What you need to know about stopping medication

There are some medicines I'm very keen for my patients to continue - especially 'preventive' medications such as those to control blood pressure, cholesterol and, if you have diabetes, blood sugar. You wouldn't notice if you stopped them, but not taking them would greatly increase your risk of complications ranging from heart attack and stroke to sight loss and amputations. With other medications, it may be safe for you to stop, but doing so too quickly could make you feel dreadful. So be tablet savvy and stay healthy.

Steroids

Your body produces its own natural steroids - in fact, you couldn't live without them. However, when you're given steroid tablets for any length of time, your body stops making so much of its own. Side effects of stopping long-term steroids too quickly include extreme tiredness and weakness, dizziness, poor appetite and weight loss, tummy pain, sickness and diarrhoea. The higher the dose, the more dangerous it is to stop too quickly.

Sometimes doctors prescribe short courses of steroids - for instance, for a flare-up of asthma, the lung condition COPD or the bowel conditions Crohn's disease or ulcerative colitis. You're likely to be given a high dose - say, 30 milligrams (mg) a day. But as long as you're only taking them for 7-10 days, it's usually safe for you to stop at the end of the course without tailing off. Stopping steroid inhalers suddenly doesn't cause withdrawal effects - but it could lead to a flare-up of your lung condition.

For other conditions like polymyalgia or rheumatoid arthritis, you may be prescribed long-term steroids, albeit at a lower dose. If you're taking steroids for more than a couple of weeks, you should always step down slowly (sometimes by as little as ½-1 mg a day reduction every week) and only under doctor's advice.

Reducing steroid side effects

It's worth bearing in mind that if you're taking steroid tablets long-term, you're at higher risk of osteoporosis. Lifestyle measures can help reduce your risk of steroid-induced osteoporosis. Your doctor should assess how high your risk is (this will depend on your age, sex, smoking and alcohol intake as well as the dose and duration of steroid treatment) and may well recommend regular treatment with tablets called bisphosphonates. You won't get any short-term side effects if you stop these, but you will be at higher risk of breaking a bone.

Antidepressants

Millions of people take antidepressants, and the majority don't have any problems coming off them. However, up to 1 in 3-4 people have side effects when they stop, particularly if they go 'cold turkey'. Side effects range from tiredness, headache, aching and sweating to anxiety and problems sleeping, and in some cases they can be extremely debilitating.

Doctors are becoming much more aware of the risks of these sorts of withdrawal effects, and no longer prescribe antidepressants for mild depression. When you start antidepressants, they take a few weeks to work, and you can develop short-term side effects (speak with your GP or pharmacist rather than stopping straightaway).

You have the best chance of avoiding a relapse in your depression if you continue the medication for at least six months after you feel better. If you've had severe or recurrent depression, you may benefit from longer-term treatment. Agree a plan with your doctor for tailing off medication slowly, and do go back to see them if you develop withdrawal side effects or your depression symptoms return.

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Painkillers

Headaches are another very common problem - almost everyone gets them occasionally. But some people have their lives blighted by severe daily headaches - and bizarrely, the most common reason for these is taking too many painkillers. If you take simple painkillers like paracetamol or ibuprofen at least three times a week, or codeine-based painkillers two or more times a week for at least three months, you run a risk of medication-overuse headache. Taking triptans (for migraine) at least twice a week for three months or more carries the same risk.

In this case, the only solution is to stop the tablets completely. This often means worse headaches for a few weeks, so you should do it with help from your doctor. They may be able to recommend an interim medication to help relieve the side effects of the withdrawal - for instance, medication to relieve nausea or a short course of anti-inflammatory tablets if your headaches were due to overuse of codeine-based painkillers or triptans.

Because your symptoms may get worse before they get better, pick a time to withdraw your medication when you don't have lots of commitments coming up.

Sleeping tablets

I probably have more arguments with my patients over sleeping tablets than any other medicine. Every doctor knows it's miserable when you can't sleep, but we also know sleeping tablets stop working well within just a couple of weeks. In fact, a study matching women who took sleeping tablets long term with those who didn't showed that taking those taking sleeping tablets had no better sleep than those who didn't

They've also been linked with a higher risk of falls and even deaths, regardless of whether you use them every day or a couple of times a month. So your doctor will undoubtedly be trying to get you to stop.

Unfortunately, along with worse sleep for weeks if you stop suddenly, coming off sleeping tablets (particularly temazepam) can leave you feeling anxious and jittery. Speak with your doctor about cutting the dose down slowly if you've been taking them for any length of time.