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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 (rinivil, !estril", an A#$ inhibitor% amlodipine

(&orvasc", a calcium channel blocker% hydrochlorothiaide (#T! and various other brand names", a

thiaide diuretic% furosemide ()asi*", a loop diuretic% and metoprolol ()opressor, Toprol", a beta

blocker.

How they can cause fatigue:+lood-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

vitamins and minerals that your body needs for energy.

#heck the safety information that comes with your blood-pressure medications and you may well see

e*treme 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. or older patients, a benothiaepine calcium channel blocker, such as

diltiaem (#ardiem", is often the best choice.

An omega- fish oil supplement may help to lower your blood pressure, too. +ecause omega- 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.

ore good news:/mega- fatty acidsare also thought to be natural fatigue fighters.

!. "tatins and fibrates

Why they're prescribed:0tatinsand fibrates are used to treat high cholesterol. The top-selling

statins are atorvastatin ()ipitor", rosuvastatin (#restor" and simvastatin (!ocor"% the top-selling fibrate

is fenofibrate (Tricor".

How they can cause fatigue:0tudies show that statins stop the production of satellite cells in the

muscle, stopping muscle growth. 0ome researchers have also suggested that statins interfere with

the production of energy at the cellular level in the same way that they interfere with the production of

cholesterol.

1uscle 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. The fibers are harmful to the kidneys and can result in severe kidney damage and

even kidney failure.

Alternatives:2f 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 +34 (3,555 mcg

daily", folic acid (655 mcg daily" and vitamin +7 (455 mg daily".

#. $roton pump inhibitors

Why they're prescribed:roton pump inhibitorsare used to treat gastroesophageal reflu* disease

(8$9:" and other similar disorders. 1ore than 45 million Americans take prescription 2s, including

esomepraole (&e*ium", lansopraole (revacid", omepraole (rilosec" and pantopraole (rotoni*",

some of which are available over the counter.

http://www.aarp.org/health/drugs-supplements/info-02-2012/beta-blockers-may-cause-depression-neel.htmlhttp://healthtools.aarp.org/galecontent/omega-3-fatty-acidshttp://healthtools.aarp.org/galecontent/omega-3-fatty-acidshttp://www.aarp.org/health/drugs-supplements/info-04-2012/statin-side-effects-armon-neel.htmlhttp://www.aarp.org/health/drugs-supplements/info-03-2012/proton-pump-inhibitors-side-effects-neel.htmlhttp://www.aarp.org/health/drugs-supplements/info-03-2012/proton-pump-inhibitors-side-effects-neel.htmlhttp://www.aarp.org/health/drugs-supplements/info-02-2012/beta-blockers-may-cause-depression-neel.htmlhttp://healthtools.aarp.org/galecontent/omega-3-fatty-acidshttp://www.aarp.org/health/drugs-supplements/info-04-2012/statin-side-effects-armon-neel.htmlhttp://www.aarp.org/health/drugs-supplements/info-03-2012/proton-pump-inhibitors-side-effects-neel.html

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How they can cause fatigue: atients who take 2s 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 :A has advised doctors and other health care providers to obtain serum

magnesium levels before prescribing 2s and then periodically thereafter.

2f you need to discontinue a 2, you must do it very slowly. ;nder your doctor's guidance, you'll

gradually drop the dose in 45 mg increments, with 35 to 3< days between each taper, until you are

completely off the drug. 2n some people the process takes even longer.

2f you still have severe reflu* problems, you and your doctor may want to consider the use of an 4

blocker such as ranitidine (=< mg every 34 hours" taken as needed. 0ome of my patients have

reported success with the home remedy of apple cider vinegar and honey (one tablespoon of each in

a glass of water", taken throughout the day, along with melatonin at bedtime.

%. Ben&odia&epines

Why they're prescribed:+enodiaepines,commonly known as tran>uiliers, are used to treat a

variety of an*iety disorders, agitation and muscle spasms, and to prevent seiures. +ecause

benodiaepines have a sedative?hypnotic effect, they are sometimes used to treat insomnia and the

an*iety component of depression.

#ommonly prescribed benodiaepines include alpraolam (@ana*", clonaepam (lonopin",

diaepam (Balium", loraepam (Ativan" and temaepam (9estoril".

(2mportant noteC Although olpidem (Ambien" is not a benodiaepine, it interacts with the same

neurotransmitters in the brain and has many of the same pharmacologic characteristics, so it also can

cause fatigue."

How they can cause fatigue: +enodiaepines can cause sedation and fatigue by dampening

activity in key parts of the central nervous system (#&0".

eople who take a benodiaepine for more than two or three weeks may develop a tolerance to the

drug, and over time may need to take increasing doses to achieve the same effect, only worsening

their fatigue. )ong-term effects also may include muscle weakness.

2t's important to remember that it takes older people up to three times longer than younger people to

flush these drugs out of their bodies. The ensuing buildup of the drug in the body puts older people at

a much higher risk for e*periencing fatigue and for developing physical or psychological dependence.

+enodiaepine withdrawal can also cause fatigue.

Alternatives:Talk with your doctor or other health care provider. 1any patients with mild an*iety or

insomnia don't need benodiaepines at all, but stopping or reducing the dosage of a benodiaepine

should always be monitored by a professional, as serious withdrawal effects can occur.

or all the conditions listed above, there are alternative drugs and nondrug treatments. 1elatonin, in

doses from to 35 mg before bedtime, for instance, sometimes helps to reestablish healthy sleep

patterns.

. Antihistamin

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engapa mere(a diresep(an:Antihistamindigunakan untuk meringankan atau mencegah geDala

gangguan alergi (seperti demam" atau pilek biasa. +eberapa antihistamin Duga digunakan untuk

mencegah mabuk, mual, muntah dan pusing, dan untuk mengobati kecemasan atau insomnia.

Bagaimana mere(a dapat menyebab(an (elelahan:Antihistamin adalah depresan

00. ebanyakan daftar kelelahan dan kantuk antara potensi efek samping, beberapa daftar pusing

dan lemas.

/rang tua umumnya tidak harus menggunakan diphenhydramine (+enadryl" - ditemukan dalam

bantuan tidur dengan nama berakhiran 1 - karena efek obat penenang yang kuat, yang secara

dramatis meningkatkan risiko Datuh dan patah tulang.

elelahan Duga merupakan efek samping terdaftar fe*ofenadine (Allegra", antihistamin lain yang

populer. /rang tua umumnya tidak harus menggunakan obat ini karena sistem ginDal mereka tidak

dapat efisien Delas itu, yang memungkinkan obat untuk membangun di dalam tubuh.

Alternatif:antihistamin generasi baru seperti loratadine (#laritin" dan cetiriine (!yrtec" yang lebih

baik ditoleransi oleh pasien yang lebih tua dan menimbulkan risiko yang lebih rendah untuk kelelahan.

). Antidepresan

engapa mere(a diresep(an:0ementaraantidepresanbiasanya digunakan untuk mengobati

depresi, mereka Duga sering diresepkan untuk gangguan kecemasan, gangguan makan, gangguan

obsesif kompulsif, sakit kronis, berhenti merokok dan beberapa gangguan hormon-mediated, seperti

kram menstruasi yang parah.

Ada berbagai Denis antidepresan, termasuk antidepresan trisiklik, inhibitor monoamine o*idase

(1A/2s", selektif serotonin re-uptake inhibitor (0092", antagonis dopamin dan lithium, antara lain.

Antidepresan umumnya diresepkan termasuk dulo*etine (#ymbalta", fluo*etine (roac", paro*etine

(a*il", sertraline (!oloft", dan venlafa*ine ($ffe*or".

Bagaimana mere(a dapat menyebab(an (elelahan:elelahan adalah efek samping yang umum

dari obat antidepresan, terutama selama minggu-minggu awal pengobatan. arena antidepresan Dugadapat memperburuk kelelahan yang disebabkan oleh kondisi lain, menggoda keluar penyebab

seringkali sulit.

ara peneliti telah menyarankan bahwa antidepresan dapat menyebabkan kelelahan melalui efeknya

pada kimia otak yang disebut neurotransmiter - terutama serotonin dan norepinefrin - dan

hormon.8angguan dalam sekresi tubuh dari hormon stres kortisol, misalnya, telah terkait erat dengan

geDala kelelahan.

Antidepresan Duga dapat menurunkan kadar kalium (hipokalemia", yang pada gilirannya dapat

menyebabkan kelemahan otot.

Alternatif:+icarakan dengan dokter Anda atau penyedia perawatan kesehatan lainnya tentang

menyesuaikan dosis antidepresan Anda (efek samping sering berhubungan dengan dosis" atauapakah nondrug terapi mungkin bekerDa sama dengan baik atau lebih baik bagi Anda daripada

obat. Anda mungkin Duga ingin menDelaDahi obat switching, terutama Dika Anda lebih tua dan

mengambil salah satu antidepresan trisiklik, yang dianggap sebagai obat yang berpotensi tidak patut

untuk orang tua.

*. Antipsi(oti(

engapa mere(a diresep(an:Antipsikotikdigunakan untuk mengobati skiofrenia, gangguan

bipolar dan kondisi keDiwaan serius lainnya. Antipsikotik Duga sering diresepkan off label untuk

mengobati agitasi dan depresi, antara lain.

Antipsikotik umumnya diresepkan termasuk aripipraole (Abilify", haloperidol (aldol", olanapine

(!ypre*a", risperidone (9isperdal" dan iprasidone (8eodon".

http://healthtools.aarp.org/healthday/health-tip-using-antihistamineshttp://healthtools.aarp.org/healthday/health-tip-using-antihistamineshttp://www.aarp.org/health/drugs-supplements/info-09-2011/doctors-overprescribing-antidepressants-health-discovery.htmlhttp://www.aarp.org/health/drugs-supplements/info-09-2011/doctors-overprescribing-antidepressants-health-discovery.htmlhttp://www.aarp.org/health/drugs-supplements/info-09-2011/doctors-overprescribing-antidepressants-health-discovery.htmlhttp://healthtools.aarp.org/galecontent/antipsychotic-drugshttp://healthtools.aarp.org/galecontent/antipsychotic-drugshttp://healthtools.aarp.org/healthday/health-tip-using-antihistamineshttp://www.aarp.org/health/drugs-supplements/info-09-2011/doctors-overprescribing-antidepressants-health-discovery.htmlhttp://healthtools.aarp.org/galecontent/antipsychotic-drugs

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Bagaimana mere(a dapat menyebab(an (elelahan:The antipsikotik yang kuat 00

depresan. :alam studi, efek samping termasuk kelelahan, lesu dan lemah. +anyak obat ini Duga

menurunkan tingkat dopamine, yang dapat menyebabkan mengantuk dan mengantuk Duga.

Alternatif:+icarakan dengan dokter Anda atau penyedia perawatan kesehatan lainnya tentang

kemungkinan mengurangi dosis atau beralih ke obat antipsikotik lain. :an Dika Anda telah diresepkan

antipsikotik untuk membantu Anda tidur atau untuk beberapa penggunaan off-label lain, Anda akan

baik-disarankan untuk mencari tahu lebih lanDut terbukti, pengobatan lebih aman untuk geDala

Anda. (1isalnya, pada pasien yang lebih tua, khususnya, obat ini meningkatkan risiko gagal Dantung."

+. Antibiotics

Why they're prescribed:Antibiotics are used to treat health conditions caused by bacteria, including

ear and skin infections, urinary tract infections, food poisoning, pneumonia, meningitis and other

serious illnesses. They're also used to treat or prevent infections that can complicate surgery or other

medical procedures.

#ommonly prescribed antibiotics include amo*icillin (various brand names", aithromycin (!ithroma*",

ciproflo*acin (#ipro" and levoflo*acin ()eva>uin".

How they can cause fatigue:9esearchers have long known that some people who take antibiotics

e*perience feelings of tiredness and e*treme fatigue, but it's still not clear e*actly why. 9ead the

safety and prescribing information for sulfametho*aole?trimethroprim (+actrim :0", for e*ample, and

you'll see unusual tiredness or weakness listed as a potential side effect. 0imilarly, the package

insert for cephale*in (efle*, eftabs, ani*ine, +iocef, !artan" lists fatigue as a potential side effect.

Alternatives:2 believe, as do many doctors and other health care professionals, that antibiotics are

grossly overprescribed. 2f you have a minor bacterial infection, ask your physician if an antibiotic is

really needed and if a natural alternative might the trick. 0tudies show that garlic, for e*ample, fights

bacterial infections and helps to prevent the spread of pathogens. +ut consultation with a health

professional is essential, as garlic can interfere with blood thinners, nonsteroidal anti-inflammatory

drugs (&0A2:s" and other medications.

,. iuretics

Why they're prescribed::iuretics (sometimes called water pills" are used to treat high blood

pressure, glaucoma, edema and other conditions.

How they can cause fatigue::iuretics can interfere with the balance of electrolytes the maDor

ones being sodium, potassium and chloride in your body. $lectrolyte imbalances can cause serious

health problems, including e*treme fatigue, muscle weakness and achy Doints, bones and muscles

(along with many other symptoms not related to fatigue".

Alternatives:Talk with your doctor or other health care provider about cutting back on your use of

salt, e*ercising more and limiting your fluid intake.

Ask the Pharmacist is written byArmon B. Neel Jr.,PharmD, CGP, in collaboration with journalist Bill

Hogan. hey are coauthors o!Are Eour rescriptions illing EouF,which was "ublishe# last year by

Atria Books.

$n!ormation containe# in the Ask the Pharmacist column by Dr. Armon B. Neel Jr. is inten#e# to hel"

in#i%i#uals an# their !amilies become more in!orme# about me#ication usage an# interactions, an# be

better health care consumers. Any a#%ice or in!ormation "ro%i#e# shoul# not be !ollowe# in lieu o! a

"ersonal consultation with a traine# me#ical "ro!essional.

http://www.aarp.org/health/experts/armon-b-neel/http://www.aarp.org/health/experts/armon-b-neel/http://www.aarp.org/health/experts/armon-b-neel/http://www.aarp.org/health/experts/armon-b-neel/