AFib Medications and Fatigue
Question: I had polio at 3 months old - my right leg was affected. Now I’m 65 and have PPS. I have AFib (Atrial Fibrillation) and was put on Eliquis and Metoprolol.
Can either one of these medications cause pain and make you tired all time? I've always had fatigue issues. It seemed to get worse after taking these two medications. It’s very difficult, as you know, to find someone who knows about PPS.
Answer: In short, Yes! Your medications and medical condition can certainly be causing your fatigue.
In fact if functional loss is primarily from fatigue and there is not clear focal weakness and atrophy that has worsened in recent years the issues could be entirely medical and not PPS at all. Since I don't have a full history, I am simply saying that to emphasize the functional impact of the medical issues at hand rather than to say PPS is not the cause (that is a specific diagnosis that needs to be between you and your treating physician).
Atrial fibrillation is an uncontrolled rapid and irregular beat of the Atrium (top chamber) of the heart. Contractions can be so quick that the actual pumping of blood is affected leading to the risk of developing a clot in the Atrium that could later be pumped out into the circulation and cause a stroke. This risk is addressed by the Eliquis (an oral blood thinner). Eliquis itself has few side effects but the big concern is uncontrolled bleeding - it is an important drug to be aware of but not pertinent to your current complaints. Metoprolol on the other hand has common side effects of fatigue, sleep disturbance and even depression. It is meant to slow the heart and counteract the potential rapid heart rate of the AFib. If mild, these are sometimes symptoms that need to be tolerated since the rapid heart rate can be a bigger issue. This risk/benefit ratio is very patient specific and well beyond the scope of this reply. Nevertheless, it is certainly possible that the fatigue is entirely due to metoprolol and this should be discussed with a cardiologist. Sometimes other medications are available OR a simple dose adjustment is needed.
Lastly, Atrial Fibrillation can occur in isolation but also can occur in the setting of heart valve issues or coronary heart disease. You have not mentioned those diagnoses but, if present, they can also clearly contribute to fatigue and loss of function due to ineffective cardiac output (the amount of blood pumped out with each beat).
In summary: Yes, medications can certainly be playing a role and risks/benefits of medications in this setting is very individualized and best addressed between the patient and their PCP (primary care physician) or cardiologist.
On a separate but related note, it struck me that you were not aware that Metoprolol causes this side effect. There are easily accessible resources online and it certainly something your pharmacist could tell you about. It is surprising that your prescribing physician did not mention it or you did not recall that he did. (Additionally, I am making a presumption that you did not bring up the fatigue as a clear issue and ask about the medication). This might be a situation where you have a doc who is just not taking the time OR that you are not clearly organizing your concerns and questions in advance, Often it's a combination of both. Either way, I am certain that your PCP or cardiologist will engage this once you bring it to their attention. If you are not satisfied with the response after a couple of attempts, then it might be a good idea to seek care elsewhere. I hope this information helps.
Warm Regards,