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What Causes Severe Fatigue While On Promethazine And Xanax?
Question: My wife, age 73, had a severe stroke Saturday, July 1, 2016. She immediately went to our local hospital. The stroke continued to get worse for three days even though she was being treated properly. She stayed in the hospital for 25 days getting therapy. She had home nursing and then outpatient therapy. Christmas morning, she had a serious TMI and stayed in the hospital to Feb. 1. She has had home then outpatient therapy (speech, occupational, and physical) since then. She has had several minor TMIs or something since then. The latest was April 2 at 4:26 pm. We had just come back from a short walk. I immediately gave her one tablet Promethazine 25 mg tablet for nausea or vomiting. During the next hour she had 6 bowel movements and she threw up once. Her temperature was 96.7 f, pulse 67. She is always extremely fatigued even though she gets10 hours sleep a night. She eats good, is hydrated, reads many books, walks some with her walker. She has little control of her urine or bowels. She goes to urinate every 2 1/2 hours to protect her. Her blood pressure drops when she stands up. These are her medicine: Allergies: alcohol in all forms, iodine, Betadine
Alendronate 1 tab 70 mg (Fosamax) once weekly in morning
Ambien (zolpidem tartrate) l0 mg 90 tabs one tablet by mouth at bedtime
Aspirin 1 tab 81 mg daily
Carvedilol 12.5 mg (Coreg) 1 tab/2 times a day
Clopidogrel 1 tab 75 mg (Plavix) once daily
Lisinopril 5 mg 1 tab/2 times a day
Paroxetine (Paxil tab) HCL tabs 20 mg one tab at bedtime 90 tabs
Promethazine 25 mg tablet as needed once every 8 hours for nausea or vomiting
Pravastatin Sodium 20 mg at bedtime
VESIcare 10 mg once daily
Zetia Tabs (Ezetimibe) l0 mg 90 tabs one tablet/day
Do you have any suggestions?
I sent the wrong medicine list. See below
Allergies: alcohol in all forms, iodine, Betadine
*Amlodipine Besylate 5 mg oral daily
*Ezetimibe (Zetia) 10 mg oral with evening meal
*Alendronate Sodium (Fosamax) 70 mg oral every 7 days
*Alprazolam (Xanax) .25 mg oral at bedtime as needed for anxiety
*Amlodipine besylate 5mg 1 per day
*Aspirin 325 mg oral once daily
*Carvedilol (Coreg) 12.5 mg oral twice daily for blood pressure control
*Clopidogrel Bisulfate (Clopidogrel) 75 mg oral daily
*Pantoprazole Sodium (Protonix) 40 mg oral twice a day
*Paroxetine Hcl (Paxil) 20 mg oral at bedtime
*Polyethylene Glycol (Miralax)17 gm oral daily as needed
*pravastin sodium 20mg 1 per day at bedtime
*promethazine 25 mg 1 every 8 hrs as needed for nausea/vomiting
*Solifenacin succinate (Vesicare) 10 mg oral daily
*Sucralfate (Carafate) 1 gm oral before meals & bed for stomach acid
*Vesicare 10 mg 1 per day
*vitamin d3 400iu 2 capsules per day
Alendronate 1 tab 70 mg (Fosamax) once weekly in morning
Ambien (zolpidem tartrate) l0 mg 90 tabs one tablet by mouth at bedtime
Aspirin 1 tab 81 mg daily
Carvedilol 12.5 mg (Coreg) 1 tab/2 times a day
Clopidogrel 1 tab 75 mg (Plavix) once daily
Lisinopril 5 mg 1 tab/2 times a day
Paroxetine (Paxil tab) HCL tabs 20 mg one tab at bedtime 90 tabs
Promethazine 25 mg tablet as needed once every 8 hours for nausea or vomiting
Pravastatin Sodium 20 mg at bedtime
VESIcare 10 mg once daily
Zetia Tabs (Ezetimibe) l0 mg 90 tabs one tablet/day
Do you have any suggestions?
I sent the wrong medicine list. See below
Allergies: alcohol in all forms, iodine, Betadine
*Amlodipine Besylate 5 mg oral daily
*Ezetimibe (Zetia) 10 mg oral with evening meal
*Alendronate Sodium (Fosamax) 70 mg oral every 7 days
*Alprazolam (Xanax) .25 mg oral at bedtime as needed for anxiety
*Amlodipine besylate 5mg 1 per day
*Aspirin 325 mg oral once daily
*Carvedilol (Coreg) 12.5 mg oral twice daily for blood pressure control
*Clopidogrel Bisulfate (Clopidogrel) 75 mg oral daily
*Pantoprazole Sodium (Protonix) 40 mg oral twice a day
*Paroxetine Hcl (Paxil) 20 mg oral at bedtime
*Polyethylene Glycol (Miralax)17 gm oral daily as needed
*pravastin sodium 20mg 1 per day at bedtime
*promethazine 25 mg 1 every 8 hrs as needed for nausea/vomiting
*Solifenacin succinate (Vesicare) 10 mg oral daily
*Sucralfate (Carafate) 1 gm oral before meals & bed for stomach acid
*Vesicare 10 mg 1 per day
*vitamin d3 400iu 2 capsules per day
Brief Answer:
Read below
Detailed Answer:
I read your question carefully and I understand your concern.
I wish you had been able to upload some medical reports, discharge papers or something so that I was able to see the brain area which was involved and the supposed origin. Once a stroke has happened there is not a treatment to reverse the damage which happened, management is aimed towards medication to prevent recurrences but without having no information on the source it is not possible to provide an opinion on that.
The rest of the treatment is aimed at alleviating symptoms and rehabilitation (physical, occupational and speech therapy).
I am not sure what you mean by TMIs, the only medical acronym coming to mind is transmural myocardial infarction, but I do not think that is the case as it's hard to see one survive several heart attacks. Perhaps you mean TIAs? If yes then again the issue of the need to learn the origin of the stroke rises again, without reports hard to suggest if anything more can be done to prevent them.
The one suggestion I can provide concerns her therapy with medication which act on central nervous system, which can cause drowsiness, dizziness, fatigue. I am referring to medication like Xanax, promethazine and paroxetine.
Xanax is not recommended to be used for long term anxiety treatment. Over time it creates tolerance (same dosage is not effective anymore) and dependence. Its side effects include drowsiness, confusion, memory problems, fatigue, particularly in an elderly individual so it is not advised to be used for long term, only for a few weeks. If long term treatment is deemed necessary usually medications like antidepressants of SSRI class like paroxetine is used. So I would continue Paroxetine, but slowly withdraw Xanax.
The second issue I have with your medication is the use of Promethazine. Promethazine as well has side effects on central nervous system, may cause confusion, drowsiness, movement slowing, fatigue etc so its use may also play a role in her fatigue. Of course most medications have side effects and they should be weighed against benefits. In her case nausea and vomiting can be just as distressing a symptom. But I wonder whether other options like ondansetron have been considered. Also I wonder what is the suggested cause of this persisting vomiting, it is not a common post-stroke symptom. Has the possibility of the vomiting being influenced by medication been considered (like Fosamax for example).
Another issue I would like to tackle is the use of both Aspirin and Clopidogrel. Their use together for stroke prevention doesn't go beyond 90 days as there isn't any more significant benefit and there is the risk of hemorrhagic side effects, continuing only one of them should be considered.
I remain at your disposal for other questions.
Read below
Detailed Answer:
I read your question carefully and I understand your concern.
I wish you had been able to upload some medical reports, discharge papers or something so that I was able to see the brain area which was involved and the supposed origin. Once a stroke has happened there is not a treatment to reverse the damage which happened, management is aimed towards medication to prevent recurrences but without having no information on the source it is not possible to provide an opinion on that.
The rest of the treatment is aimed at alleviating symptoms and rehabilitation (physical, occupational and speech therapy).
I am not sure what you mean by TMIs, the only medical acronym coming to mind is transmural myocardial infarction, but I do not think that is the case as it's hard to see one survive several heart attacks. Perhaps you mean TIAs? If yes then again the issue of the need to learn the origin of the stroke rises again, without reports hard to suggest if anything more can be done to prevent them.
The one suggestion I can provide concerns her therapy with medication which act on central nervous system, which can cause drowsiness, dizziness, fatigue. I am referring to medication like Xanax, promethazine and paroxetine.
Xanax is not recommended to be used for long term anxiety treatment. Over time it creates tolerance (same dosage is not effective anymore) and dependence. Its side effects include drowsiness, confusion, memory problems, fatigue, particularly in an elderly individual so it is not advised to be used for long term, only for a few weeks. If long term treatment is deemed necessary usually medications like antidepressants of SSRI class like paroxetine is used. So I would continue Paroxetine, but slowly withdraw Xanax.
The second issue I have with your medication is the use of Promethazine. Promethazine as well has side effects on central nervous system, may cause confusion, drowsiness, movement slowing, fatigue etc so its use may also play a role in her fatigue. Of course most medications have side effects and they should be weighed against benefits. In her case nausea and vomiting can be just as distressing a symptom. But I wonder whether other options like ondansetron have been considered. Also I wonder what is the suggested cause of this persisting vomiting, it is not a common post-stroke symptom. Has the possibility of the vomiting being influenced by medication been considered (like Fosamax for example).
Another issue I would like to tackle is the use of both Aspirin and Clopidogrel. Their use together for stroke prevention doesn't go beyond 90 days as there isn't any more significant benefit and there is the risk of hemorrhagic side effects, continuing only one of them should be considered.
I remain at your disposal for other questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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