ADHD Medication Holiday

Why does a medication holiday work?

Question: What is a Medication Holiday?

Answer: A medication holiday is a deliberate, temporary suspension from medication. This differs from medication non-compliance. It can vary in length of time from a weekend, to a month duration. When considering a medication holiday, it typically involves the use of stimulant medications (eg dexamphetamine), not the non-stimulants (eg atomoxetine).

If you are considering a medication holiday it is important to discuss this with your doctor before commencing. Your physician may also refer to his break as a drug holiday, structured treatment interruption or medication suspension.

 

Indications for structured treatment interruption

A medication holiday can be recommended when:

  • assessment is required
  • evaluation of progress is indicated
  • to determine if medication is still necessary
  • assessment of current regimen (dose and frequency) of prescribed medication if recommended
  • if the medication is significantly impacting sleep patterns, and
  • if there are concerns regarding individuals’ weight that is a direct relation to medication use.

Factors to consider before a medication break

When considering a drug holiday also consider what type of ADHD does you child have? Hyperactive, inattentive or combined? Why? Because ADHD does not take holidays!

Yes, during the school holidays or on weekends children are not required to undertake academic tasks or required to sit and concentrate for extended period of time, however will their hyperactivity increase risk of harm, or will their inattentive lead to poor decision making?

Further it is important to consider:

  • the environment – is it new? will there be crowds? is there a quiet space available?
  • the people the individual will be spending time with – familiar people or new faces? what is the impact on play dates? and
  • overall wellbeing of the individual, actually ask them how do you feel on and off your medication?, not just the perceived non-school tasks undertaken.

The child’s well-being is the primary consideration and includes behaviours of impulse control, perceived safety (or lack of), reduced ability to focus, and heightened emotional stress. It is because of these for some individuals a medication holiday can be a negative and unproductive experience.

Medication profiles

Each medication has specific characteristics relating to absorption, distribution and elimination, these are referred to as pharmacokinetics. It is important to be aware of these when considering a medication holiday.

The table below outlines details for the three stimulant medications available in Australia. For each medication listed is the approximate data for peak absorption ie the maximum amount of medication absorbed by the body after oral ingestion; duration of action ie the length of time the medication is active in the body; and half life is the time taken for the concentration of a medication to reduce to half its original value.

Peak absorptionDuration of actionHalf life
Dexamphetamine
2 hours4 – 6 hours10 hours
Lisdexamphetamine (Vyvanse®)
3.5 hours13 hours9 hours
Methylphenidate (Ritalin®)
2 hours4 – 6 hours2 – 3 hours
Methylphenidate (Ritalin LA®)
Bimodal – 2 hour and 6 hours8 hours3 hours
Methylphenidate (Concerta®)
Bimodal – 1-2 hours, and 6 – 8 hours12 hours3 – 4 hours

 

How to implement the break from medication

If the combined decision is made for a medication holiday, the time frame will depend on the dose of prescribed medication. Most stimulant medication can be stopped abruptly ie without titration, however if your child is prescribed the maximum dose a weaning process is highly recommended (this will be instructed by your paediatrician or psychiatrist).

Strategies

An increased use and focus on non-pharmacological strategies may be necessary during a medication holiday. These include mindfulness, yoga, exercise, fidget toys, quiet spaces, and social stories. Your psychologist, occupational therapist or developmental educator will be able to assist you with these practices.

 

Indispensable Pharmacist tip: In Australia, prescriptions for stimulant medications expire 6 months from initial prescribing date, so if you are taking a medication holiday, keep an eye on these dates.  Should you need to talk to a pharmacist, we are ready to answer any questions you may have

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