RxISK’s SoS Zone: Symptoms on Stopping

[Note: The current version of the Withdrawal Zone works differently than described below.]

Birth of the SoS zone

Backed into a corner by Panorama’s Shelley Jofre in 2003, GSK’s Alastair Benbow was faced with an accusation that GSK’s Paxil – Seroxat was addictive. No it’s not he said. He had a snag though, he couldn’t use the words withdrawal or dependence, as to most people these sound like addiction words. Around 1995, the SSRI companies spent millions trying to rewrite the English language getting doctors to stop using “withdrawal” and to start using “discontinuation” instead.

But soon after discontinuation was coined, Lilly launched an attack on GSK, saying Paxil-Seroxat was bad for discontinuation problems. Discontinuation began to develop its own unsavory odor. So for a few reasons Alastair couldn’t used discontinuation. Whether it was a flash of inspiration or blind panic, he reached for the closest lifeline – people can have Symptoms on Stopping, he said. And so RxISK’s SoS Zone was born.

SoS problems happen on a range of drugs from treatments for gastritis and heartburn to beta-blockers for hypertension or antidepressants and SoS after many of these drugs can be far worse than the abuse problems linked to opiates, speed or other drugs of abuse. The SSRIs and antipsychotics may be the worst drugs there are in terms of the long-term consequences with the benzodiazepines not far behind, but a host of other drugs cause problems from the PPIs used for gastric problems and heartburn to osteoporosis drugs, dopamine agonists and others.

The table below drawn from the FDA data on RxISK will be a surprise to many. But even this is not complete. There are unquestionably other drugs that cause problems. Few people on PPIs, contraceptives or other drugs realise they might have serious SoS – they tend to think or may be told that any problems stem from their underlying illness.

In terms of handling the problems Symptoms on Stopping throw up, there are a series of papers on RxISK that offer help. These are Dependence and Withdrawal, Stopping Antidepressants and Medicine Induced Stress Syndromes. We will need help from readers to broaden these out to cover all drugs.

We also need to get as many as possible report SoS problems to us even if its less than clear whether the problem links to medication or the illness. The SoS Zone comes with a terminator algorithm that can help you in cooperation with your pharmacist, nurse or doctor work out whether the problem you are having is likely to stem from your treatment or your illness.

Drug Group	SoS	Abuse	Addiction	Dependence	Intoxication
Anticonvulsants	2,360	749	834	684	2,611
Anti-Clotting Drugs	201	192	209	143	584
Antipsychotics	1,849	901	727	505	5,411
Benzodiazepines	1,985	2,575	1,762	1,197	2,751
Benzo – Z Hypnotics	382	434	439	298	451
Cardiovascular Ds	245	392	217	120	2,125
Dopamine Agonists	135	165	158	143	344
Gastric – H2 Blockers	18	39	54	40	69
Gastric – PPIs	193	44	75	62	415
HRT & Contraception	309	33	34	26	588
Monoclonal Antibodies	177	86	122	105	953
Opiates	4,830	7,460	8,323	4,679	2,861
Osteoporosis Ds	299	276	244	249	981
Statins	118	46	41	35	493
Steroids	181	53	105	97	856
SSRI & SNRIs	17,515	2,407	2,934	2,409	5,171

Profiling the data

The data in this table intrigue and fascinate. Over the next few weeks we will present tables with each of these drug groups in turn so you can see how your particular drug compares with other drugs in the same group. Quite aside from the drugs in each of these tables you will be able to look up other treatments for your condition and see how they compare.

As might be expected, addictive and abuse behaviors are found more with opiates than any other drugs but the benzodiazepines and antidepressants are not far behind.

Drunken or intoxicated behavior is a well known feature of steroid treatment but the table shows it also happening on anticonvulsants and antipychotics.

The oral contraceptives are well-known to cause rebound difficulties from severe skin problems to depression, and these show up here. But equally there are almost as many SoS reports on drugs for osteoporosis as well as on PPIs like esomeprazole or lansoprazole. The PPIs are not well known as causing withdrawal and osteoporosis drugs even less so. The osteoporosis drugs show up as dark horses with a substantial rate of reporting of abuse and addiction.

One of the most interesting groups here are the Biologicals or Monoclonal Antibodies, a drug group that includes well know drugs like Humira, Tysabri, Lucentis and Enbrel. These are the most expensive drugs in medicine and possibly the most lethal. They are expensive because their use was supposedly going to be restricted to relatively rare serious disease states but they are increasingly being promoted for minor conditions with young men being asked by Abbott, the makers of Humira, to consider if their backache might be ankylosing spondylitis. Against this background, this rate of SoS and intoxication problems suggests this is a drug group to watch.

Over the next few weeks we will break out the data on individual drugs starting with the dopamine agonists, next week. The dopamine agonists as can be seen here are linked to reports of abuse, addiction, and dependence as might be expected of drugs that are closely related to Crystal Meth. But what is striking as well are the number of reports of withdrawal or discontinuation problems – there is an increasingly well defined DAWS or Dopamine Agonist Withdrawal Syndrome.

Some health warnings

1. The presence of a 0 in some later tables means the drug is not available in the US but is in Europe or elsewhere.
2. The data on the benzodiazepines is short-changed at the moment; it will be updated as we load more drugs into the mix.
3. We have missed Clozapine in the antipsychotic group. This has some of the most serious withdrawal problems in medicine.
4. The lower rate of problems for older drugs in all groups in the tables that follow is misleading. These data do not go back before 2004.