The rebound effect, or rebound phenomenon, is the emergence or re-emergence of that were either absent or controlled while taking a medication, but appear when that same medication is discontinued or reduced in dosage. In the case of re-emergence, the severity of the symptoms is often worse than pretreatment levels.
Definition
The rebound effect, or
pharmaceutical rebound phenomenon, is the emergence or re-emergence of
that were either absent or controlled while taking a medication, but appear when that same medication is discontinued or reduced in dosage. In the case of re-emergence, the severity of the symptoms is often worse than pretreatment levels.
Examples
Sedative hypnotics
Rebound insomnia is
insomnia that occurs following discontinuation of
sedative substances taken to relieve primary insomnia. Regular use of these substances can cause a person to become dependent on their effects in order to fall asleep. Therefore, when a person has stopped taking the medication and is 'rebounding' from its effects, they may experience insomnia as a symptom of
Drug withdrawal. Occasionally, this insomnia may be worse than the insomnia the drug was intended to treat.
Common medicines known to cause this problem are
eszopiclone,
zolpidem, and
such as
benzodiazepines which are prescribed to people having difficulties falling or staying asleep.
Rebound depression may appear to arise in patients previously free of such an illness.
Daytime rebound effects of anxiety, metallic taste, perceptual disturbances which are typical benzodiazepine withdrawal symptoms can occur the next day after a short-acting benzodiazepine hypnotic wears off. Rebound phenomena do not necessarily only occur on discontinuation of a prescribed dosage. Another example is early morning rebound insomnia which may occur when a rapidly eliminated hypnotic wears off which leads to rebounding awakeness forcing the person to become wide awake before he or she has had a full night's sleep. One drug which seems to be commonly associated with these problems is triazolam, due to its high potency and ultra short half life, but these effects can occur with other short-acting hypnotic drugs.
Stimulants
Rebound effects from
stimulants such as
methylphenidate or dextroamphetamine include stimulant psychosis, depression and a return of ADHD symptoms but in a temporarily exaggerated form.
Up to a third of ADHD children experience a rebound effect when methylphenidate is withdrawn.
Antidepressants
Many
, including SSRIs, can cause rebound depression,
panic attacks,
anxiety, and
insomnia when discontinued.
Antipsychotics
Sudden and severe emergence
or re-emergence
of psychosis may appear when
are switched or discontinued too rapidly.
Alpha-2 adrenergic agents
Rebound hypertension, above pre-treatment level, was observed after
clonidine and
guanfacine discontinuation.
Continuous usage of topical decongestants ( ) can lead to constant nasal congestion, known as rhinitis medicamentosa.
Humanized antibodies
Denosumab inhibits osteoclast recycling, which results in the accumulation of pre-osteoclasts and osteomorphs. When denosumab therapy is discontinued, the induced cells quite quickly and abundantly differentiate into osteoclasts causing
bone resorption (rebound effect) and increasing the risk of fractures. For improving mineral bone density and preventing fractures after denosumab discontinuation,
bisphosphonate administration is recommended.
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Other medications
Another example of
pharmaceutical rebound is a
rebound headache from painkillers when the dose is lowered, the medication wears off, or the drug is abruptly discontinued.
In 2022, reports of viral RNA and symptom rebound in people with COVID-19 treated with Paxlovid were published. In May, CDC even issued a health alert informing physicians about "Paxlovid rebounds", which received attention when US president Joe Biden experienced a rebound. The cause of the rebound is unclear however, since around a third of people with COVID-19 experience a symptom rebound regardless of treatment.
Abrupt withdrawal of highly potent , such as clobetasol for psoriasis, can cause a much more severe case of the psoriasis to develop. Therefore, withdrawal should be gradual, until very little actual medication is being applied.
See also
