Ten Medications that may be Dangerous to Stop

“Can I just stop my medication?”  This question, frequently asked of primary care doctors, has a complicated answer. For starters, if you are taking a medication that controls an ongoing medical problem like high blood pressure, diabetes, or high cholesterol, you should never stop it on your own –or your problem will return. Many patients come clean during a visit and report they just plain stopped their meds. So when is this dangerous? 

Abruptly stopping these ten medications may lead to dangerous problems.  The higher the dose and the longer you’ve been taking them, the worse the situation.  Wean off, don’t stop.  

Topamax (Topiramate). Taken for epilepsy, migraine headache prevention, weight loss (Qsymia), and alcohol abuse disorder, this is a medication you should not abruptly discontinue.  Instead, taper your dosage gradually to prevent rebound effects….over 2 to 8 weeks. Why? Stopping it suddenly increases seizure frequency. This happens; I’ve seen it. 

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Effexor XR (Venlafaxine XR).  Venlafaxine XR is commonly prescribed for depression, generalized anxiety disorder, and menopause symptoms.  Effexor (Venlafaxine) carries the nickname “Side-Effexor” partly for this reason: stopping and not weaning Venlafaxine XR, due to its short half-life (how long it takes for the medication to leave your system),  may lead to noticeable withdrawal symptoms. Instead, taper the dose by 37.5 to 75 mg per day each week over four weeks. Abrupt discontinuation of venlafaxine may cause agitation, sweating, dizziness, fatigue, nausea, restlessness, and tremor. Not fun. 

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Paxil (Paroxetine). An SSRI antidepressant widely used for depression and anxiety and approved in a low dose as Brisdelle for hot flashes; Paroxetine may cause withdrawal symptoms due to the short half-life. Paroxetine needs to be tapered down over two to four weeks before discontinuation. If you just stop it, symptoms may include nausea, vomiting, diarrhea, headaches, lightheadedness, dizziness, sweating, tremors, and sleep disturbances (vivid dreams, insomnia). Wean it down. 

Gabapentin/Neurontin. Prescribed for neuropathic pain, seizures, and hot flashes related to menopause, don’t just stop it. Withdrawal symptoms may begin between 12 hours to  7 days after stopping but most between 24 and 48 hours.  Agitation is the most common symptom and is reported by half of those experiencing symptoms of withdrawal. Confusion and disorientation have also been reported, along with sweating, stomach complaints, and insomnia. 
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Benzodiazepines. Prescribed for short-term use for anxiety symptoms, this whole class of medications, including Alprazolam (Xanax), Lorazepam (Ativan), and Diazepam (Valium), cannot be abruptly discontinued IF you’ve been using them for more than a few weeks. Symptoms are more common in those receiving high doses or who’ve been on prolonged treatment. Rebound or withdrawal symptoms, including seizures, may occur following abrupt discontinuation or significant decreases in dose. The risk of seizures is greatest 24 to 72 hours after you stop, so instead, decrease your doses slowly and monitor for withdrawal symptoms. 

Propranolol. Beta-blockers like Propranolol are prescribed to treat high blood pressure, palpitations, and anxiety symptoms. While all beta-blockers may have a mild effect, Inderal (propranolol) is a short-acting beta-blocker, and rapid discontinuation may lead to withdrawal syndrome.  In addition to a rise in blood pressure, beta-blocker withdrawal in folks with underlying heart disease can lead to chest pain and even more severe problems.  The crazy thing is this can occur even in patients who have no previous history of heart issues.

Clonidine (Catapres). Clonidine (Catapres) tablets and Catapres-TTS patches are used to treat high blood pressure. Stopping them abruptly may result in a surge of catecholamine release. Rebound very high blood pressures can occur, so Clonidine should be weaned slowly. If you’ve been on higher doses of Clonidine, this is more likely to occur. Don’t stop this on your own. 

Prednisone/Steroids. Prescribed as potent anti-inflammatories for various conditions, including asthma, allergies, hives, inflammatory arthritis, gout, etc. If you’ve been taking prednisone for more than 1-2 weeks and just stop it, you may get into trouble. Why? When you are taking prednisone tablets, your adrenal gland production of cortisol declines. When you abruptly stop your prednisone, the result may be low cortisol, causing weakness, nausea, vomiting, diarrhea, and abdominal pain. It’s not fun and can be very serious. Wean it off. 
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Baclofen. Prescribed to decrease muscle cramps, spasms, and rigidity, including in folks with spinal cord injury and multiple sclerosis, Baclofen withdrawal is more common when administered directly into the spinal canal but can also occur with tablets. Interestingly, Baclofen is used for alcohol withdrawal syndromes. Withdrawal symptoms include restlessness, insomnia, confusion, hallucinations, seizures, psychotic manic or paranoid states.

 Opioid pain medications.  Opioids are prescription analgesics like codeine and morphine, and if you’ve been taking them long term, abrupt discontinuation produces symptoms like diarrhea, generalized pain, restlessness, and anxiety. Withdrawing from opioids is no joke; wean them down. 

Dr. O.