I can inform you regarding Acetazolamide - it is possible to stop it suddenly without any negative inpact. I suppose the same regarding thiazide diuretics. In contrast, corticosteroids systemic or topical asan ophthalmic drops will tapered gradually

Thanks Dr. Marianne for your answer.

Yes, as I find it, most medications and psychotropic agents seems to have variable degree of withdrawal effects, including steroids and hormones. Even tylenol, theophylline, and few others like paracetamol also exhibit withdrawal symptoms if stopped abruptly. It's really hard to find medications which do not have withdrawal symptoms associated with long term use. Effects of withdrawing diuretic therapy have been discussed and studied widely in medical literature, and thiazide diuretics (considering the risk benefit ratio), seems to have mild dependence or rebound effects when stopped suddenly. I am trying to find other medications which have minimal dependence and withdrawal symptoms.

Best Regards, Sidharta

Antibiotics, especially antibacterials. They have minimal or no direct effect on the physiology of the patient as the bacteria is there target. In fact, I know of no antibiotic that is withdrawn in any matter other than instantly

Thanks Kevin for your answer. Yes you are correct. Exactly antibiotics, since they are either given for a limited schedule (short course), or over an extended period i.e., 5 days, 7 days,1- 3 months etc. I need to know what long term medications other than antibiotics (i am asking about general medications) that have minimal withdrawal effects.

Regards, Sidharta

In order to experience the symptoms of withdrawal, one must have first developed a physical or mental dependence. This happens after consuming one or more substances for a certain period of time, which is both dose dependent and varies based upon the drug consumed. For example, prolonged use of an anti-depressant is most likely to cause a much different reaction when discontinued than the repeated use of an opioid, such as heroin. Withdrawal symptoms from opiate abuse (such as heroin/morphine) include anxiety, sweating, vomiting, and diarrhea. Alcohol abuse withdrawal symptoms include irritability, fatigue, shaking, sweating, and nausea. Withdrawal from nicotine brings on irritability, fatigue, insomnia, headache, and difficulty concentrating. Symptoms and body response to the absence can vary from mild discomfort, or to the return of previous underlying medical problems and their respective symptoms. Many legal and unrestricted chemicals and/or substances available without prescriptions and over the counter can cause withdrawal effects when users stop consuming them, even if taken as directed.Fore more plz read at following link.

Regards

https://en.wikipedia.org/wiki/Drug_withdrawal

Bupropion (wellbutrin), an antidepressant and smoking cessation medication, had zero cases of withdrawal syndrome associated with it last time I checked. Low doses 150-300 mg/d generally do not need a taper. I generally do a quick taper (3-5 days) for inpatients taking doses of 450 mg/d.

Aripiprazole (abilify), an antipsychotic, had two case reports regarding withdrawal syndrome when I looked recently. I feel the level of evidence was poor for these cases. The terminal half-life is 70h for the parent drug and 96h for the active metabolite, making for discontinuation syndrome unlikely. I generally discontinue doses of 20 mg/d or less without a taper with no problems.

Thanks Dr. Mcgrane for referring to Bupropion which as far as literature on withdrawal syndromes is concerned, cause minimal dependence. However, there is a general view that withdrawal from antidepressants are bound to cause some withdrawal syndrome, only the intensity varies.  In fact, most drugs that belong to SSRI, MAOIs, TCA etc. have withdrawal symptoms associated with abrupt discontinuation.

So even this drug (wellbutrin) also seems to have some withdrawal syndrome related to sudden or even tapered withdrawal: e.g., mild depression, vomiting, headache, paraesthesia. As bupropion has no effect on serotonin system, perhaps its action on the dopaminergic system may attribute to mild withdrawal symptoms. But you are correct to point out that this phenomenon with bupropion is rare, which is true indeed, Only one case reports such an incident so far.

I found this case report which reports withdrawal symptoms associated with anti-depressant medication discontinuation. The paper highlights a case with bupropion1.

Otherwise, the case for Aripiprazole may be a strong evidence that it causes minimal withdrawal syndrome when tapered gradually.

1Bupropion-Associated Withdrawal Symptoms: A Case Report

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC181057/

Regards, Sidharta

Although your question looks quite simple it is actually quite complex.

Quite a lot of medications can be withdrawn abruptly but they may come with some minor or major physiological effects. These effects may be due to one of several possibilities I have listed just a few examples:

**The body being used to a certain level of therapy for a condition and now not getting it meaning the condition is noticed again. The simple example here is chronic paracetamol use in Osteo arthritis. If it was suddenly stopped I don’t think you would get true withdrawals from this but the patient would definitely notice the increase in pain. So it would be interpreted as withdrawal but it probably isn’t really classed as a clinical withdrawal.

**Many blood pressure medications can be stopped suddenly if needed (usually if they suddenly become hypotensive) but they also usually have quite a pronounced rebound hypertension effect. I also don’t think that this is classed as a true clinical withdrawal.

**Medications such as antidepressant, benzodiazepine, and opioid pain medication (And many more) have what I would call a true clinical withdrawal effect. This is where the patient, over time, develops a physical or psychological dependence on the drug. When these medications are stopped the withdrawal effects are more than just symptoms related to the disease state that they are used to treat. These effects can be quite varying and can be very severe and intolerable for the patient in some cases.

I guess it depends how we interpret the question. As all medications cause an effect on the body and if stopped they will no longer cause that effect, if the effect in question can be felt by the patient this can often be mistaken as withdrawal.

Just because a medication may cause some withdrawal does not exclude sudden stoppage. We have to decide if the need for suddenly stopping a medication outweighs any possible withdrawal issues. That is probably the more important point. It can be a case by case situation.

This is all just in my humble opinion.

Thanks Dr. Stephen for your insightful answer. Indeed when the need arises, some medications may be stopped suddenly which depends on how patients would respond to such abrupt withdrawal, i.e., it is different for subacute or chronic diseases when compared to acute illnesses, or, when the symptoms of a particular disease is reversed the drug can be withdrawn abruptly following clinical evidence of alleviation of acute conditions.

Regards, Sidharta

Certainly not a beta blocker.  I know of a case where a woman did not have enough money to refill her beta blocker Rx and stopped "cold turkey."  She was taking the beta blocker for the tx of angina.  As a result, she experienced some sort of cardiac event (probably a tachycardia) and died.  In general, I would be very cautious about stopping virtually any drug that has been taken over a long period of time (several weeks to months), especially if the drug impacts on the cardiovascular system or lowers BP.  Rebound effects can be quite severe and precipitate life-threatening effects.

Caution and safety always should be two parameters kept foremost in mind.  Primum non nocere!