidepressants differ from benzodiazepines in the onset and course of their actions (Fig. 2). Most cause an increase in anxiety on initiation of therapy, and anxiolytic effects occur later. In comparative studies, improvement matches that on benzodiazepines after 4 weeks (Rocca et al. 1997). Withdrawal effects, particularly rebound, are less problematic with antidepressants, although stopping treatment is associated with a significant rate of relapse, and a withdrawal syndrome has been described for most of the shorter-acting drugs. 

Dosage Based on transaminase elevations Any elevation accompanied by symptoms of liver injury or serum bilirubin 2 or more times upper limit of normal, stop treatment. 

AST/ALT greater than 3 or less than 6 times upper limit of normal, reduce dose or interrupt treatment. AST/ALT greater than 5 or less than 9 times upper limit of normal, stop treatment. AST/ALT greater than 8 times upper limit of normal, slop Ireatment. 

If elevations occur, modify dose as follows ALT <3 times upper limit normal (ULN), continue current dose ALT >3 to <5 times ULN, reduce dose by 40 mg qd and resume dose titration when within normal limits ALT >5 times ULN, stop treatment rechallenge may be tried if ALT is < 10 times ULN... 

Particular care must be exercised when switching from an MAOI to other antidepressant classes. In patients who have completed an MAOI trial without achieving a therapeutic response, treatment with other antidepressants should not be started until 14 days after discontinuation of the original MAOI. Equal care is required when switching from most other antidepressants to an MAOI. An interval equal to five times the half-life of the drug, including active metabolites, is required between stopping treatment with other antide-... 

All patients had a 3-month single-blind baseline amphetamine titration period and all 62 patients improved significantly during this time. They were then randomized to amphetamine or placebo. During the 12-month double-blind phase, 71% of the children in the placebo group and 29% in the amphetamine group stopped treatment or were switched to open treatment. Most of these dropouts occurred in the first 3 months of the double-blind trial. Thirty-two children (8 on placebo and 24 on amphetamine) completed the study as planned. Early dropouts were considered in a separate statistical analysis. 

Clinical studies have also found that anxious patients treated for up to 12 months are able to stop treatment abruptly without withdrawal symptoms ( 34, 50). 

Considerable concern exists regarding the occurrence of idiosyncratic blood dyscrasias with carbamazepine, including fatal cases of aplastic anemia and agranulocytosis. Most of these have been in elderly patients with trigeminal neuralgia, and most have occurred within the first 4 months of treatment. The mild and persistent leukopenia seen in some patients is not necessarily an indication to stop treatment but requires careful monitoring. The most common idiosyncratic reaction is an erythematous skin rash other responses such as hepatic dysfunction are unusual. 

In 46 patients with Paget s disease given synthetic salmon thyrocalcitonin 80 IU/day for 3 months, there were hot flushes in 35% and nausea in 24% in only one case was it necessary to stop treatment because of intractable diarrhea (16). 

Gonadorelin inhibits nitric oxide-mediated arterial relaxation, which disappears within 3 months after stopping treatment. This effect was abolished with add-back hormone replacement in a prospective, randomized study of 50 women treated for 6 months (6). 

Hypercalcemia was present in 11% of 541 women 4-6 hours after parathyroid hormone 20 micrograms/day and in 28% of 552 women after 40 micrograms/day (12). The dose was halved because of hypercalcemia in 3 and 11% of the women taking 20 and 40 micrograms/day respectively. Nine of the women taking 40 micrograms/day stopped treatment because hypercalcemia persisted after dosage reduction. 

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