A drug holiday is a temporary interruption of therapy. It typically lasts for a few days or weeks but the term may be used for longer periods. It is not intended to be a permanent discontinuation of all therapy.
Types of drug holiday:
(1) planned, as part of a therapeutic strategy
(2) accidental (travel, drug shortage, trauma, etc)
(3) self-determined by the patient (compliance issue)
Rationale in a therapeutic strategy:
(1) manage drug toxicity that has been difficult to manage
(2) simplify a complex regimen
Complications:
(1) retroviral rebound syndrome
(2) possibly emergence of a drug resistant clone
The need for caution may be greater if:
(1) the patient has advanced HIV disease
(2) the patient has multiple significant comorbid conditions
A patient with the immune reconstitution syndrome may be tempted to interrupt therapy but this should be managed differently.
Recommendations:
(1) Outline a plan prior to the holiday which includes goals.
(2) Monitor the patient carefully during the holiday for evidence of relapse.
(3) Reinstitute therapy if needed or according to the plan.
(4) Test for resistance if the patient does not respond to reintroduced therapy.
