Abrupt Withdrawal

Clinically important consequences are known, and might occur for a variety of reasons, e.g. a patient interrupting drug therapy to undergo surgery. The following are examples:

• Cardiovascular system: (3-adrenoceptor blockers, antihypertensives (especially clonidine).

• Nervous system: all depressants (hypnotics, sedatives, alcohol, opioids), antiepileptics, antiparkinsonian agents, tricyclic antidepressants.

• Endocrine system: adrenal steroids.

• Immune inflammation: adrenal steroids.

Resurgence of chronic disease which has progressed in severity although its consequences have been wholly or partly suppressed, i.e. a catching-up phenomenon, is an obvious possible consequence of withdrawal of effective therapy, e.g. levodopa in Parkinson's disease; in corticosteroid withdrawal in autoimmune disease there may be both resurgence and rebound.

Drug discontinuation syndromes, i.e. rebound, withdrawal and resurgence (defined above) are phenomena that are to be expected. In many cases the exact mechanisms remain obscure but clinicians have no reason to be surprised when they occur, and in the case of rebound they may particularly wish to use gradual withdrawal wherever drugs have been used to modify complex self-adjusting systems, and to suppress (without cure) chronic diseases.

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