A Narcolepsy Patient Role Model
Meeta Goswami, Charles P. Pollak, Felissa L. Cohen, Michael J. Thorpy, Neil B. Kavey, Austin H. Kutscher, Jill C. Crabtree in Psychosocial Aspects of Narcolepsy, 2015
In my 18 years as chief executive officer of a high-tech growth company, I never required special treatment or accommodations due to my narcolepsy, although I generally avoided evening meetings or social affairs. At the time of my retirement, only my successor as C.E.O. was aware of my narcolepsy, as a result of my asking him for a contribution to narcolepsy research! I have no problem as a result of severe narcolepsy, although the drug laws have caused my doctor and pharmacist to be harassed periodically, and the cost of my medication has risen to ten times what it cost in 1969. I never take a daytime nap. In order for a narcoleptic patient to have a decent quality of life, special accommodations and naps on the job must be avoided. Our society is not able to provide special privileges in the work place. That is very unfortunate, but the way it is. I have never taken a "drug holiday," not even for a single day. What justification can be given for a patient to virtually withdraw from existence for two days out of seven? What benefit is gained from "drug holidays"?
Chronic daily headache: diagnosis and treatment
Stephen D. Silberstein, Richard B. Upton, Peter J. Goadsby in Headache in Clinical Practice, 2018
Increased activity of the on-cells in the pain modulation system of the brainstem could enhance the response to any painful or non-painful stimuli and result in sensitization. Ttie activity of this system is enhanced during opioid withdrawal. A similar mechanism may occur during drug-induced headaches. CM not associated with drug overuse may result from sensitization of nociceptors in the nucleus caudalis as a result of enhanced on-cell activity, which could be, in part, a problem of the network that modulates pain from the head and face. Continued high fluctuating doses of ergots, analgesics, or opioids could result in resetting of the pain control mechanisms in susceptible individuals, perhaps by enhancing on-cell activity, enhancing central sensitization through N-methyl-D-aspartate receptors, or blocking adaptive antinociceptive changes. Compensatory adaptive changes associated with frequent headaches (if they occur) may not be enough to allow continued drug effectiveness. If tolerance has decreased drug effectiveness, a drug holiday could renew the response.82 Drug overuse may, in part, prevent the occurrence of antinociceptive adaptive changes.
Medication for Pain
Harold G. Koenig in Chronic Pain, 2013
Cyclobenzaprine (Flexeril) and methocarbamol (Robaxin) are medicines that help to relax tense muscles and thereby ease pain. Muscles may be tense because of psychological stress, a response to inflammation, or the body’s response to pain itself. Whatever the cause, if muscles contract and tighten up, this reduces blood flow to the muscles—causing ischemia (lack of oxygen) that results in pain and inflammation. It is easy for a vicious cycle to develop, leading to more and more pain as muscles become more and more tense. Cyclobenzaprine and similar drugs help to interrupt this vicious cycle, increasing blood flow to muscles and reducing pain and inflammation. Sometimes very low doses of these medications are effective. For example, I have found that one-fourth of a 10 mg cyclobenzaprine at night helps to relieve my pain and keep me functional. Because my body will tend to get used to this small dose, I periodically need to give it a “drug holiday.” This means doing without the drug for a week or ten days, allowing my body to become sensitive to it again.
Investigating the effects of age, IQ, dosing, and anthropometric measures on the treatment persistence in long-term methylphenidate use
Published in Nordic Journal of Psychiatry, 2023
Mustafa Tuncturk, Cagatay Ermis, Dicle Buyuktaskin, Eren Halac, Ekin Sut, Oben Ozkan, Nazan Gundogan, Guldal Unutmaz, R. Ogulcan Ciray, Serkan Turan, Aynur Akay Pekcanlar
The sample was divided into two groups according to the persistence status of patients. Persistence was defined as the continuation of MPH for at least two years in our study without more than 4 months of unplanned discontinuation [31]. Persistence also endorsed drug holidays only when a clinician suggested intermittent discontinuation of MPH treatment [31]. A drug holiday was defined as a planned and periodic break from MPH use during school vacations based on the suggestion of a clinician [32]. In our clinical practice, after the first year of treatment, drug holidays are commonly suggested during school vacations to reduce tolerance and side effects (e.g. growth parameters, etc.) when children have no academic task. Patients and families who abided by clinicians’ decisions and continued MPH treatment in the following school term were counted in the persistent group.
Update on BRAF and MEK inhibition for treatment of melanoma in metastatic, unresectable, and adjuvant settings
Published in Expert Opinion on Drug Safety, 2019
Kristy Kummerow Broman, Lesly A Dossett, James Sun, Zeynep Eroglu, Jonathan S Zager
In a phase I trial (coBRIM) of combination vemurafenib and cobimetinib, patients with BRAFV600E/K-mutated melanoma who had progressed on vemurafenib monotherapy (n = 66) or never received a BRAF inhibitor (n = 63) were treated with maximum tolerated doses of both drugs (vemurafenib 960 mg twice daily, cobimetinib 60 mg daily for 21 days, then 7 day drug holiday) [78]. BRAF-inhibitor naïve patients had an objective response rate of 87%, with 6 (10%) CRs and median PFS of 13.7 months (95% CI 10.1–17.5). By contrast, only 15% (n = 10) of patients who had recently progressed on vemurafenib responded to combination therapy. In those patients who crossed over to combination therapy after progressing on monotherapy, only 9% responded, suggesting that patients are best suited to receive combination therapy up front.
Introducing sexual dysfunction in mental care
Published in Expert Opinion on Drug Safety, 2021
Marie Gombert, Pura Ballester, Ana Segura, Ana M Peiró
Drugs involving a low risk of SD should be preferred. To decrease SD as a side effect of a drug, choose olanzapine, ziprasidone, quetiapine, and aripiprazole, rather than paliperidone, risperidone, and amisulpride. Avoid serotonergic antidepressants and choose agomelatine or bupropion. Interestingly, adding or switching to another medication may also be associated with ADRs, and with the risk of favoring a prescribing cascade. The adjoint strategies for treatment should be personalized [56]: (a) Giving time for a spontaneous ADR reduction; (b) Total or partial suspected drug deprescription as ‘drug holiday’ that can be a suspension of drug for 2 days in the week following half-life pharmacokinetic data; (c) Switch to a drug with fewer SD; (d) Diagnose, monitor, and treat the specific ADR.
Related Knowledge Centers
- Adverse Drug Reaction
- Antidepressant
- Chlorpromazine
- Drug Tolerance
- Selective Serotonin Reuptake Inhibitor
- Sexual Dysfunction
- Immune System
- L-Dopa
- HIV
- Therapeutic Effect