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What Causes Fatigue While On Celexa, Clonazepam And Ambien?
Question: I am a 54 year old female. I weigh 127 lbs. and am 5 ft 6. I don't smoke or drink. I have a history of SVT and PVC's and PAC's, MVP, and some regertation. I also have an anyeursym in my atrial septum. I have a yearly echo and just had one last Thursday. I take Tenormin 50 mg, but only take a fourth of this at bedtime unless I am having an episode of SVT. I also take Celexa 10 mg, at bedtime, Clonazepam, 1 mg, at bedtime, Ambien, 5 mg, at bedtime. I have been on the Tenormin since age 22. I have been taking the rest of my medications since I think 2000. On Monday night, I started to feel really tired feeling and short of breath, like I was trying to yawn and couldn't or take a deep breath and wouldn't go all the way down. I have this from time to time. When I say tired feeling, I don't mean tired like a lack of sleep, or like sleep would help. I refer to it as a scary tired. I feel like a walking dead person. My blood pressure also when I take it is 90/53 or a little lower. My heart rate also is about 50. I could understand this if I had taken a larger does of my Tenormin, but haven't. I didn't even take any Tuesday or Tuesday night or all day yesterday. Today it still remains low. I have been to the dr. in the past when this has happened and he doesn't seem to care or give me any reasons as to why this is happening and why I feel so tired and short of breath. I don't think it is normal for my heart rate to be so low and blood pressure, plus I feel so very tired. Too tired to even think or function. Can you please tell me what I need to do, or if there are any tests that could be done to find out why this is happening and what is wrong? Is this dangerous? Please help???
Brief Answer:
Too many night medications.
Detailed Answer:
Hi,
Thanks for asking.
I am Dr. Jyothi BL and I will be answering your query.
Looking at the medical history and query, my opinion is as follows:
1. Celexa, Clonazepam and ambien all act at the CNS level and they are known act at the level of central nervous system and reduce its activity.
2. All these medications at bedtime, would also reduce activity of all the systems, your muscular system, cardiovascular system and even respiratory system. However, the dose is not high enough and it is only adequate to help in sleep by lowering your overall body function.
3. At occasions, along with atenolol, which is being used as an anti-hypertensive, will reduce the heart rate and blood pressure. At these times, you are getting these episodes.
There is nothing wrong with you per se. You are on too many medications at night for induction of sleep.
However, during these episodes avoid getting up, you could fall due to hypotension.
Blood pressure is low. However, do let me know your usual blood pressure and indications for various medications. Other medications other than tenormin are also mildly affecting your blood pressure and overall body system function and Ambien, for example is used only for short term treatment of insomnia.
You need to reduce the dosage of other medications, and if necessary, get weaned of.
Hope this helps.
Any further queries, happy to help again.
Dr. Jyothi BL
Too many night medications.
Detailed Answer:
Hi,
Thanks for asking.
I am Dr. Jyothi BL and I will be answering your query.
Looking at the medical history and query, my opinion is as follows:
1. Celexa, Clonazepam and ambien all act at the CNS level and they are known act at the level of central nervous system and reduce its activity.
2. All these medications at bedtime, would also reduce activity of all the systems, your muscular system, cardiovascular system and even respiratory system. However, the dose is not high enough and it is only adequate to help in sleep by lowering your overall body function.
3. At occasions, along with atenolol, which is being used as an anti-hypertensive, will reduce the heart rate and blood pressure. At these times, you are getting these episodes.
There is nothing wrong with you per se. You are on too many medications at night for induction of sleep.
However, during these episodes avoid getting up, you could fall due to hypotension.
Blood pressure is low. However, do let me know your usual blood pressure and indications for various medications. Other medications other than tenormin are also mildly affecting your blood pressure and overall body system function and Ambien, for example is used only for short term treatment of insomnia.
You need to reduce the dosage of other medications, and if necessary, get weaned of.
Hope this helps.
Any further queries, happy to help again.
Dr. Jyothi BL
Above answer was peer-reviewed by :
Dr. Yogesh D
I don't understand why this would happen just some days, and not all the time. I didn't even take any of my tenormin on Tuesday or Tuesday night or all day yesterday. I only took one fourth last night, but cut my clonazepam back by half, but still today blood pressure is low and heart rate still in the 50's. So far tonight I have taken one half of the clonazepam and no tenormin, I took my celexa and no ambien so far, but probably won't be able to sleep unless I take the Ambien. I can't stop feeling like I need to draw a deep breath or yawn and can't. It wears me out when I feel like this.
Brief Answer:
Sleep training necessary.
Detailed Answer:
Hi,
Thanks for asking again.
Medications have a high half life and usually might take 3-4 days, to be removed from system depending on type. Some of them can take more than a week.
In my opinion you can possibly, try to cut down on other medications not blood pressure medications under care of your physician. You can take Ambien for sleep.
However, Sleep training through regular sleeping hours, avoiding sleep in afternoon or small sleeps, having food 2-3 hours before sleep, avoiding watching tv or being on phone, having a hot bath etc, will be necessary. You need to follow a routine to get weaned of medications.
If you regular blood pressure is under control, blood pressure medication may be partially reduced. Do discuss with your doctor regarding it.
Hope it helps.
Any further queries, happy to help again.
If you do not have any further queries, you can close the discussion and rate the answer.
Dr. Jyothi BL
Sleep training necessary.
Detailed Answer:
Hi,
Thanks for asking again.
Medications have a high half life and usually might take 3-4 days, to be removed from system depending on type. Some of them can take more than a week.
In my opinion you can possibly, try to cut down on other medications not blood pressure medications under care of your physician. You can take Ambien for sleep.
However, Sleep training through regular sleeping hours, avoiding sleep in afternoon or small sleeps, having food 2-3 hours before sleep, avoiding watching tv or being on phone, having a hot bath etc, will be necessary. You need to follow a routine to get weaned of medications.
If you regular blood pressure is under control, blood pressure medication may be partially reduced. Do discuss with your doctor regarding it.
Hope it helps.
Any further queries, happy to help again.
If you do not have any further queries, you can close the discussion and rate the answer.
Dr. Jyothi BL
Above answer was peer-reviewed by :
Dr. Prasad
I did cut back on my clonazepam and still no tenormin, but still so very tired and weird feeling. Tiring me to try to draw a deep breath. My lower legs also have some swelling and tops of my ankles or top of feet. It is gone when I wake up, but is there some kind of test to make sure this is not from my heart? Would the echo I had done last week show if the swelling was from my heart? If it were not pumping the blood right, would this show it up, and if not, what kind of test would? If there were some blockage in my legs or bad veins or arteries in my legs to cause this swelling, what would show it up. I am just very concerned because I have all these weird feelings, and feel so very tired and not good at all.
Brief Answer:
Edema is of cardiac cause only
Detailed Answer:
Hi,
Thanks for asking again.
It will take some more time for drugs level to reduce and overall improvement to occur. However, if you have symptoms related to drug, do take it or discuss with your doctor.
The swelling in legs, ankles and feet is due to cardiac edema. Leg elevation with two or three pillow is going to improve it. It is of cardiac cause, and occurs occasionally in hypertensives and you need not worry about it.
Echo, if it is showing reduce contraction or reduced cardiac output, then it indicates cardiac cause.
If there were blockage in legs, it would have been very painful.
Check your blood pressure regularly. Avoid anxiety and relax.
Take good amount of proteins and a vitamin rich nutritional diet. It will help improve overall well being.
Any further queries, happy to help again.
If you do not have any further queries, you can close the discussion and rate the answer.
Regards,
Dr. Jyothi BL
Edema is of cardiac cause only
Detailed Answer:
Hi,
Thanks for asking again.
It will take some more time for drugs level to reduce and overall improvement to occur. However, if you have symptoms related to drug, do take it or discuss with your doctor.
The swelling in legs, ankles and feet is due to cardiac edema. Leg elevation with two or three pillow is going to improve it. It is of cardiac cause, and occurs occasionally in hypertensives and you need not worry about it.
Echo, if it is showing reduce contraction or reduced cardiac output, then it indicates cardiac cause.
If there were blockage in legs, it would have been very painful.
Check your blood pressure regularly. Avoid anxiety and relax.
Take good amount of proteins and a vitamin rich nutritional diet. It will help improve overall well being.
Any further queries, happy to help again.
If you do not have any further queries, you can close the discussion and rate the answer.
Regards,
Dr. Jyothi BL
Above answer was peer-reviewed by :
Dr. Shanthi.E
The swelling in legs, ankles and feet is due to cardiac edema. Leg elevation with two or three pillow is going to improve it. It is of cardiac cause, and occurs occasionally in hypertensives and you need not worry about it.
Echo, if it is showing reduce contraction or reduced cardiac output, then it indicates cardiac cause.
I don't understand what you mean when you say the swelling is due to cardiac edema. What is cardiac edema, and what causes it? Also, what do u mean when u say it is of cardiac cause, and occurs in hypertensives? What does it mean that my heart is doing or not doing? Would the echo I had over a week ago show this?I looked up the cardiac edema you speak of and say not to worry about, and it says it is congestive heart failure. How is this nothing to worry about? Why would I be having congestive heart failure and what can I do to fix it? What tests will show if this is what's going on? I am really concerned now, because it says u have shortness of breath, fatigue, and swelling. I have all of these things.
Echo, if it is showing reduce contraction or reduced cardiac output, then it indicates cardiac cause.
I don't understand what you mean when you say the swelling is due to cardiac edema. What is cardiac edema, and what causes it? Also, what do u mean when u say it is of cardiac cause, and occurs in hypertensives? What does it mean that my heart is doing or not doing? Would the echo I had over a week ago show this?I looked up the cardiac edema you speak of and say not to worry about, and it says it is congestive heart failure. How is this nothing to worry about? Why would I be having congestive heart failure and what can I do to fix it? What tests will show if this is what's going on? I am really concerned now, because it says u have shortness of breath, fatigue, and swelling. I have all of these things.
Brief Answer:
Swelling is the only thing now. Others no.
Detailed Answer:
Hi,
Thanks for asking.
Yes, lower limb swelling secondary to cardiac edema is secondary to congestive cardiac failure. These are usually episodic and usually disappear.
The fatigue and shortness of breath, you are attributing at present is secondary to weakness and age.. The shortness of breath seen in cardiac failure will be due to fluid collection in lung. You will have frothy sputum, difficulty in breathing and it will be present all the time. Improves in sitting position as the fluid goes down and increases in lying down position. (patients with congestive cardiac failure, cannot lie down. They will require bed elevation)
Your doctor would have detected fluid on chest examination and as he has not detected anything, even on echo, you do not have it.
In chronic hypertensives, edema of leg does occur at many occasions. It is usually seen during times of stress and it will slowly improve.
In the mean time, limb elevation in lying down position or diuretics will solve the problem. As you are already hypotensive, you cannot be put on diuretics.
During periods of stress, heart wont be able to function upto normal standard. During these period, due to certain back logging or congestion in blood vessels, you are going to have fluids coming out of vessels leading to edema.
Once limb is elevated, it goes back into blood vessels.
Cardiac edema is postural in nature. If you stand, in the legs, lie down, in the backs. It is pitting edema (If you press on the swelling with finger, it will form pit and then after some time pit disappears again.
The present stress is possible hypotension, which the heart is trying to adjust. Do not worry. Once these symptoms improve, your swelling will reduce and disappear.
Echo is adequate to detect cardiac failure. No other tests is necessary. However, other causes like serum proteins to rule out other causes is necessary.
Any other queries, happy to help again.
Dr. Jyothi BL
Swelling is the only thing now. Others no.
Detailed Answer:
Hi,
Thanks for asking.
Yes, lower limb swelling secondary to cardiac edema is secondary to congestive cardiac failure. These are usually episodic and usually disappear.
The fatigue and shortness of breath, you are attributing at present is secondary to weakness and age.. The shortness of breath seen in cardiac failure will be due to fluid collection in lung. You will have frothy sputum, difficulty in breathing and it will be present all the time. Improves in sitting position as the fluid goes down and increases in lying down position. (patients with congestive cardiac failure, cannot lie down. They will require bed elevation)
Your doctor would have detected fluid on chest examination and as he has not detected anything, even on echo, you do not have it.
In chronic hypertensives, edema of leg does occur at many occasions. It is usually seen during times of stress and it will slowly improve.
In the mean time, limb elevation in lying down position or diuretics will solve the problem. As you are already hypotensive, you cannot be put on diuretics.
During periods of stress, heart wont be able to function upto normal standard. During these period, due to certain back logging or congestion in blood vessels, you are going to have fluids coming out of vessels leading to edema.
Once limb is elevated, it goes back into blood vessels.
Cardiac edema is postural in nature. If you stand, in the legs, lie down, in the backs. It is pitting edema (If you press on the swelling with finger, it will form pit and then after some time pit disappears again.
The present stress is possible hypotension, which the heart is trying to adjust. Do not worry. Once these symptoms improve, your swelling will reduce and disappear.
Echo is adequate to detect cardiac failure. No other tests is necessary. However, other causes like serum proteins to rule out other causes is necessary.
Any other queries, happy to help again.
Dr. Jyothi BL
Above answer was peer-reviewed by :
Dr. Shanthi.E
What does it mean when you say lower limb swelling secondary to cardiac edema is secondary to congestive heart failure? Does this mean I have heart failure? I just don't understand what all this means when it says secondary to and then secondary to again. I have never been told by my heart dr I have heart failure of any kind. Is sounds scary. Then u say the shortness of breath is secondary to weakness and age. What again does it mean when you say secondary to? And why would age make me short of breath? My sister is older than me and my Mom is 85 and doesn't have any shortness of breath. Then u say in chronic hypertensives swelling may occur. What does chronic hypertensives mean? U say I am already hypotensive, so can't take diuretics . I don't know what this means. Then u say when there are periods of stress the heart won't be able to function up to normal standards, and congestion in the blood vessels. What does this mean? Does it mean I have something wrong with my blood vessels? What does it mean when u say periods of stress, heart won't be able to function? What kind of stress, and what causes it? U say the stress is possible hypotension, and what does this mean? Then u mention serum proteins to rule out other causes. Is this just blood work? If I ask the dr for a serum protein test, will he know what I mean? I am sorry for all the questions, but I don't know what all this means?
Brief Answer:
Yes, your doctor will know.
Detailed Answer:
Hi,
Thanks for asking again.
Sorry to confuse you with so much details.
Yes, your doctor will know serum protein test. Also get your hemoglobin level checked.
Anemia and muscle weakness (due to age or medications) could be causing your shortness of breath. As it is present only at night, and not during day, it is not due to congestive cardiac failure.
Lower limb swelling is usually seen in congestive cardiac failure. Episodes are seen in patients suffering from hypertension. You were on Tenormin for possible hypertension for a longer time. So, I called it as chronic hypertension.
At present you are hypotensive and heart is functioning more to improve blood pressure levels. So, I called this as stress period.
Nothing is wrong with your blood vessels. At present except for your low blood pressure and occasional breathlessness, you are perfectly alright.
Secondary usually means "due to"
Hope it helps.
Any further queries, happy to help again.
Dr. Jyothi BL
Yes, your doctor will know.
Detailed Answer:
Hi,
Thanks for asking again.
Sorry to confuse you with so much details.
Yes, your doctor will know serum protein test. Also get your hemoglobin level checked.
Anemia and muscle weakness (due to age or medications) could be causing your shortness of breath. As it is present only at night, and not during day, it is not due to congestive cardiac failure.
Lower limb swelling is usually seen in congestive cardiac failure. Episodes are seen in patients suffering from hypertension. You were on Tenormin for possible hypertension for a longer time. So, I called it as chronic hypertension.
At present you are hypotensive and heart is functioning more to improve blood pressure levels. So, I called this as stress period.
Nothing is wrong with your blood vessels. At present except for your low blood pressure and occasional breathlessness, you are perfectly alright.
Secondary usually means "due to"
Hope it helps.
Any further queries, happy to help again.
Dr. Jyothi BL
Above answer was peer-reviewed by :
Dr. Shanthi.E
I was only put on the Tenormin due to my heart rate being very high. Then was diagnosed with SVT finally. So I do have congestive cardiac failure? This sounds bad and scary.
Brief Answer:
Echo will confirm- look into reports.
Detailed Answer:
Hi,
Thanks for asking again.
If breathlessness is all day long, along the swelling - it appears to be initial symptoms of congestive cardiac failure.
However, if you did not have hypertension, then other causes like medications, needs evaluation. What did the echo reports say? Do discuss with your doctor.
This is not so scary as you are scared. Ionotropic agents can be used to improve cardiac function, if required.
Meet your doctor and discuss regarding the medications and echo report. As I do not have echo reports, I cannot comment any further regarding congestive cardiac failure.
Hope it helps.
Any further queries, happy to help again.
If you do not have any further queries, you can close the discussion and rate the answer.
Thanks for asking.
Take care.
Dr. Jyothi BL
Echo will confirm- look into reports.
Detailed Answer:
Hi,
Thanks for asking again.
If breathlessness is all day long, along the swelling - it appears to be initial symptoms of congestive cardiac failure.
However, if you did not have hypertension, then other causes like medications, needs evaluation. What did the echo reports say? Do discuss with your doctor.
This is not so scary as you are scared. Ionotropic agents can be used to improve cardiac function, if required.
Meet your doctor and discuss regarding the medications and echo report. As I do not have echo reports, I cannot comment any further regarding congestive cardiac failure.
Hope it helps.
Any further queries, happy to help again.
If you do not have any further queries, you can close the discussion and rate the answer.
Thanks for asking.
Take care.
Dr. Jyothi BL
Above answer was peer-reviewed by :
Dr. Yogesh D
So if I do have congestive cardiac failure would the echo confirm this?
Brief Answer:
Yes
Detailed Answer:
Hi,
Thanks for asking again.
Yes, along with clinical findings, echo is a very important test for confirmation of congestive cardiac failure.
Hope it helps.
Any further queries, happy to help again.
If you do not have any further queries, you can close the discussion and rate the answer.
Thanks for asking.
Take care.
Dr. Jyothi BL
Yes
Detailed Answer:
Hi,
Thanks for asking again.
Yes, along with clinical findings, echo is a very important test for confirmation of congestive cardiac failure.
Hope it helps.
Any further queries, happy to help again.
If you do not have any further queries, you can close the discussion and rate the answer.
Thanks for asking.
Take care.
Dr. Jyothi BL
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Above answer was peer-reviewed by :
Dr. Yogesh D
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