Table 3:

Medications commonly associated with withdrawal-related adverse events (44), (45)

MedicationEffect of discontinuation*Withdrawal-related manifestations
Increased risk of discontinuation syndrome
Antianginal agentRecurrenceAngina
AnticonvulsantWithdrawal, recurrenceAnxiety, depression, seizures
BenzodiazepineWithdrawal, rebound, recurrence: common strategy is to taper by 10% of the dose every 1–2 wk until the dose is at 20% of the original dose, then taper by 5% every 2–4 wkSeizures, agitation, anxiety, delirium, insomnia
Beta-blockerRebound, recurrenceAngina, hypertension, acute coronary syndrome, tachycardia
CorticosteroidWithdrawal, rebound, recurrence if used long termAnorexia, hypotension, nausea, suppression of the hypothalamic–pituitary–adrenal axis
Decreased risk of discontinuation syndrome
ACE inhibitorRecurrenceHeart failure, hypertension
AntipsychoticWithdrawal, recurrence:
  • When used for behavioural and psychiatric symptoms of dementia, taper dose with goal to stop drug every 3 mo or more if clinically appropriate (taper by 25% every 1–2 wk)

  • Some behaviours decline as disease worsens

Dyskinesias, insomnia, nausea, restlessness
AnticholinergicWithdrawalAnxiety, nausea, vomiting, headaches, dizziness
DigoxinRecurrence: patients can usually be followed for signs and symptoms of heart failure and medication restarted as neededHeart failure, tachycardia
DiureticRecurrenceHeart failure, hypertension, edema
Narcotic analgesiaWithdrawal: if medication used long term, tapering will decrease risk of physical withdrawalAbdominal cramping, anxiety, chills, diaphoresis, diarrhea, insomnia
  • Note: ACE = angiotensin-converting enzyme.

  • * Recurrence = recurrence of original symptoms, withdrawal = symptoms associated with withdrawal, rebound = recurrent symptoms that are worse than the original symptoms.