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.
If you need to discontinue a PPI, you must do it very slowly. Under your doctor's guidance, you'll gradually drop the dose in 20 mg increments, with 10 to 15 days between each taper, until you are completely off the drug. In some people the process takes even longer.
If you still have severe reflux problems, you and your doctor may want to consider the use of an H2 blocker such as ranitidine (75 mg every 12 hours) taken as needed. Some 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.
Why they're prescribed: Benzodiazepines, commonly known as tranquilizers, are used to treat a variety of anxiety disorders, agitation and muscle spasms, and to prevent seizures. Because benzodiazepines have a sedative/hypnotic effect, they are sometimes used to treat insomnia and the anxiety component of depression.
Commonly prescribed benzodiazepines include alprazolam (Xanax), clonazepam (Klonopin), diazepam (Valium), lorazepam (Ativan) and temazepam (Restoril).
(Important note: Although zolpidem (Ambien) is not a benzodiazepine, 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: Benzodiazepines can cause sedation and fatigue by dampening activity in key parts of the central nervous system (CNS).
People who take a benzodiazepine 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. Long-term effects also may include muscle weakness.
It'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 experiencing fatigue and for developing physical or psychological dependence.
Benzodiazepine withdrawal can also cause fatigue.
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.
For all the conditions listed above, there are alternative drugs and nondrug treatments. Melatonin, in doses from 3 to 10 mg before bedtime, for instance, sometimes helps to reestablish healthy sleep patterns.