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Rules for taking medication vacations

There's sometimes a temptation to stop taking a medication, especially if you are either having side-effects or are feeling better. But Long Island experts say few patients should ever stop their regimen without a doctor's permission.

"If patients stop their medications without supervision, conditions could worsen and become very dangerous," said Dr. Susan Hirsch, an internist who's affiliated with North Shore University Hospital and sees patients in Great Neck. People with heart issues, including those who take high blood pressure drugs, face an especially high level of risk if they stop drugs such as clonidine (Catapres) or beta-blockers, she said.


Another group of medication-takers -- those with anxiety, depression or both -- should be especially cautious about stopping medications known as SSRIs (selective serotonin reuptake inhibitors, a class of antidepressants), including such well-known drugs as Prozac, Paxil, Zoloft and Celexa. "Stopping SSRIs abruptly can cause severe withdrawal symptoms such as flu-like illness, lightheadedness or electric sensations in the back of the head," Hirsch said.

People who take these drugs should taper off their usage slowly and never take a "drug holiday," she noted.

Stopping medications can also be especially dangerous for people with HIV, the virus that causes AIDS, because breaks can cause the virus to gain strength. And people who take antibiotics must not take a break without a physician's recommendation because dormant germs can return and become strong, said Dr. Aaron Glatt, executive vice president and chief administrative officer at Mercy Medical Center in Rockville Centre.


However, physicians may advise a medication "vacation" in certain circumstances:

Doctors may recommend temporarily stopping certain drugs -- like blood thinners -- before surgery.

A doctor may stop a statin drug used to treat high cholesterol and check levels in a few months to see if it's necessary to restart it, Hirsch said.

Physicians may recommend a permanent break from Fosamax, a drug used to treat osteoporosis, and similar medications after someone has taken it for five years. In 2011, the U.S. Food and Drug Administration said the drugs don't seem to have benefits after that length of time.

Cancer patients may also take medication vacations in some circumstances. Glatt said that physicians might stop the drugs for a few weeks so patients can become healthy enough to tolerate them.

What if a drug costs too much? Some people may feel tempted to save money by not taking their prescription or over-the-counter drugs as directed, considering that some medications cost hundreds or thousands of dollars a year. But that's a bad idea, Hirsch said, especially because there are things patients can do to lower costs.

"Always ask your doctor about the cheapest alternatives and generics," she said, and be open about cost being an issue. "Sometimes, the doctor is not aware there is a problem with affordability or assumes insurance will cover it."

It's also important to keep in mind that going off medication could worsen a medical condition like high blood pressure, she said, and lead to more costs in the long run.


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