How do you wean off bystolic

Let them monitor your blood pressure. They can down-regulate the dose over a series of weeks allowing the dosage to taper off.

When you reach a level that your blood pressure remains stable with either a lower dose or finally no medication at all you are then safe to stop medicating. It can take a while. Sometimes you will need to keep going at the lower dose until your body gets used to it. In some cases it ends up being not advisable to drop the medication completely. Blood pressure and hypertension left unregulated can be detrimental to your entire circulatory system and can be a threat to your heart and life over time.

Many of the newer blood pressure medications do not have the same risks as many of the older medications. Many adults live life just fine with a low dose of blood pressure medication with no side effects. It simply helps to keep their heart pumping in a normal rhythm and pressure which allows the entire body to work better and more efficiently. If you are interested to learn what you can do for your health that is best to regular your blood pressure we would love to see you in for a consultation at Tampa Cardiovascular Associates in Tampa, Florida.

Or visit us online at www. You must be logged in to post a comment. Dr Marques first treated me when I was having a cardiac arrest. He explained to my family what was happening, what had to happen and what the results could be. He treated me by placing a tent to open up an artery. After four days in the hospital, I started office visits, twice a year, and this all happened well over ten years ago. He knows his stuff. Marques and staff is absolutely wonderful. Marques is very kind, patient, knowledgeable, and most importantly has a big heart who really cares for his patients.

He always has great advice. He listens to your situation, concerns, and takes the time to answer your questions. Sawar explained in detail my condition and how we were going to treat my condition.

South Island general practice support ». Practice acquisition and careers in health ». Click here to register ». Forgot your login? Login to my bpac. Remember me. A practical guide to stopping medicines in older people The majority of older people who require drug therapy take multiple medicines. In this article Polypharmacy increases the risk of adverse effects and medicine interactions How do you decide which medicines can be stopped?

What are the likely consequences of stopping medicines? How to stop medicines Specific guidance on stopping medicines References In this article. Key concepts The majority of older people who require drug therapy take multiple medicines Withdrawing medicines may be the best clinical decision Factors to consider when deciding if a medicine can be stopped include the wishes of the patient, clinical indication and benefit, appropriateness, duration of use, adherence and the prescribing cascade Only stop or reduce one medicine at a time Tapering the dose helps reduce the likelihood of an adverse withdrawal event.

Polypharmacy increases the risk of adverse effects and medicine interactions The majority of older people have more than one medical condition, more than one prescriber and take more than one medicine. How do you decide which medicines can be stopped?

Factors to consider when deciding if a medicine can be stopped include: The wishes of the patient Clinical indication and benefit Appropriateness Duration of use Adherence The prescribing cascade. Medicines can be grouped as: Those that keep the patient well and improve day-to-day quality of life e. In some cases, if these medicines are stopped, the patient may become ill or unable to function.

However, some drugs may be able to be stepped down, stopped or used on an as required basis prn e. Those that are used for the prevention of illness in the future e. A decision about whether to stop medicines such as these should include consideration of the risks and benefits of treatment for that particular patient, the length of time required for benefit and the life expectancy of the patient.

The wishes of the patient The majority of people who take medicines would prefer not to, or at least to take only those that are really needed.

Clinical indication Check that there is still a valid clinical indication and ongoing clinical benefit for each medicine. Appropriateness Check that the medicine is appropriate for use in an older person see below.

Benzodiazepines, which can cause excessive sedation and increase the risk of falls. Dextropropoxyphene, which can cause confusion and excessive sedation particularly in older people. Evidence shows that it is no more effective for pain than regular paracetamol use.

When considering any new medicine for an older person, check if it is appropriate by considering the following questions: Adapted from Holmes, 2 Is there an indication for the drug? Is the medicine effective for the condition?

Are there clinically significant drug-drug interactions? Is there unnecessary duplication with other medicines? Is the likely duration of therapy known and acceptable to both doctor and patient?

Will the patient take the medicine — what are the likely adverse effects, is the dose correct, are the directions practical? Is this medicine the least expensive alternative compared with others of equal usefulness? Duration of use Check how long the patient has been on the medicine. Adherence Check if the patient is taking all of their prescribed medicines.

The prescribing cascade When a patient presents with new symptoms, consider an adverse medicine reaction as a possible cause. Amitriptyline has anticholinergic actions which can cause urinary retention leading to overflow incontinence. If this is not recognised, oxybutynin may be prescribed, which aggravates the incontinence because it also has anticholinergic actions.

In addition, the patient then becomes constipated and a laxative is prescribed. One medicine has led to the use of three others. Stopping the amitriptyline and finding an alternative medicine for the pain may be the best action A patient taking a calcium channel blocker presents with ankle swelling. Avoid prescribing a diuretic as they are not effective in this situation.

How a medicine is stopped is likely to alter the risk of withdrawal symptoms For some classes of medicine e. For example, abrupt discontinuation of: A beta-blocker may result in rebound tachycardia, an increase in blood pressure and, in some circumstances, cardiac ischaemia. An antidepressant may result in withdrawal symptoms that are similar to those of depression, which may make it difficult to determine whether the original depression has returned, or if the symptoms are a result of the abrupt discontinuation.

A PPI is more likely to result in rebound hyperacidity. How to stop medicines Take a stepwise approach to stopping medicines A four step process can be used when stopping medicines: 13 Recognise the need to stop Reduce or stop one medicine at a time Consider if the medicine can be stopped abruptly or should be tapered Check for benefit or harm after each medicine has been stopped Recognise the need to stop a medicine When the patient presents for a renewal of medicine ask if they have any new symptoms including adverse effects or any concerns about their medicine.

A general guide to tapering medicine: Halve the dose. At the next scheduled visit review progress, then either: Maintain at half dose Continue to taper e.

Specific guidance on stopping medicines Antidepressants Benzodiazepines Antihypertensives Statins Warfarin NSAIDS Acid suppressants Bisphosphonates Oral Corticosteroids Antiparkinson agents Antidepressants Antidepressants should be tapered rather than stopped abruptly, to reduce the risk of developing a discontinuation syndrome and to allow time to assess the possible re-emergence of depressive symptoms Table 1.

Antidepressant Discontinuation Syndrome 16,22 Antidepressant discontinuation syndrome can occur with rapid discontinuation of any antidepressant. Symptoms are variable. Symptoms are likely to appear within one week of rapid dose reduction or abrupt discontinuation of an antidepressant. Symptoms are often mild and short lived and resolve without treatment in about ten days.

For patients with more severe symptoms the pre-reduction dose may need to be restarted which usually results in resolution of symptoms within 24 hours.

Subsequent tapering then needs to be at a slower rate. Table 1 : A guide to discontinuing antidepressants General tapering guide Withdrawal effects An antidepressant should not be stopped abruptly if it has been taken for six weeks or more The dose should be reduced gradually over at least four weeks, or longer if withdrawal symptoms emerge 17 Wide range of symptoms including anxiety, gastrointestinal disturbance, headache, insomnia, irritability, malaise, myalgia, recurrence of depression Specific classes Withdrawal effects SSRIs and venlafaxine Taper slowly over several weeks or months e.

There may be a delay before symptoms present for patients on higher doses of fluoxetine because of the longer half-life. Discontinuation syndrome appears to occur more frequently with paroxetine and venlafaxine.

This may partly be due to the shorter half-life of these drugs. TCAs Tricyclic and related antidepressants e. MAOIs Withdraw slowly Neuropsychiatric symptoms may be more prominent and include severe anxiety, agitation, altered sleep, hallucinations, delirium and paranoid psychosis Benzodiazepines Regular and prolonged use of hypnotics should be avoided because of the risk of tolerance to effects, dependence and an increased risk of adverse events.

Table 2 : A guide to discontinuing benzodiazepines Tapering guide Withdrawal effects Slowly taper the dose in steps of approximately one-eighth of the daily dose every two weeks 18 If withdrawal symptoms occur, maintain at the current dose until symptoms settle and then continue to taper, usually at a slower rate Wide range of symptoms including anxiety, mood changes, insomnia, palpitations, tremor, headache, gastrointestinal disturbance, muscle stiffness and spasms Benzodiazepine withdrawal syndrome Alternative withdrawal method 18 Dose equivalence 15,18,20 Transfer patient to an equivalent daily dose of diazepam, preferably taken at night Reduce the dose of diazepam every two to three weeks by 2 or 2.

If withdrawal symptoms occur, maintain this dose until there is improvement. Continue to reduce the dose, if necessary by smaller amounts. It is better to reduce too slowly rather than too quickly. Stop diazepam completely. The withdrawal period may vary from about four weeks to more than one year. Antihypertensives Beta-blockers are the cardiovascular medicine most often associated with adverse withdrawal events.

Table 3 : A guide to discontinuing antihypertensives 18 General tapering guide Withdrawal effects Most antihypertensives should be tapered. Taper dose at approximately monthly intervals, over three to six months. Wide range depending on the specific medicine and the condition being treated. May include ankle oedema, weight gain, headache, tachycardia, increased blood pressure, worsening heart failure or angina, myocardial infarction.

Specific classes Withdrawal effects Beta-Blockers Gradual dose reduction necessary Sudden withdrawal may cause or exacerbate angina Calcium channel blockers Consider gradual reduction Sudden withdrawal may exacerbate angina Thiazides It may not be practical to cut tablets so either stop or consider alternate day dosing initially then twice weekly dosing Possible exacerbation of the underlying condition Angiotensin-converting enzyme inhibitors Consider gradual reduction Possible exacerbation of the underlying condition.

Statins The decision to stop a statin is based on an assessment of individual benefits and risks. Warfarin In older people taking warfarin, low initial and maintenance dosages are recommended e. Table 4 : A guide to discontinuing warfarin Tapering guide Withdrawal effects Stop abruptly or Taper over several weeks A rebound hypercoagulable state with a risk of thrombosis, has been reported in some patients but this can occur even if the dose is tapered and may reflect the initial pro-thrombotic state for which treatment was started Table 5 : A guide to discontinuing NSAIDs Tapering guide Withdrawal effects Consider prn use or regular use at a lower dose Can be stopped abruptly or Halve the dose for two to four weeks then stop Review the need for gastric protection therapy i.

Acid suppressants Many people remain on acid suppressants despite there being no ongoing clinical indication e.

Table 6 : A guide to discontinuing acid suppressants General tapering guide Withdrawal effects Halve the dose for four to eight weeks then stop or step down to a less potent agent Consider providing an antacid for dyspepsia symptoms Recurrence of oesophagitis and indigestion symptoms Specific medicines Withdrawal effects Proton pump inhibitors PPI Consider alternate day dosing. Capsules cannot be halved. Bisphosphonates The beneficial effects e.

Alendronate can be stopped abruptly without the need for tapering. Table 7 : A guide to discontinuing oral corticosteroids Tapering guide Comments For patients who have been on corticosteroid treatment for three weeks or longer reduce the dose, e. Once the dose has reached 5—10 mg daily, reduce the dose more slowly, e.

Reduce more slowly initially if it is likely that the disease will relapse e. Antiparkinson agents The majority of patients respond initially to levodopa and its use improves the quality of life. Table 8 : A guide to discontinuing antiparkinsonian medicines Tapering guide Withdrawal effects Antiparkinsonian medicines should not be stopped abruptly as there is a small risk of neuroleptic malignant syndrome 18 Reduce the dose gradually over about four weeks Sinemet CR tablets are scored and may be administered as half tablets Hypotension, psychosis, pulmonary embolism, rigidity, tremor A symptom complex resembling the neuroleptic malignant syndrome may occur.

Symptoms include muscular rigidity, elevated body temperature, mental changes, diaphoresis, tachycardia, and tachypnea. There may be an increase in serum creatine kinase concentration. Measuring the quality of medicine use in older adults. J Am Geriatr Soc ; Reconsidering medicine appropriateness for patients late in life. Arch Intern Med ; Dilemmas in prescribing for elderly people. Why is it difficult? BPJ ; Prioritizing and stopping prescription medicines.

CMAJ ; 8 Holmes HM. Rational prescribing for patients with a reduced life expectancy. Clin Pharm Ther ;85 1 Managing comorbidities in patients at the end of life.

BMJ ; Potentially inappropriate medicine use in the community-dwelling elderly. JAMA ; 22 Inappropriate prescribing for elderly americans in a large outpatient population. Arch Int Med ; 15 Dextropropoxyphene — review concludes risk-benefit balance unfavourable. Prescriber Update ;31 1 Potentially inappropriate prescribing in an Irish elderly population in primary care.

Br J Clin Pharmacol ;68 6 Inappropriate drug prescribing in older adults: the updated Beers criteria — a population-based cohort study. Br J Clin Pharmacol ;60 2 Medicine withdrawal trials in people aged 65 years and older: A systematic review. Drugs Aging ;25 12 Discontinuing medicines: a novel approach for revising the prescribing stage of the medicine-use process. J Am Geriatr Soc ; 56 10 JAMA ;— Therapeutic Guidelines: Psychotropic.

Version 6. Melbourne: Therapeutic Guidelines Limited; Muzina DJ. Discontinuing an antidepressant? Tapering tips to ease distressing symptoms. Curr Psych ;9 3 Identification of common mental disorders and management of depression in primary care. An evidence-based best practice guideline. NZGG, Wellington, Managing Insomnia. Benzodiazepine and z-drug withdrawal. CKS, Available from: www.

Randomized clinical trial of supervised tapering and cognitive behavior therapy to facilitate benzodiazepine discontinuation in older adults with chronic insomnia. Am J Psych ; Serotonergic agents and discontinuation syndrome — reminder. Guidelines on oral anticoagulation warfarin : third edition — update. British Society for Haematology ;— Qvigstad G, Waldum H. Rebound hypersecretion after inhibition of gastric acid secretion.

Basic Clin Pharm Tox ; Sweetman SC. Martindale: The complete drug reference. Pharmaceutical Press, London, March Martin TJ, Grill V. Bisphosphonates - mechanisms of action. Aust Prescr ; Comments There are currently no comments for this article. Make a comment:. Please login to make a comment.