These types of drugs should not be discontinued at will to avoid worsening of the original disease

In the process of health management, drug treatment always plays an important role. Some drugs can be discontinued after the disease is cured, but in clinical treatment, some drugs should not be discontinued at will to avoid "withdrawal reaction" or even worsen the original disease. For example, sudden discontinuation of anticoagulants may cause serious consequences such as myocardial infarction or cerebral infarction.

So, which medicines should not be discontinued at will?

1. Glucocorticoids

Long-term and high-dose use of glucocorticoids, such as prednisone, prednisolone, dexamethasone, triamcinolone, etc., can feedback inhibit pituitary-adrenal cortex secretion, reduce adrenocorticotropic hormone, cause adrenal insufficiency or adrenal cortex atrophy, and reduce glucocorticoid synthesis and release.

If the medication is stopped suddenly, the atrophied adrenal glands will not be able to release glucocorticoids in time, leading to adrenal cortex insufficiency or crisis. The patient will experience symptoms such as fatigue, nausea, vomiting, hypotension, and in severe cases, shock.

To prevent the occurrence of drug-induced adrenal insufficiency, the daily maintenance dose of glucocorticoids should be gradually reduced, or the intermittent dosing method should be adopted to gradually reduce the dose until the main symptoms can be controlled, and then slowly stop the drug.

2. Antihypertensive drugs

Most cases of hypertension require long-term antihypertensive medication. Blood pressure should be monitored during medication, the effects of the medication should be observed, and the type and dosage of the medication should be accurately adjusted. Do not stop taking the medication on your own if there are no symptoms. Sudden discontinuation of medication can cause rebound hypertension, aggravated angina pectoris, secondary myocardial infarction, intracranial hemorrhage, etc. In severe cases, it can cause sudden death.

3. Antianginal drugs

Coronary heart disease is caused by insufficient blood supply to the myocardium due to coronary artery stenosis. Long-term use of drugs that improve coronary circulation, such as nifedipine, propranolol, metoprolol, etc., if suddenly stopped, may cause rebound ischemia symptoms, leading to angina pectoris, myocardial infarction, arrhythmia, and in severe cases, sudden death.

If you need to stop the drug, you should gradually reduce the dosage. The discontinuation process should be at least 3 days, and often up to 2 weeks. If there are withdrawal symptoms, such as angina attacks, you need to restart the drug and gradually stop taking it after it stabilizes.

4. Anticoagulants

After heart valve replacement, large vessel stenting, coronary artery stenting intervention, and anticoagulant treatment for diseases such as pulmonary embolism, myocardial infarction or deep vein thrombosis, you should follow the doctor's instructions. Some patients need to take anticoagulants for life. During the medication period, you should follow the doctor's instructions, regularly monitor INR and prothrombin time, and control them within the appropriate range.

If the dosage is increased arbitrarily, the drug is stopped on its own, or the dosage is insufficient, it will lead to bleeding tendency or thrombosis, resulting in serious consequences.

5. Anti-epileptic drugs

Long-term use of anti-epileptic drugs such as ethosuximide, sodium valproate, phenobarbital, phenytoin sodium, valproamide, lamotrigine, gabapentin, etc., if suddenly stopped, can cause emotional agitation, insomnia, anxiety, convulsions, twitching, epileptic seizures, and even status epilepticus.

6. Thyroid medication

During the use of antithyroid drugs to treat hyperthyroidism, thyroid function must be tested regularly based on symptoms, signs, and treatment response, and the dosage of drugs such as propylthiouracil and methimazole must be accurately adjusted. Some patients also require long-term therapy (2 to 3 years) to reduce the chance of recurrence of hyperthyroidism.

When levothyroxine and thyroxine are used for the treatment or replacement therapy of hypothyroidism, it is necessary to regularly test the values ​​of free T3, free T4, high-sensitivity thyrotropin and other indicators to accurately adjust the dosage to avoid drug-induced hyperthyroidism caused by insufficient or excessive drug dosage. Most patients need to take medication for life and cannot stop taking it at will.

7. Antidiabetic drugs

After being diagnosed with diabetes, long-term medication is generally required and blood sugar must be closely monitored. The efficacy of the medication must be observed and the type and dosage of the medication must be adjusted. Medication should not be stopped or increased at will to avoid poor blood sugar control or excessive control leading to hypoglycemia.

For some patients, especially those with type 1 diabetes, if they suddenly stop taking insulin, it may cause blood sugar rebound, leading to a significant increase in blood sugar, and even induce hyperosmolar diabetic coma and diabetic ketoacidosis, which is life-threatening.

8. Anti-HBV drugs

Lamivudine, adefovir dipivoxil, entecavir, etc. are used for long-term treatment of hepatitis B virus infection. If the course of treatment is short, relapse is likely, and sudden discontinuation of the drug may lead to severe deterioration of hepatitis.

9. Anti-tuberculosis drugs

During the course of anti-tuberculosis treatment, even if the symptoms of tuberculosis have disappeared, anti-tuberculosis treatment must be continued. The current short-term treatment requires 6 months, otherwise it is easy to relapse, or even develop into drug-resistant tuberculosis, becoming refractory tuberculosis, and the course of treatment at this time is up to 18 months. Therefore, anti-tuberculosis treatment must be closely followed up, and medication cannot be stopped, reduced, or reduced at will.

10. Antimicrobial drugs

When treating bacterial infections, the course of treatment will vary depending on the pathogens and individual immunity. It is generally used for 72 to 96 hours after the body temperature returns to normal and symptoms disappear. Special circumstances should be followed according to the doctor's advice. Stopping the drug too early will not only fail to achieve the treatment goal, but also easily lead to bacterial resistance.

11. Anti-Parkinson's drugs

Anti-Parkinson's disease drugs such as bromocriptine, pergolide mesylate, benzhexol hydrochloride, and amantadine should not be stopped suddenly because of the possibility of malignant neuroleptic syndrome, which manifests as high fever, muscle rigidity, psychological changes, etc., and hospitalization is required if necessary.

12. Antidepressants

Antidepressants such as paroxetine, fluvoxamine, venlafaxine, etc. Antidepressant withdrawal symptoms generally appear within 2 to 4 days and usually include specific sensory, physical, cognitive-emotional manifestations, often with sensory and physical symptoms, including flashes of light, "electric shock" sensations, nausea, and excessive sensitivity to sounds or lights. There are also non-specific anxiety and fear.

So, when can you stop taking the medicine?

This problem requires specific guidance from doctors based on the specific condition of the disease, and cannot be generalized. Therefore, during the period of taking medication, whether increasing or decreasing the dosage or stopping the medication, patients must follow the doctor's instructions to ensure their own safety to the greatest extent.

Author: Chen Ye Liu Yanping

Source: Shanghai Pudong New Area People's Hospital