7 Medications That Can Make You Tired

About 20% of patients who see a family medicine provider complain of fatigue. Fatigue can be described as generalized weakness (difficulty starting activities), difficulty sustaining activities, difficulty with concentration and memory, or any combination of the above. 

While certainly not the only answer, several medications may cause fatigue, drowsiness, or sleepiness. Here are some of the common culprits.  

1) Antihistamines

These are medications used for allergies, hives, nasal congestion, itchy rashes, or as a sleep aid. 

• Diphenhydramine (Benadryl) and doxylamine (Unisom) are both very sedating and are available over the counter. 

• Hydroxyzine (Atarax) is an antihistamine that requires a prescription and also causes drowsiness. 

• Over-the-counter medications containing “Nighttime” in the name or ending in “PM,” like Tylenol PM, usually contain diphenhydramine or doxylamine and can cause drowsiness, too.  

• Although they are sometimes called “non-sedating” antihistamines, allergy medications such as cetirizine (Zyrtec), levocetirizine (Xyzal), fexofenadine (Allegra), and loratadine (Claritin) can also cause fatigue.

2) Muscle relaxants

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

3) Antidepressants

Antidepressant medications are used not only to treat depression and anxiety but also chronic pain and even insomnia. Several antidepressants may cause fatigue to different extents.

• Trazodone, an older antidepressant, causes sleepiness in 42% of people taking it and is commonly prescribed for insomnia.

• Serotonin reuptake inhibitors (SSRIs) like escitalopram (Lexapro), citalopram (Celexa), paroxetine (Paxil), and fluoxetine (Prozac), taken for depression or anxiety, can make you feel sleepy. 

• The serotonin-norepinephrine reuptake inhibitors (SNRIs) are similar medications used to treat depression, anxiety, and sometimes, chronic pain. They include duloxetine (Cymbalta) and venlafaxine (Effexor) and can also cause drowsiness and fatigue.  

• Amitriptyline (Elavil) and nortriptyline (Pamelor) are an older type of antidepressant known as tricyclic antidepressants. They are used to treat depression and anxiety, and they are used off-label for chronic pain and to prevent migraines. They too can cause drowsiness and fatigue, among other side effects. Providers tend not to prescribe them as often as other antidepressants due to their greater potential for side effects. 

Another option? Studies have shown that bupropion (Wellbutrin) is 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.

4) Topiramate

Topiramate causes drowsiness and fatigue in up to 15% of people using it. Topiramate is commonly used to treat seizures and prevent migraine headaches, and for weight loss (Qsymia contains topiramate). The drug carries the nickname Dopamax because those taking it may feel “dopey.”

The higher the dose, the worse the fatigue with topiramate. 

5) Beta blockers

Beta blockers wear many hats and include medications such as metoprolol (Lopressor), carvedilol (Coreg), bisoprolol (Zebeta), and propranolol (Inderal). They are commonly prescribed to improve survivability after a heart attack, lower blood pressure, control heart rate in patients with irregular heart rate (atrial fibrillation), and help prevent a migraine headache, among other uses.

Since beta blockers can lower your heart rate, people who take them may feel more tired than usual. Talk with your prescriber to see if starting at a low dose and slowly increasing the dose over time can help with fatigue. 

6) Narcotics

Narcotics like hydrocodone (Vicodin, Lortab, Norco), oxycodone (Roxicodone), and acetaminophen/codeine (Tylenol with codeine) are used for different types of pain, such as chronic pain, pain after surgery, and pain from cancer. They may make you sleepy.

7) Benzodiazepines

Benzodiazepines like lorazepam (Ativan), diazepam (Valium), and alprazolam (Xanax) are used to treat anxiety, insomnia, and seizures. They often cause you to feel sleepy as well.

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Dr O.