I take a lot of tablets and feel tired: could it be my medication?

Which medicines can cause tiredness, which other causes need ruling out and how to ask for a review without stopping any treatment on your own.

Yes, medication can be one of the causes of your tiredness. Several widely used groups of medicines (some for blood pressure, antihistamines, sleeping pills, tranquillisers, steroids or diuretics) can cause fatigue or drowsiness, and when you take several at once their effects can add up. But there are other possible causes too, so the sensible step is to ask for a review, not to stop tablets on your own.

Feeling drained affects your work, your mood and your wish to do things. In this article we help you spot clues, prepare for your appointment and know when to seek help without waiting.

Which medicines can cause tiredness?

MedlinePlus, the information service of the US National Library of Medicine, lists allergy antihistamines, blood pressure medicines, sleeping pills, steroids and diuretics among the medicines that can cause drowsiness or fatigue, as well as sedatives, some antidepressants and tranquillisers.

A side effect being listed in the leaflet does not mean it is happening to you, but it is a clue worth mentioning.

Why does taking many medicines increase the risk?

When you take several medicines, their sedating effects can add up, some can raise the levels of others in the blood and it becomes harder to tell which one is behind a symptom. This is known as polypharmacy, and it is common in people with several long-term conditions.

How you take them matters too: a sleeping tablet taken late, an antihistamine added for a cold or a recent dose change can explain why you feel worse that week. That is why it helps to note when the tiredness started and what changed in your treatment. To find out more, read what polypharmacy is and how to reduce its risks.

Which other causes need ruling out?

Tiredness has many possible causes, and not all of them are medication. MedlinePlus mentions, among others, anaemia or iron deficiency, depression, sleep disorders such as insomnia or apnoea, an underactive or overactive thyroid, diabetes, heart failure and kidney or liver disease.

Seek help straight away if the tiredness comes with confusion or dizziness, blurred vision, passing very little or no urine, recent weight gain with swelling, or thoughts of harming yourself. Book an appointment soon if you have a fever, unexplained weight loss or frequent sweating.

How do I ask for a medication review?

The most useful thing is to arrive at your appointment with specific information. Your doctor or pharmacist can check whether each medicine is still needed, whether the dose or timing is right and whether any can be changed or safely stopped (known as deprescribing).

1. Make a list of everything you take, including over-the-counter products, supplements and herbal remedies.
2. For one or two weeks, note when you feel most tired and what time you take each medicine.
3. Note whether it started after a change in treatment.
4. Ask directly: "Could any of these medicines explain my tiredness?"
5. In the meantime, do not stop any medicine: some must not be stopped suddenly.

If you find it hard to raise, we give you ideas in how to talk to your doctor if you think you take too many medicines and how to prepare for an appointment to review your medicines.

A practical example: Andrés, always exhausted

Take the case of Andrés, 66, recently retired, who takes eight medicines: bisoprolol and another blood pressure drug, a statin, metformin, a stomach protector, lorazepam at night and, for the past month, an antihistamine for his allergy. Lately he falls asleep on the sofa in the afternoon and has stopped going for walks.

Andrés notes how he feels for ten days and takes all his boxes to the pharmacy. The pharmacist tells him that several of his medicines can cause drowsiness and advises him to book an appointment with his GP, without stopping anything in the meantime.

At the appointment, his GP orders a blood test to rule out anaemia and thyroid problems, swaps the antihistamine for a less sedating one and plans a gradual withdrawal of the lorazepam with him. A few weeks later, Andrés is back to his morning walks.

How can IMA Health help you?

When you take many medicines, being clear about what you take and when is the first step to spotting problems. At IMA Health we coordinate with a specialised pharmacy that prepares your medication by day and time of each dose, we deliver it to your home and we provide personalised follow-up. If your doctor changes or stops a medicine, the change is reflected in your preparation and you do not have to remember it yourself.

Sources

• MedlinePlus: Fatigue
• CIMA (AEMPS): leaflet for Bisoprolol Cinfa 10 mg (in Spanish)
• CIMA (AEMPS): leaflet for Atorvastatina Cinfa 10 mg (in Spanish)
• CIMA (AEMPS): leaflet for Zolpidem Cinfa 10 mg (in Spanish)

This article is for information only and does not replace advice from your doctor or pharmacist.