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Are your medications making you feel sleepy?
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Do you feel weak or tired — sometimes to the point of exhaustion — much of the time? If so, you’re not alone. Chronic fatigue accounts for more than 10 million visits to family doctors every year.
Chronic fatigue has many causes, including illnesses such as anemia and multiple sclerosis as well as depression and other psychiatric disorders. But it’s also often a side effect of drugs previously prescribed for other conditions. (I’m not talking here of the complicated disorder known as chronic fatigue syndrome, whose cause is unknown. This condition is characterized by extreme fatigue that can’t be explained by any underlying medical condition.)
Could one or more of the medications you’re taking be making you feel listless or lethargic? Read below to learn about the major classes of drugs that can cause chronic fatigue. If you suspect that your symptoms might be linked to a medication you’re taking, talk to your doctor or health care provider right away. It’s important that you do not discontinue them on your own.
1. Blood pressure medications
Why they’re prescribed: All blood pressure medications — and there are at least eight categories of them — are used to lower the pressure inside blood vessels, so the heart doesn’t have to work as hard to pump blood throughout the body.
Top-selling blood-pressure medications include lisinopril (Prinivil, Zestril), an ACE inhibitor; amlodipine (Norvasc), a calcium channel blocker; hydrochlorothiazide (HCTZ and various other brand names), a thiazide diuretic; furosemide (Lasix), a loop diuretic; and metoprolol (Lopressor, Toprol), a beta blocker. Fatigue is also one of the most common side effects that occurs with aliskiren (Tekturna, Tekturna HCT), which belongs to a newer class of drugs called renin inhibitors.
How they can cause fatigue: Blood-pressure medications may slow down the pumping action of the heart as well as depress the entire central nervous system, or, in the case of diuretics, deplete electrolytes that the body needs.
Check the safety information that comes with your blood pressure medications and you may well see “extreme tiredness” listed as a side effect. That’s an important sign that your fatigue could be drug-induced.
Alternatives: Talk with your doctor or other health care provider about switching to another type of blood pressure medication. For older patients, a benzothiazepine calcium channel blocker, such as diltiazem (Cardizem), is often the best choice.
An omega-3 fish oil supplement may help to lower your blood pressure, too. Be aware, though, that omega-3s can slightly raise levels of LDL or bad cholesterol, and other research has shown these may increase the risk of prostate cancer.
A natural benefit: Omega-3 fatty acids are also thought to be natural fatigue fighters. One 2015 study shows that metabolism increased while resting and exercise heart rate dropped in older women who took omega-3 supplements that contain 2 g EPA, 1 g DHA for 12 weeks. However, whether omega-3 actually improves resting metabolism and exercise heart rate remains unclear because there are many conflicting studies.
2. Statins and fibrates
Why they’re prescribed: Statins and fibrates are used to treat high cholesterol. The top-selling statins are atorvastatin (Lipitor), rosuvastatin (Crestor) and simvastatin (Zocor); the top-selling fibrate is fenofibrate (Tricor).
How they can cause fatigue: Studies show that statins stop the production of satellite cells that give rise to muscle tissue, stopping muscle growth. Some researchers have also suggested that statins interfere with the production of energy in cells in the same way that they interfere with the production of cholesterol.
Muscle weakness and severe muscle aches throughout the body can be symptoms of statin-induced rhabdomyolysis, a rapid breakdown of skeletal muscle that causes muscle fibers to be released into the bloodstream. A substance called myoglobin within the muscle cells that is released can result in severe kidney damage and even kidney failure.
Alternatives: If you’re among the many millions of older Americans without known coronary disease who are taking these drugs, ask your doctor or other health care provider about treating your slightly elevated cholesterol with a combination of sublingual (under-the-tongue) vitamin B12 (1,000 mcg daily), folic acid (800 mcg daily) and vitamin B6 (200 mg daily). Also, red yeast rice, a supplement first used in traditional Chinese medicine, has been found to be almost as effective as some of the moderate statins when used for short periods of time. But it also may cause some of the same muscle problems as the pharmaceutical products.
3. Proton pump inhibitors
Why they’re prescribed: Proton pump inhibitors are used to treat gastroesophageal reflux disease (GERD) and other similar disorders. More than 20 million Americans take prescription PPIs, including esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec) and pantoprazole (Protonix), some of which are available over the counter.
How they can cause fatigue: Patients who take PPIs for as little as three months are at risk of low blood levels of magnesium, which can cause loss of appetite, fatigue and weakness, among other symptoms.
Alternatives: The FDA has advised doctors and other health care providers to obtain serum magnesium levels before prescribing PPIs and then periodically thereafter.
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