Drug Discontinuation Effects Are Part of the Pharmacology of a Drug

Abstract

Most reviews of drug withdrawal effects focus on drugs of potential abuse such as opioids, benzodiazepines, etc. Abrupt discontinuation of many other drugs used in medicine cause withdrawal syndromes, some of which can be fatal. Discontinuation of a number of cardiovascular drugs can increase risk of cardiovascular events above that of people not taking these drugs. These include ␤-adrenergic receptor antagonists, aspirin, HMG-CoA reductase inhibitors (statins), and heparin. Rebound hypertension occurs after abrupt cessation of many antihypertensive drugs. The possibility of discontinuation syndromes has usually been neglected until adverse clinical events force them to be noticed. Attention to the possibility of drug discontinuation effects is an important part of drug safety evaluation.

Impact of Partner Bereavement on Quality of Cardiovascular Disease Management

“…Sudden cessation of some cardiovascular medication may lead to rebound physiological responses and increased risk of acute events. 31 Increased risk has been documented after cessation of statins, aspirin, and some anti-hypertensive medication. [31][32][33][34][35] For aspirin, a metaanalysis estimated a 3-fold increase in risk of cardiac events after cessation.…”

“…31 Increased risk has been documented after cessation of statins, aspirin, and some anti-hypertensive medication. [31][32][33][34][35] For aspirin, a metaanalysis estimated a 3-fold increase in risk of cardiac events after cessation. 35 Such effects after bereavement would markedly exacerbate the acute effects of bereavement on cardiovascular events and mortality.…”

Excess Deaths Upon Cessation of Xanthine Oxidase Inhibitor Treatment—Data From the Cardiovascular Safety of Febuxostat and Allopurinol in Patients With Gout and Cardiovascular Morbidities Trial: Comment on the Article by Choi et al

“…Why is the risk of death so high after discontinuation of xanthine oxidase inhibitor therapy? Drug discontinuation syndromes are common for drugs with CV activity , although the event rates are much lower than observed here. Most patients in the CARES trial stopped therapy due to voluntary withdrawal (19.2%), separate from those with adverse events.…”

Therapeutic use of the rebound effect of modern drugs: "New homeopathic medicines"

“…(Organon of medicine, § 60) 36 With modern drugs, a large number of iatrogenic events could be avoided if health professionals paid attention to the possible occurrence of the rebound effect or paradoxical reaction of the organism, 13 minimizing the aggravation of clinical conditions with the slow and gradual decrease of doses. Although not included in conventional adverse events of drug, "effects from the discontinuation of drugs are part of the pharmacology of the drug" 52 and should be incorporated into the teaching of modern pharmacology.…”