What are the reasons to discontinue my medication?

From the Guidelines

Discontinuing medication should be done under the guidance of a healthcare provider, as it can lead to a return of symptoms, withdrawal symptoms, or other adverse effects, and the decision to discontinue should be based on a thorough evaluation of the patient's history, current symptoms, and treatment response 1. When considering discontinuing medication, it is essential to weigh the potential benefits against the potential risks, including the risk of relapse, withdrawal symptoms, and other adverse effects.

• The patient's history of previous psychiatric symptoms and response to medication should be carefully reviewed, including any previous attempts to discontinue medication and the outcomes of those attempts 1.
• A monitoring plan should be developed to closely track the patient's symptoms and adjust the discontinuation plan as needed, taking into account the potential for a return of symptoms, which can occur weeks to months after the last dose of medication 1.
• The decision to discontinue medication should be based on a thorough evaluation of the patient's current symptoms, treatment response, and potential risks, including the risk of relapse, withdrawal symptoms, and other adverse effects 1.
• In cases where multiple medications are being taken, the decision to discontinue one or more medications should be based on a careful evaluation of the potential benefits and risks, taking into account the severity of the underlying conditions, the potential for interactions between medications, and the potential for withdrawal symptoms or other adverse effects 1.
• It is crucial to taper medications slowly to avoid withdrawal symptoms or rebound worsening of symptoms, especially when discontinuing medications such as benzodiazepines or SSRIs, which can have a high risk of discontinuation syndrome 1.
• The role of the underlying and most severe condition, as well as the sequence and rationale for which medications were combined, should contribute to the plan for discontinuation of multiple medications in children 1.

From the FDA Drug Label

Advise patients to discontinue metformin hydrochloride tablets immediately and to promptly notify their healthcare provider if unexplained hyperventilation, myalgias, malaise, unusual somnolence or other nonspecific symptoms occur Instruct patients to inform their doctor that they are taking metformin hydrochloride tablets prior to any surgical or radiological procedure, as temporary discontinuation may be required [see Warnings and Precautions ( 5. 1) ].

The reasons to discontinue metformin medication are:

• Unexplained symptoms such as hyperventilation, myalgias, malaise, unusual somnolence, or other nonspecific symptoms
• Prior to any surgical or radiological procedure, as temporary discontinuation may be required 2

From the Research

Reasons to Discontinue Medication

There are several reasons to discontinue medication, including:

• Polypharmacy, which may result in interactions and side effects that lead to morbidity and mortality 3
• The need to temporarily discontinue certain medication, for example when a patient is unable to swallow or suffers from a delirium 3
• The presence of withdrawal symptoms or rebound effects when stopping certain medications abruptly, such as psychotropic drugs, dopaminergic drugs, opioids, beta-blockers, corticosteroids, and proton-pump inhibitors 3, 4
• The desire to reduce health system expenditure and improve patient quality of life 5
• The need to avoid adverse drug withdrawal events (ADWEs) when discontinuing unnecessary medications 6

Patient-Related Factors

Patient-related factors that may influence the decision to discontinue medication include:

• Cognitions about why the medication is necessary 4
• Expectations of the effect of the medication 4
• Experience of withdrawal effects during earlier attempts to stop 4
• Fear of relapse 4
• Poor communication with healthcare professionals 4
• Lack of a trusted professional 4

Medication-Related Factors

Medication-related factors that may influence the decision to discontinue medication include:

• The type of medication, with certain classes being more likely to cause withdrawal symptoms or rebound effects 3, 4, 6, 7
• The duration of treatment, with longer durations potentially increasing the risk of withdrawal symptoms or rebound effects 7
• The presence of physiological adverse drug withdrawal events (ADWEs) with abrupt discontinuation, which is rare but can occur with certain drugs or classes 6