Drug Holiday Risks and Benefits

A drug holiday is defined as the conscious decision to stop using a regularly-prescribed medication for a period of time. Also known as a "medication vacation," drug holidays have been prescribed for a wide variety of medications and medical conditions and may be considered in order to decrease side effects, to reduce tolerance, for special holidays and events, and more. While there can be a number of benefits of a drug holiday, there are also potential risks, such as a worsening of symptoms or even the chance that medication will no longer be effective when restarted. We will take a look at the risks and benefits to consider as well as questions you may wish to ask your healthcare provider.

Overview and Definition

A drug holiday doesn’t sound like something a healthcare provider would prescribe, but sometimes it can be exactly what the doctor orders. As a conscious decision made between you and your healthcare provider, forgetting to use a medication, running out of pills, or stopping a medication without discussing the change with your healthcare provider do not classify as a drug holiday. In medical lingo, a medication vacation is referred to as a “structured treatment interruption,”​ and requires that the joint decision be made for a period of hours, days, or months, and for a particular reason.

Reasons For a Drug Holiday

There are many reasons your healthcare provider may recommend, or that you may suggest, an interrupted use of prescribed medication. Some of these include:

• To Diminish the Side Effects of Medication: Most medications come with at least a few side effects. Temporarily stopping a medication may give you a break from these side effects, and in some cases, they don’t return when a medication is resumed. Some of the side effects that may have you wishing for a medication vacation include fatigue, loss of sexual drive or potency, nausea, sleep disruption, or loss of appetite on your medication.
• To Allow the Use of Another medication: It’s well known that one medication can interact with another, and the more medications you're taking, the more likely this is to occur. An example of this would be if your healthcare provider recommends temporarily stopping a medication you're using regularly while you're prescribed another medication, such as an antibiotic for an infection.
• To See If You Still Need the Medication: Perhaps you have made some lifestyle changes, e.g. you quit smoking or lost weight, and now you and your healthcare provider aren’t certain whether you still need your blood pressure medication. Or you have been in psychotherapy and have developed healthy coping mechanisms to manage your stress, and would like to taper off your anti-anxiety medication. In situations like these, a drug holiday may be recommended as a form of trial to see if you still need the medication.
• To Decrease Tolerance To the Drug: Medication tolerance can develop with several medications, requiring higher doses to achieve the same desired effect. Through stopping medication for a period of time, your body may again become sensitive to its effects (it may become effective again), or you may require a lower dosage. Sometimes, a drug holiday is recommended before tolerance develops to maintain sensitivity to the drug.
• To Allow the Medication to Become Effective Again: In some cases, if a drug no longer works for a condition, discontinuing it for a period of time may allow it to once again become effective. One type of medication used for lung cancer, for example, loses effectiveness over time as the tumor becomes resistant. In some cases, however, it's been found that a tumor was again sensitive to the medication after it was stopped for a period of time.
• Weekends and Summer Vacations: Some medications, such as ADHD medications that are used to help students concentrate, may not be needed when school is out of session. Discontinuing the medication during summer vacations and on weekends is referred to as an ADHD Drug Holiday, and can help with growth, appetite, and sleep problems.
• For Special Events: Your high school reunion is coming up, and you really want to have a glass of wine at the celebration, but your medication requires that you avoid alcohol. There are many alcohol-medication interactions. In some cases, your healthcare provider will advise a drug holiday so that you can enjoy a special time before returning to your regular schedule of treatment.
• For Surgery: If you are taking a blood thinner, your surgeon may recommend stopping your medication for a period of time before and after surgery. 

Possible Benefits

The benefits of a drug holiday will depend on the reason for the holiday, but may include:

• The renewed effectiveness of the medication
• Decreased tolerance for the medication
• Reduced side effects of the medication
• A “vacation” from the side effects of a drug
• Ability to discontinue medication if it's found to be unnecessary
• Renewed motivation if a medication vacation deems that a medication truly is needed

Possible Risks

Just as there may be benefits, there are always risks to consider if you temporarily stop a medication. It's important to note that some medications cannot be stopped without weaning. For example, the abrupt discontinuation of some anxiety drugs can be life-threatening. Some of the potential risks of a drug holiday include:

• Loss of effectiveness. In some cases, when a medication is stopped and started again, the effectiveness is lost. In the case of some viruses, like HIV, skipping medication can allow the virus time to multiply, mutate, or develop resistance to the medication. If there is not an alternative medication available for your condition that might be effective, this could risk control of your disease.
• Complications of the condition. Many drugs are used in an attempt to prevent complications of a medical condition, such as treating high blood pressure to reduce the chance of a heart attack. A drug holiday from heart medication may not be in your best interest. Even taking a drug holiday from using osteoporosis medications may increase the risk that a fracture will occur.
• Relapse. Stopping a medication that is controlling a condition may cause the condition to recur or flare, and the damage from the relapse may be irreversible. For example, when osteoarthritis flares up, it can cause permanent damage and deformation to the joints. Likewise, a COPD flare can result in scarring to the lung tissue.
• Rebound of symptoms. In some cases, after stopping a medication, there is a resurgence of symptoms that are even worse than before. This can be frustrating when it comes to nasal congestion, stomach upset, and headaches, but takes a serious and sometimes fatal turn when it is related to depression or a serious heart condition. You may even need higher doses of medication to again get symptoms under control.
• Excessive drug effects (and side effects). After a period of time without the drug in your system, the effect of the drug may be stronger when it is resumed. This could be the desired effect or could be a dangerous/lethal effect if not resumed at lower doses. In addition, the same side effects may be experienced when resuming medication. If you had difficulty coping with the initial side effects when starting a drug, you may experience the same thing when you restart the drug.
• Poor medication compliance. Starting and then stopping a medication may make it more difficult to stick with a routine.

Questions to Ask

Before taking a drug holiday, make sure to ask your healthcare provider about any concerns she has, and what her experience has been when other patients took a drug holiday from the medication you are using. Specific questions may include:

• Is this the right time to try a drug holiday?
• What are the risks and benefits associated with a drug holiday for this specific medication?
• What side effects might I experience?
• Is there a chance the medication will no longer work if I stop it for a period of time?
• Whom should I call if I experience side effects on a night or weekend?
• Under what circumstances should I restart the medication?
• How long will I be stopping the medication?
• When should I schedule a follow-up visit?
• What symptoms should I watch for and when should I call?

Bottom Line

There are many possible benefits that may come from taking a drug holiday, but there are risks as well. If you are considering taking a drug holiday, discuss all of these pros and cons carefully with your healthcare provider, and only do so with her guidance.