Nonabused Drugs Withdrawal

The term "drug withdrawal" makes many people think of issues related to drug abuse. However, a number of drugs that have no abuse potential and are prescribed for medical illness can lead to symptoms of withdrawal when a person suddenly stops taking them. These symptoms do not necessarily mean that the person was dependent on the drug. Nonabused drugs that can produce a withdrawal syndrome include medications prescribed for cardiovascular problems, mood, and personality disorders.

Cardiovascular Drugs

Beta Blockers. Many patients receive prescriptions for beta blockers (such as atenolol, labetalol, and propranolol) to treat hypertension (high blood pressure), angina pectoris (chest pain from heart muscle deprived of oxygen), heart arrhythmias (irregular heartbeat) following heart attack, and migraine headache. When a patient abruptly stops taking a beta blocker, particularly when angina pectoris is the symptom being treated, the frequency and/or severity of angina pectoris may increase. This occurs within the first few days of discontinuing the beta blocker. (Similar withdrawal symptoms can occur when angina pectoris patients stop taking other cardiovascular drugs, such as nitroglycerin.) Withdrawal symptoms can be prevented by slowly decreasing the drug dose over several days before completely stopping the drug.

Clonidine. This drug is used for hypertension and to treat withdrawal from opiate drugs (such as heroin). When a person abruptly stops taking clonidine, blood pressure may become dangerously high. This occurs within one to two days after stopping the drug and is prevented by slowly (over several days) decreasing the drug dose before stopping it completely.

Antidepressants

Antidepressant drugs are used to treat major depression and related illnesses. They are frequently taken daily for periods of weeks or months. A person who abruptly stops taking any of the major classes of antidepressants (such as tricyclic antidepressants, monoamine oxidase inhibitors, or selective serotonin reuptake inhibitors) may experience symptoms such as nausea, abdominal pain, and diarrhea. In addition, some patients complain of a flulike illness, with weakness, chills, fatigue, headaches, and muscle aches. Patients may have difficulty falling asleep and vivid dreams or nightmares. They may become anxious, jittery, and irritable. Symptoms usually start a few days after a person stops taking the antidepressant and continue for one day to three weeks.

One class of antidepressants, selective serotonin reuptake inhibitors (SSRIs), can produce withdrawal symptoms that are easily confused with the depression for which the drugs are prescribed. Doctors may mistakenly prescribe more antidepressants to individuals who have these symptoms. This cycle of drug treatment is a significant problem, especially since the treatment of depression with medications has increased. The distinct, recognizable withdrawal symptoms that SSRIs can produce include dizziness, sensations that resemble electric shocks, numbness, and tingling skin. To reduce the risk of withdrawal symptoms, some doctors recommend that anti- depressants be gradually reduced over a four-week period rather than abruptly discontinued.

Another class of antidepressants is the monoamine oxidase inhibitor (MAOI) drugs, such as Nardil, Parnate, and Marplan. A person who has taken high doses of these drugs for long periods, and who then suddenly stops taking them, can suffer severe symptoms. These include psychosis and delirium , with visual hallucinations as well as mental confusion. Milder symptoms can include anxiety, vivid dreaming, or nightmares. Withdrawal symptoms usually disappear a few days after the person stops taking the drug.

Other Drugs

Neuroleptics. People who suffer from psychotic disorders such as schizophrenia are often prescribed neuroleptic drugs (such as Haldol, Stelazine, Resperidone, Olanzapine, and clozapine). Abruptly stopping this class of drugs results in nausea, vomiting, and headaches.

Baclofen. As a muscle relaxant, this drug is used to treat muscle spasms that occur when people suffer from some form of paralysis. When a patient abruptly stops taking baclofen, he or she may have auditory (hearing) and visual hallucinations, severe anxiety, increased heart rate and blood pressure, and seizures. When the dose of baclofen is gradually reduced before the person stops taking it completely, these symptoms either do not occur or are not as severe.

Corticosteroids. The drug prednisone is probably the best-known corticosteroid. Prednisone is used to decrease inflammation in a wide variety of conditions, such as asthma, severe allergies, skin problems, rheumatoid arthritis, and other autoimmune disorders. When a person abruptly stops prednisone therapy, symptoms may include fatigue, weakness, imbalance of blood chemicals, and the inability of the body to respond appropriately. If an individual remains in this state for more than a few hours, severe illness and death can be expected. Doses of prednisone must be slowly decreased over many weeks to prevent a withdrawal syndrome.

Comparison with Alcohol Withdrawal

Alcohol is one of the most common drugs of abuse. The cardiovascular drugs (beta blockers, clonidine, nitrates) and the muscle relaxant baclofen produce withdrawal symptoms similar to that of alcohol. In alcohol withdrawal, like withdrawal from these medications, a person's systems become overactive: blood pressure may soar, the heart may race, and the person becomes highly excitable, shaky, and confused (called delirium tremens). In the case of corticosteroids, the opposite occurs. In prednisone withdrawal, a person becomes unresponsive.

Conclusion

The human body is a coordinated and finely tuned operation of multiple messaging systems. All the drugs mentioned here interfere with these systems in some way, producing both desired and undesired effects. When these systems adapt to the presence of a drug, stopping that drug suddenly can result in withdrawal symptoms.

see also Alcohol: Withdrawal; Benzodiazepine Withdrawal; Prescription Drug Abuse.

UNINTENDED WITHDRAWAL

A drug prescribed for good medical reasons can still cause a withdrawal syndrome. One woman trying to discontinue her prescribed tranquilizers began to experience terrifying symptoms:

I lost more than 20 pounds. I lived on milk and bananas almost exclusively for two months, because I was scarcely able to swallow. . . . To make matters worse, I had to go through this harrowing time without professional support or guidance. There was virtually no medical help or information available. In fact, there was widespread denial among the medical profession that the problem of prescription-drug addiction existed.

Joan Gadsby in Addicted by Prescription: One Woman's Triumph and Fight for Change (2001).