What is a Drug Holiday?

Definition and Risks and Benefits of Drug Holidays

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What is a drug holiday, and what should you know before taking one. istockphoto.com

What is a Drug Holiday?

A reader wrote in saying that her oncologist recommended a "drug holiday" from a medication she was taking for lung cancer. She asked what this meant, what she should be concerned about, and what questions she should ask her doctor.

A drug holiday doesn’t sound like something a physician would prescribe, but sometimes it can be exactly what the doctor orders. Also known as a "medication vacation," drug holidays have been prescribed for virtually every medication and medical condition.

What are some of the reasons your doctor may suggest a drug holiday, and what are the risks and benefits?

Definition of a Drug Holiday

A drug holiday is defined as the conscious decision to stop using a regularly-prescribed medication for a period of time. Forgetting to use a medication, running out of pills, or stopping a medication without discussing the change with your doctor does not classify as a drug holiday. The decision is a joint one by both you and your physician to discontinue a medication for a period of hours, days or months for a particular reason. In medical lingo, a medication vacation is referred to as a “structured treatment interruption.”

Reasons Your Doctor Might Prescribe a Drug Holiday

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

  • To diminish the side effects of a 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 physician 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 - If you and your doctor aren’t certain whether you still need a medication, a drug holiday may be recommended as a form of trial.
  • To decrease tolerance to the drug - Medication tolerance can develop to several medications, requiring higher doses to achieve the same desired effect. Through stopping a 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 one small study, it was found that the 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.
  • 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 doctor 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:

  • 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 a 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. Some of these include:

  • Loss of the effectiveness of the medication. In some cases, when a medication is stopped and started again, the effectiveness is lost.
  • A worsening of the symptoms of the condition the drug is treating. This can be serious, for example, if the medication is treating depression or a serious heart condition.
  • Risk of Relapse. Stopping a medication that is controlling a condition may cause the condition to recur or flare, and the relapse may be irreversible.
  • Rebound of symptoms. In some cases, after stopping a medication, you may need higher doses of medication to again get symptoms under control.
  • Excessive drug effects when the drug is resumed.
  • Increased risk of poor medication compliance. Starting and then stopping a medication may make it more difficult to stick with a routine.

Questions to Ask

  • Is this the right time to try a drug holiday?
  • What are the risks and benefits?
  • 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?

Sources:

Becker, A. et al. Retreatment with erlotinib: Regain of TKI sensitivity following a drug holiday for patients with NSCLC who initially responded who EGFR-TKI treatment. European Journal of Cancer. 2011. 47(17):2603-6.

Howland, R. Mediation holidays. Journal of Psychosocial Nursing and Mental Health Services. 2009. 47(9):15-8.

U.S. Department of Veteran Affairs. VA National HIV/AIDS Website. Should you ever take a ‘holiday’ from the drugs. Updated 10/03/11. http://www.hiv.va.gov/patient/treat/drug-holidays.asp

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