Assessing Drug Induced Lethargy – Case Scenario
Drug induced lethargy is something that I see on a fairly regular basis. The challenging part is trying to identify which medication or medications are causing lethargy.
A 61 year old female complains of constant lethargy and just feels like she could sleep all day and all night. She says that she probably lays in bed about 12-16 hours per day.
Past medical history:
- Trigeminal Neuralgia
- Senna S 1 BID prn
- Aspirin 81 mg daily
- Plavix 75 mg daily
- Metformin 850 mg BID
- Tegretol 200 mg BID
- Metoprolol 50 mg BID
- Levothyroxine 100 mcg daily
- Calcium 500 mg BID
- Lipitor 40 mg daily
- Cyclobenzaprine 10 mg TID prn
- I would look at the carbamazepine and check a current level if one hasn’t been done to ensure that this medication isn’t at a potentially toxic level. Also with treating trigeminal neuralgia, we are in a much less risky situation if we reduce this medication than if we were using it for seizures.
- Hypothyroidism/TSH needs to be looked at.
- With aspirin and Plavix on board, asking about bleeding would be important as well as assessing for the potential of anemia.
- The beta blocker should be asked about. Often these can cause significant lethargy/fatigue.
- Cyclobenzaprine use needs to be reviewed as well.
What else would you look at in trying to identify what is causing this patient’s lethargy?
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