Fatigue is a common complaint from patients.  It can certainly be due to a variety of reasons, but never underestimate the possibility of medication induced fatigue especially when it comes to polypharmacy.  Here’s the medication list, and factors I would consider in trying to assess medication induced fatigue:

• Plavix 75 mg daily
• Amlodipine 5 mg daily
• Warfarin 2.5 mg daily
• Prevacid 15 mg daily
• Acetaminophen as needed
• Sumatriptan 100 mg as needed
• Amiodarone 200 mg twice daily
• Inderal 80 mg as needed
• Colace 100 mg daily
• Vitamin C 500 mg daily
• FESO4 325 mg daily

1. One thing I would consider doing is making sure that the possibility of anemia is assessed.  We have a patient on both Plavix and warfarin, as well as iron supplementation.  Anemia is a common cause of fatigue, and would be a place to start in this situation.
2. Another big question is what would propranolol’s indication be.  Beta-blockers are a notorious cause of fatigue.  Timing of initiation, indication, and if the patient is actually using it would be things that I would investigate.
3. My last point with this medication list would be to make sure that TSH has been assessed.  Amiodarone is well known for causing hypothyroidism and could potentially be a factor in thyroid function.

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