Tired all the time, fatigued? The answer may be right in your medicine cabinet. Many of the medicine you and I take to control our blood pressure, reduce our bad cholesterol, control depression and anxiety, reduce allergies, have a nasty side-effect which your doctor may not tell you. (maybe because the suggestion that you might be tired will actually make you tires.)
Normally I don’t talk about myself in the columns (unless it’s for the purpose of transparency), but in this case I am the perfect example of what I am trying to convey, so I will be giving full disclosure of the meds I am taking and their impact on me.
For the past few years I have felt like I have chronic fatigue, waking up in the morning feeling I hadn’t slept well no matter how many hours I was asleep.
Daily naps around 2 p.m. were a necessity. I chalked it up to getting older – big 65 in September.
And then I read a medical story in AARP Health Newsletter (Sign up for the AARP Health Newsletter.) written by Dr. Armond B. Neel Jr. about the “9 Types of Medications That Can Lead to Chronic Fatigue, these drugs could be the cause of that tired feeling.”
It was an eye opener. It turns out I take six of the 9 drugs, no wonder I had been tired. I used the information in the article to consult with my internist (a wonderful doctor – Harvey Hameroff of West Hartford) and temporarily dropped one medication, cut back slightly on two, and changed the time that I took other meds. Before making ANY changes to your medical regiment you MUST talk to their doctor and maybe also your pharmacist.
Here are the nine classes of drugs Dr. Neel mentions in his article, which he said may be responsible for Chronic fatigue, which accounts for more than 10 million visits to family doctors every year.
1. Blood-pressure medications
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. Because omega-3 fatty acids are very important in preventing and managing heart disease, adding more fish to your diet and taking a fish oil supplement is almost certainly a good idea.
2. Statins and fibrates
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)
.3. Proton pump inhibitors
Alternatives: The FDA has advised doctors and other health care providers to obtain serum magnesium levels before prescribing PPIs and then periodically thereafter.
Alternatives: Talk with your doctor or other health care provider. Many patients with mild anxiety or insomnia don’t need benzodiazepines at all, but stopping or reducing the dosage of a benzodiazepine should always be monitored by a professional, as serious withdrawal effects can occur.
Alternatives: Newer-generation antihistamines such as loratadine (Claritin) and cetirizine (Zyrtec) are better tolerated by older patients and present a lower risk for fatigue.
Alternatives: Talk with your doctor or other health care provider about adjusting your antidepressant dose (side effects are often dose-related) or whether nondrug therapies might work just as well or better for you than a drug. You might also want to explore switching drugs, especially if you’re older and taking one of the tricyclic antidepressants, which are considered to be potentially inappropriate drugs for older people.
Alternatives: Talk with your doctor or other health care provider about the possibility of reducing dosage or switching to another antipsychotic drug. And if you’ve been prescribed an antipsychotic to help you sleep or for some other off-label use, you’d be well-advised to seek out more proven, safer treatments for your symptoms. (For instance, in older patients, especially, these drugs increase the risk of heart failure.)
Alternatives: I believe, as do many doctors and other health care professionals, that antibiotics are grossly overprescribed. If you have a minor bacterial infection, ask your physician if an antibiotic is really needed and if a natural alternative might the trick. Studies show that garlic, for example, fights bacterial infections and helps to prevent the spread of pathogens. But consultation with a health professional is essential, as garlic can interfere with blood thinners, nonsteroidal anti-inflammatory drugs (NSAIDs) and other medications.
Alternatives:Talk with your doctor or other health care provider about cutting back on your use of salt, exercising more and limiting your fluid intake. Ask the Pharmacist is written by Armon B. Neel Jr. in collaboration with journalist Bill Hogan.
So let’s take a look at the meds that I take regularly and what I did as the result of reading this article and consulting with my internist, which whom I have an excellent relationship – we both consider my health care to be a partnership where I am free to question and he is free to tell me that he knows for sure, what he is not positive about:
1. Blood-pressure medication, 2. Statins and fibrates, 4. Benzodiazepines, 5. Antihistamines, 6. Antidepressants, 7. Antipsychotics
The biggest change I made is to stop taking Crestor for six weeks to see what impact that has on raising my energy. I just stopped a few days ago and have not felt much difference. I will take a cholesterol test next month to see what change it made in my cholesterol readings. I am also taking fish oil supplements and adding more fish to our diet.
I have decided to also take two medications that prevent depression and anxiety – Effexor and Abilify at different times of the day. Even though both are 24-hour release meds, I have a suspicion that they are front-loaded, which means the initial few hours have more affect than the rest of the 24 hours. So I take Abilify – which can actually increase you energy, early in the morning, and I take Effexor in the evening along with Xanex – to help me sleep. I am cutting back slightly on the Effexor, trying to reduce from 225 mg to 150. In all cases where there are generics available, I take those.
Just when I thought there was not much I can do about drugs that control allergies to air pollution, I discovered a new generic med that I purchased at Costco a few days ago called Aller-Fex, which claims to be non-drowsy. So far it is working. When Singular generics are available at a reasonable price, I may try that.
I encourage everyone to read the COMPLETE article and take responsibility for your health by doing the necessary research. Consumer Reports, Wall Street Journal, and AARP are excellent starting places. And remember, when you place a chemical in your body – even an aspirin – it will have positive AND negative consequences. There is no such a thing as a medicine that only has benefits.
All three publications cost money, but isn’t your health worth the $125 a year getting Internet access to those excelent sources of information. And their stories will lead you to other great sources.
Interestingly, I am far from the only person who discovered the connection between these meds and their side effects. A friend told me that her husband Jack dropped
“Jack (my husband) always felt pretty fatigue and sore until he went off his cholesterol medicine. He lost weight and has a lot more energy —–and even his blood pressure is lower. (he does take a blood pressure pill). He has been watching his diet more closely and stopped eating cheese — which he loves and used to eat a lot of each week. That made a big difference for him. I think after a while the cholesterol medicine can do a number on your body,” Jack’s wife – who is in the health field, wrote me.
Two other Connecticut consumers also had experience with this issues:
“I’ve had lots of adjustments over the years with my meds, that I take almost all of them at night now and it seems to make me less fatigued during the day. My doc also lowered all doses down to the very smallest amount that still is effective. Standard doses “recommended” for me were way too strong. So that certainly helped too. I agree when you said that you think some of the drugs are “front loaded”, because that was my thought too.
Donna wrote me: “I’m on Lexapro for depression and Trazodone for sleep. I used to take statins for my cholesterol but the side effects were terrible. I don’t have a problem getting to sleep, it’s STAYING asleep that is the problem. I’ve been told it was age. (God I HATE that excuse). I’ll be 60 in February. Whoever said life begins at 40 is SOOOO full of it.”
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