Is Your Prescription Making You Tired?

two prescription bottles with pills next to them
Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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More than one in ten visits to a primary care doctor is for fatigue. Fatigue is composed of three major components: generalized weakness (difficulty in initiating activities), easy fatigability (difficulty in completing activities), and mental fatigue (difficulty with concentration and memory). While certainly not the only answer, medications may cause fatigue. Here are some of the common culprits.   

Beta Blockers

Beta-blockers wear many hats. They are commonly prescribed to improve survivability after a heart attack, lower blood pressure, help prevent a migraine headache, and control heart rate in atrial fibrillation. But, there is a downside. They can make you sleepy.

Carvedilol (Coreg), atenolol and metoprolol are common offenders when it comes to fatigue, occurring in more than 10% of people taking them. In fact, a quarter to half of the folks taking beta blockers discontinue their use during the first year of taking them, often for fatigue.

Pro tip, starting at low doses and titrating up will help with the fatigue so lower doses of beta blocker, increasing over time, is the way to go.

Antihistamines

These are medications used for allergies, hives, nasal congestion, and itchy rashes. Benadryl, Atarax and cyproheptadine are all very sedating, and most available over-the-counter. Over the counter meds ending in ‘pm’ like Tylenol PM contain Benadryl and of course will cause drowsiness.  

Although they are sometimes called “non-sedating” antihistamines, allergy meds Zyrtec (cetirizine), Allegra (Fexofenadine) and Claritin (loratadine) can also cause fatigue.

Muscle relaxants

Many folks taking muscle relaxants for back or neck pain have no idea these may make them feel like Gumby for a few days. Commonly prescribed muscle relaxants cyclobenzaprine, Soma (carisoprodol) and Zanaflex (tizanidine) are hugely sedating.

Two good options for muscle relaxants that work just as well and won’t make you nearly as tired are Skelaxin (metaxalone) and Robaxin (methocarbamol).  

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Antidepressants

12% of people taking serotonin reuptake inhibitors (SSRIs) like escitalopram, citalopram and fluoxetine report feeling sleepy. Studies indicate the SSRI paroxetine (Paxil) is the most sedating.

The serotonin-norepinephrine reuptake inhibitors Cymbalta (duloxetine) and Savella can also cause drowsiness and fatigue and Effexor (venlafaxine) is the most likely of the SNRIs to cause fatigue.

Amitriptyline and Nortriptyline are also used to treat depression, chronic pain, and migraine and cause drowsiness and fatigue. In some studies, up to 40% of folks taking these two reported fatigue. That’s high.

Another good option? Studies have shown that bupropion SR and XL (Wellbutrin XL) are just as effective as SSRIs for the remission of major depressive symptoms. Those taking bupropion are less likely to suffer symptoms of sleepiness and fatigue than those treated with SSRIs.

Topiramate (Topamax)

Topiramate causes drowsiness and fatigue in up to 15% of people using it. Commonly used for prevention of seizures, migraine headache and weight loss (Qsymia contains topiramate), Topamax carried the nickname Dopamax because those taking it may feel ‘dopey.’

The fatigue is worse the higher the dose. Also, the longer-acting expensive version of Topiramate called Trokendi XR is associated with more fatigue in patients than the generic Topiramate.

And last but not least

Dr O.

References:

Pattern of Adverse Drug Reactions Reported with Cardiovascular Drugs in a Tertiary Care Teaching Hospital. J Clin Diagn Res. 2015 Nov;9(11)

Discontinuation of beta-blockers in cardiovascular disease: UK primary care cohort study. International Journal of Cardiology Vol 167 (6) 10 Sept 2012 pages 2695-2699.

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