Doctors normally spend much of their time telling patients to keep taking their tablets, especially if they have chronic or incurable conditions that need to be kept under control.
But what does it mean when your GP or specialist orders you to stop your medication, at least for a few weeks or months?
So-called ‘drug holidays’, where patients temporarily abandon their regular medicines, are a surprisingly common feature of medical practice.
In some cases, they’re recommended because of the drug’s severe side-effects. But there are some instances where taking ‘time off’ can actually be better for a patient’s health.
Prostate cancer, for example, is often treated with monthly hormone jabs to suppress the body’s production of testosterone, known to feed tumour growth.
These powerful drugs can have debilitating side-effects, ranging from impotence and hot flushes to swollen breasts and thinning bones.
In some cases, men have to be taken off the drugs for a few months to let these side-effects subside, before returning to treatment once more.
Canadian scientists, however, recently showed that men given such a holiday — usually lasting a few months — not only lived just as long as those who remained on continuous treatment but had a much better quality of life through being exposed to fewer side-effects.
Professor Steve Jackson, chairman of the Royal College of Physicians Joint Specialist Committee for Clinical Pharmacology, says drug holidays do have their uses but are not suitable for all types of chronic illness.
‘For example, in people who have epilepsy, it would clearly be a mistake to have a drug holiday as they could potentially have a seizure.’ He and other experts stress drug holidays should only ever be instigated by a doctor.
But what are the illnesses where drug holidays are used and could you benefit from some time off your medication?
Depression: Antidepressants can have a range of side-effects, including loss of sexual desire and impaired arousal in about 50 per cent of patients.
There’s some evidence a two-day holiday can lower the rate of sexual side-effects without increasing the risk of the depression relapsing.
One study found a two-day break led to a 50 per cent improvement in sexual function during the break.
However, holidays work better with drugs that clear the system quickly, such as Paxil, and not with those that clear slowly, such as Prozac.
Painkillers
Psychiatrist Dr Cosmo Hallstrom says: ‘Just as it takes several weeks for antidepressants to have any effect (on the symptoms of depression) when you start taking them, it also takes several weeks for the effects to wear off.
‘But the sexual impairment disappears almost straight away once you come off the pills.
This means most people can take a few days off without suffering a relapse in their condition.’
Osteoporosis: Bisphosphonates are prescribed for osteoporosis, as they slow the rate at which bone cells die. But the drugs have been linked to inflammation in the gullet, and, less commonly, to fractures, and damage to the jawbone.
U.S. scientists studied 139 men and women who’d been taking bisphosphonates for several years, and then came off them for five years. They found that during the holiday, patients’ bone density barely changed.
‘One theory is that bisphosphonates are retained in the bone for a long time,’ says Sarah Leyland, senior nurse at the National Osteoporosis Society.
‘So you could stop taking them and they will carry on working. But if you have a very low bone mineral density, and are at high risk of a fracture, you shouldn’t have a holiday.’
Migraine: Methysergide is commonly used to prevent migraine and cluster headaches.
It is a highly effective drug but can cause life-threatening fibrosis, a thickening of connective tissue around the heart, lungs and abdomen.
As a result, patients must not be on the drug for more than six months at a time, before having a one-month drug holiday.
If patients relapse during the month-long break, they use other anti-migraine drugs designed to ease attacks rather than prevent them.
High blood pressure: Hypertension has no obvious signs or symptoms and many people feel perfectly fine.
As a result, GPs are constantly trying to convince patients to keep taking their daily anti-hypertensive tablets, even though they are not suffering in any way.
Professor Jackson says one way doctors often get the message across is to give patients a couple of weeks drug holiday so they can see the effects on their blood pressure.
As the drugs leave their system, their blood pressure readings almost always creep up again.
