Correct me if I’m wrong with my premise. Let’s look at something like opioid tolerance. You take an opioid and (simplified) it attaches to opioid receptors in your body and you feel pain relief, euphoria, etc. The drug mimics the natural endorphin cycle that your body uses to control pain. However, the signal/receptor mechanisms in cells try to reach a homeostasis. This results in pharmacodynamic tolerance - as an agonist binds to the receptors in high numbers, the cells detect they’re being overstimulated and downregulate the number of receptors to that agonist drug (or in the case of an antagonist, the reverse). Then your reaction to the drug is reduced, and that’s tolerance. You need a bigger dose to have the same effect, and importantly, if you stop taking the drug, because the number of receptors has been downregulated, it actually changes your baseline function. In the case of opioids, your natural endorphins are less effective at blocking the pain because there are fewer receptors for them, and so when an opiate user stops using opiates, they actually experience more pain than they would if they never touched opiates.
But do all drugs have this sort of pharmacodynamic tolerance effect? Let’s say you take a blood pressure medication that binds to some sort of receptor and changes how your body regulates blood pressure. Does your body then upregulate or downregulate (depending on the particular action of the drug) the receptors that respond to it? Wouldn’t you become tolerant to it and need bigger doses in the same way that opioid users do? Wouldn’t you gradually make the problem worse, as you make the body’s baseline state have a function that works in the opposite direction of the drug? In this case, a higher baseline blood pressure without the medication.
Now, opiates are addictive because they release a pleasurable response, and not all drugs do that. That’s part of what drives the constant seeking of higher doses. But in principle, do medications that agonize/antagonize receptors have this sort of effect? It doesn’t seem so, as people don’t routinely increase the doses on their medication with use, and I’ve never heard anyone talking about having baseline levels of a problem actually increase because drugs have been used to treat it, but I don’t see why this wouldn’t be the case for all drugs.
My WAG is that the answer is no. Opiates (and similar, like tramadol) affect the brain differently from other medication.
Supposedly people who drink somewhat regularly develop a bit more tolerance to the effects of alcohol (though I don’t know if they genuinely are more functional, or are just better at coping after a drink or two). I would bet that a lot of medications that affect brain chemistry may have similar issues, but that is not based on anything other than my own guess.
NSAIDs don’t seem to have any kind of tolerance effect, in my experience. Longer-term use of course poses risks due to side effects, as the mild damage (e.g. to your stomach) doesn’t have as much time to heal between doses. I suspect that is the case with many classes of meds: the side effects are tolerable in the short term, but could cause problems in the longer t erm.
Medications losing effectiveness, requiring larger doses, due to the underlying condition WORSENING, is not the same as tolerance, of course.
One thing I’ve noticed (from personal experience, and from reading package inserts etc.) is that often there will be something about med side effects typically going away after a bit. I’ve always been a bit baffled by that, but when I use a nebulizer for the first time in a while, I give the local hummingbirds a run for their money the first couple of doses, then it settles down. No clue why.
Not a doctor, but my guess is no. I take Salbutamol for asthma. Salbutamol is a beta agonist. I’d be in a good deal of trouble if I ever developed a tolerance for that
IANAD -The bit I recall reading was about cold medications - “they make the cold worse”. What the articles really meant is, cold is a virus, and the medication does not affect the virus itself, it simply masks the symptoms. So you have a bad cold, stuffy nose, cough like crazy. When you pause taking the medication, the symptoms return. The contention is they may in fact be worse - your nose or lungs have being trying to rid itself of this irritation, and haven’t been allowed to. Now that this reaction is not repressed, that reaction comes back even stronger.
So I guess the question is - what does the medicine do, exactly? For a lot of medications, they are chemicals that suppress a body’s natural processes, or overdose on one of the components of the body’s function. SOme are like the proverbial hitting a delicate mechanism with a hammer to get it to work.
If this is true, I wouldn’t think it has to do with tolerance of your own body. Rather, I think it would have to do with the fact that your symptoms are ways that your body tries to kill the virus, remove it, or inhibit its replication (fever = heat; runny nose = physically removing germs from your nasal passageways; coughing = removing the virus from your airways; etc). If you mask the symptoms then this would presumably allow the virus to build up and make the situation worse.
However, I’m not sure how much of the work of fighting infection is done by these symptoms and how much is done by white blood cells. I would guess that your white blood cells can handle a common cold even without fever or coughing, so I doubt symptoms would actually grow worse.
I’m sure that’s true with alcohol. I rarely drink. If I have a full bottle of beer, or a large glass of wine, after not drinking for a few months, I feel it. If I’ve had a drink or two in the past few days, it takes two drinks to get the same effect. And for me, the effect is a negative. I want to hide in a corner and go to sleep. It definitely interferes with my enjoying myself.
When I travel to Germany and expect to drink beer regularly (because it can be easier to get than water) I sometimes “pre game” by having a shot of whiskey just before bed for a night or two. That lets me drink a glass of beer with lunch and still enjoy my afternoon.
There’s probably some degree of tolerance with any drug, but it varies a lot. As others have mentioned, there’s little tolerance to NSAIDs. And my gastroenterologist told me to stop taking H2 blockers like famotidine on a regular basis, and instead rely on PPIs like omeprazole. He said that H2 blockers are a good rescue drug, if I have a one-time incident and need help asap, but that if I take it every day I will develop a tolerance and it won’t help much. Whereas I can take PPIs indefinitely without them losing effectiveness.
(Note that there are downsides to being on PPIs, and I am not advising anyone to start taking them. But in my case, the downsides are less dangerous than my reflux disease.)
I think cold medications are in a class all by themselves. Yes, they mask symptoms without affecting the virus. But they go beyond that to a whole bigger tier. By masking symptoms they help sufferers lead their usual lives, going out in public and spreading the disease. Cold medications actually convert people who didn’t have a cold and weren’t using the medication, into people who do have a cold, and perhaps begin using the medication themselves. I actually think the people who market them take this into account somewhat, promoting a culture of working when contagious, hoping to get some business benefit by expanding the market base of people with colds. I think the advertisements focus a bit too much on the patient returning to circulation with the virus.
Pot doesn’t. Quite the opposite. It takes most people several tries to get high on marijuana the first time. Then once you’re an experienced toker, you can get a good head on from a single lungful.
Indeed. I and many others do a tolerance break. For two weeks every year I abstain. Otherwise I use it daily. During my tolerance break I have AMAZING dreams (I normally do not dream or do not remember my dreams).
After two weeks of abstaining, the first bowl is wonderful.
I have questioned this effect. It was noticeable in the good olde days when the weed was low potency and first time users often ended up coughing out most of the smoke, getting a headache, and burning itching eyes that would disguise what minor high they might achieve. My anecdotal experience is limited but I’ve never heard of anyone ingesting THC in properly made brownies the first time and not feeling the effect. This is certainly something that can be easily tested now outside of the old restrictions designed to prevent, obscure, and distort genuine scientific testing of the effects of THC.
I refer to myself as a micro doser with THC. That’s not because I don’t enjoy the high. If I go over that amount I get almost nothing out of it. I find I can only use it once a day, If I use a little bit too much one day I have to skip the next day or two. As long as I stay at a certain level I never seem to build any tolerance.
In order for tolerance to develop, there has to be a mechanism that explains that tolerance. For example, alcohol is metabolized by enzymes called alcohol dehydrogenases which are produced in the liver. If you drink alcohol, the liver over time produces more of the alcohol dehydrogenases.
If you lack one or more of these enzymes, a small amount of ingested alcohol can have an extreme effect. Aldehyde dehydrogenase 2 (ALDH2) deficiency affects 40% of East Asians and is responsible for “Asian flush syndrome”.
It’s fun when you have to drop the dosage or stop taking it. Years back, my doctor had me (briefly) on a QUADRUPLE dose of it for a few weeks. I dropped down from 4 to 3 tablets and was miserable for a few days until things settled - there was quite a rebound. Ditto when I went from 3 to 2, and 2 to 1, and on the rare occasions where I’ve run out of my PPI.
I don’t think rebound is quite the same as “building a tolerance” though. And I HAVE gone to a different / stronger PPI, but in my case that is the underlying condition worsening.
It could be virus load increasing, or even simply allowing conditions to continue that promote other problems. When I’ve had a bad cold that is turning into bronchitis, which often (In my case) brews a secondary infection, the general advice is to avoid cough suppressants - because all the crud my body is trying to hack up (including parts of my lungs, my toenails etc.), if left in place, is a dandy habitat for nasties to breed. And this in theory could cause a bad cold to go into full-blown bacterial bronchitis - i.e. making it worse.
But the original OTC meds or whatever don’t make the COLD ITSELF worse, they just - in theory - allow something else to happen.
I’ve been taking metformin for getting on to 20 years (type 2 diabetes). In the meantime I have lost 60 lb. The last couple times I was tested the blood sugR was low (A1C was 4.6, then 5.4) and the metformin dose was halved. So I am clearly not developing any resistance to it. Nor to my BP drugs either.
The only thing worse than getting old is not getting old.
Some people do develop tolerances to medications if they take them long enough, and this has nothing to do with addiction.
The first one that comes to mind is Zofran, the first 5HT3 inhibitor used mainly for chemotherapy-associated nausea and vomiting. Especially at the extremely high doses used for platinum-based chemo, for which only 5HT3 inhibitors are reliably effective, sometimes Zofran (ondanstron) becomes less effective. I haven’t heard of it losing effectiveness when used for other types of long-term nausea, like hyperemesis, although I suppose it’s possible.
And of course we’re all aware of antibiotic resistance, which isn’t quite the same thing.
