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Medications that can result in adverse drug withdrawal reactions if stopped abruptly*[1-6]

Medications that can result in adverse drug withdrawal reactions if stopped abruptly*[1-6]
Medication Symptoms that can result from abrupt discontinuation
Acetylcholinesterase inhibitors Agitation, aggression, hallucinations, reduced consciousness, abrupt cognitive decline
Antiseizure medications Anxiety, depression, seizures
Antidepressants Akathisia, anxiety, chills, gastrointestinal distress, headache, insomnia, irritability, malaise, myalgia
Antiparkinsonian agents Hypotension, psychosis, pulmonary embolism, rigidity, tremor
Antipsychotics Dyskinesias, insomnia, nausea, restlessness
Baclofen Agitation, anxiety, confusion, depression, hallucinations, hypertonia, insomnia, mania, nightmares, paranoia, seizures
Benzodiazepines Agitation, anxiety, confusion, delirium, insomnia, seizures
Beta blockers Angina pectoris, anxiety, severe hypertension, myocardial infarction, tachycardia
Clonidine Agitation, headache, severe hypertension, palpitations
Corticosteroids Anorexia, hypotension, nausea, weakness
Opioids Abdominal cramping, anxiety, chills, diaphoresis, diarrhea, insomnia, restlessness
Proton pump inhibitors Gastric upset, heartburn (due to rebound hyperacidemia)
* This is a partial list. When in doubt, it is typically safer to slowly taper a medication than to stop it abruptly. Adverse drug withdrawal reactions (ADWRs) refer to adverse physiological changes caused by medication withdrawal beyond a simple return of the underlying condition the medications are intended to treat, for example as may occur when medication exposure has resulted in up- or down-regulation of end-organ receptors that result in receptor over- or under-activation when the medication is abruptly withdrawn. Not included in this table is the wider spectrum of adverse drug withdrawal events (ADWEs), which can include return or worsening of the condition a medication was being used to treat or adverse psychological responses to medication withdrawal.[6]
References:
  1. Graves T, Hanlon JT, Schmader KE, et al. Adverse events after discontinuing medications in elderly outpatients. Arch Intern Med 1997; 157:2205.
  2. Singh S, Dudley C. Discontinuation syndrome following donepezil cessation. Int J Geriatr Psychiatry 2003; 18:282.
  3. Haastrup P, Paulsen MS, Begtrup LM, et al. Strategies for discontinuation of proton pump inhibitors: a systematic review. Fam Pract 2014; 31:625.
  4. Kim J, Blackett JW, Jodorkovsky D. Strategies for effective discontinuation of proton pump inhibitors. Curr Gastroenterol Rep 2018; 20:27.
  5. Reeve E, Farrell B, Thompson W, et al. Evidence-based clinical practice guideline for deprescribing cholinesterase inhibitors and memantine. The University of Sydney, Sydney 2018. Available at: https://cdpc.sydney.edu.au/wp-content/uploads/2019/06/deprescribing-recommendations.pdf (Accessed on January 9, 2020).
  6. Reeve E, Moriarty F, Nahas R, et al. A narrative review of the safety concerns of deprescribing in older adults and strategies to mitigate potential harms. Expert Opin Drug Saf 2018; 17:39.
  7. Hanlon JT, Tjia J. Avoiding adverse drug withdrawal events when stopping unnecessary medications according to the STOPPFrail Criteria. Sr Care Pharm 2021; 36:136.
Adapted from: Bain KT, Holmes BM, Beers MH, et al. Discontinuing medications: a novel approach for revising the prescribing stage of the medication-use process. J Am Geriatr Soc 2008; 56:1946.
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