Drug holiday for statin patients.
Drug holidays are a strategy in the management of many long-term conditions. They are periods during which the patient stops taking the medicine he or she has been taking, probably temporarily. The length of the drug holiday varies from a month to a year.
There are good reasons for drug holidays. The homeostatic impulse causes the body to adapt to medicines and efficacy often falls. After a drug holiday the medicine sometimes works better. The drug holiday also allows the body to take a break from negative side effects. This is often a rationale for holidays from harsh drugs used to treat HIV and cancer. Further, the absence of the drug in the body prompts the immune system to “step up” in some cases and this enhanced immunity may fight the disease in a different manner than the drugs and may continue even after the holiday is over.
Statins aren’t so toxic in most people that frequent holidays are needed, and indeed the consensus prescribing guidelines do not call for holidays. However, some feel they are warranted.
Statins are relatively new drugs in the long scope of history, and although they have been studied extensively, even the largest retrospective studies cannot account for the subtle effects over decades of use because there aren’t that many people who have been taking the drugs for decades. But going forward, it is likely millions of people will take statins for decades.
Which is an argument for employing holidays even when apparent side effects are limited or non-existent. There are no formal studies or guidelines we know of to state how long a statin holiday should be or how often it should occur or which patients should take them. Pharmaceutical companies don’t fund studies about holidays from their products.
However, there are anecdotes of statin drug holidays and some movement on the fringes. This is not the wild-eyed anti-statin hysteria you see in some quarters, but instead a sober approach to patient health.
A 6-week holiday has been proposed for patients who are suspected to be suffering bad side effects. While blood tests early in a statin regiment can find the worst effects on the liver, further and slow-developing side effects can be missed and patients may not associated muscle pain or memory loss with their statins. A 1.5 month break from statins is thought to be enough for side effects to fade and the holiday functions as a test to see if muscle weakness goes away. Some doctors at Scripps Mercy Hospital propose this and measuring physical grip strength to see if muscle weakness is affected. These doctors give the patients coenzyme Q10 and fish oil during the holiday and if symptoms are still present after 6 weeks, they propose extending the holiday another 6 weeks except in patients with heart disease. The doctors suggest using a different statin or a resin after the holiday.
Other doctors have supervised holidays for patients in certain circumstances. Here is a report of a patient removed from statin therapy during antibiotic treatment for pneumonia. The relationship between statins and pneumonia is unclear with suggestions that statins increase risk for lung infections and also that statins offer protection against lung damage.
Also see: Intermittent dosing