Believe it or not, some of the medications you’re using on a regular basis could cause a boomeranging of your symptoms, triggering them to come back (perhaps even stronger) after you’ve used the drug too long or stopped taking it. This phenomenon is often referred to as the rebound effect, and it can occur with pain relievers, nasal spray decongestants, whitening eye drops and proton pump inhibitors, among other drugs. Here’s a look at what’s behind this phenomenon, how to guard against it and what to do if it happens to you.
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Medication Overuse Headaches
Using combination analgesics (such as Excedrin), non-steroidal anti-inflammatory drugs, or NSAIDs, opioids, triptans or other acute medications for headaches two or more days per week over an extended period can lead to a rebound effect; under those conditions, these medications may induce more frequent headaches because the brain has become so used to having the drug present.
“Many of the people I see with chronic migraines have medication overuse, or rebound, headaches,” says Dr. Brian Grosberg, director of the Hartford Healthcare Headache Center at the Hartford HealthCare Neuroscience Institute in Connecticut. Indeed, a 2010 study from Munich, Germany, found that half of patients with chronic migraine had medication overuse headaches.
To prevent this phenomenon, “limit your use of acute pain medications to no more than two days per week consistently if you need them for an extended period of time,” Grosberg advises. If you have rebound or frequent headaches, wean yourself off of the overused medication under the supervision of your doctor and discuss a daily preventive treatment instead. “It may take weeks to months for these preventive medications to build up in your system enough to reduce the frequency and intensity of headaches,” Grosberg says, but it’s worth being patient.
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The Return of Red Eyes
Rely on a get-the-red-out variety of eye drops for more than three consecutive days and your eyes can become dependent on them. Because these drugs cause constriction of blood vessels to help remove redness, symptoms may increase with prolonged use of these drops, says Dr. Marguerite McDonald, a clinical professor of ophthalmology at the NYU Langone Medical Center. Basically, your eyes can become dependent on the active ingredients to prevent the symptoms from returning as the drops wear off. If you quit using them cold turkey, time it wisely because “the rebound redness will be significant for three to four days,” McDonald says. “An eye doctor can prescribe steroid drops to make withdrawal palatable.”
If your eyes are persistently red after you’ve kicked the whitening-drop habit, see an eye doctor to figure out the cause and a better treatment. “These drops should not be used to disguise chronic dry eyes, blepharitis, ocular allergy or other eye conditions that can cause chronic redness,” McDonald says. There are more effective treatments for each of these conditions that don’t trigger rebound redness.
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Rebound Congestion
If you use a decongestant nasal spray for more than four consecutive days, your symptoms could come back with a vengeance if you suddenly stop using the drug. The reason: When you stimulate the receptors in the nasal passages with the drug, the blood vessels constrict, shrinking the swollen tissues. But the longer you use the spray, the less the blood vessels respond to it, so congestion recurs and you need more of the drug to get the previous effect, explains Jack Fincham, a professor of pharmaceutical and administrative sciences at the Presbyterian College School of Pharmacy in Clinton, South Carolina. If you suffer from chronic nasal congestion, see your doctor to determine the underlying cause so that you can get a more appropriate treatment.
Boomerang Heartburn
If you take proton pump inhibitors, or PPIs, for chronic heartburn or gastroesophageal reflux disease (aka, GERD) and you suddenly stop taking them, you could get rebound symptoms. Here’s how this can happen: PPIs reduce the amount of stomach acid produced by glands that line the wall of the stomach. It’s hypothesized that when people stop taking PPIs, “the body ramps up production of gastrin, a hormone that stimulates stomach cells to start the production of acid,” explains Dr. Cindy M. Yoshida, a professor of medicine at the University of Virginia Digestive Health Center in Charlottesville. While gastrin levels are higher, stomach acid levels can rise and cause rebound symptoms. Indeed, a 2009 study from Copenhagen found that when healthy volunteers took a PPI daily for eight weeks then switched to placebo for four weeks, 44 percent of them experienced acid-induced symptoms after withdrawal.
If this happens to you, one option is to restart the PPI and gradually taper it off — by taking it every other day, then every third day and so on, Yoshida says. Another option is to use histamine receptor 2 antagonists (H2RA, for short), such as Zantac or Pepcid, or antacids when symptoms arise, Yoshida says. “Antacids and H2RAs don’t cause this [rebound] problem.”
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Are You Suffering From the Rebound Effect? originally appeared on usnews.com
