Do finasteride, sotalol, carvedilol, or losartan cause afternoon fatigue?

Beta-Blockers (Sotalol and Carvedilol) Are Recognized Causes of Fatigue; Losartan and Finasteride Are Not

Beta-blockers including sotalol and carvedilol are well-documented causes of fatigue, while losartan and finasteride do not have established associations with afternoon fatigue specifically.

Beta-Blockers and Fatigue

Sotalol

• Fatigue is a common, dose-related adverse effect of sotalol, occurring in 18.9-19.6% of patients taking 160-320 mg daily doses compared to 8.5% with placebo 1
• The ACC/AHA guidelines explicitly identify fatigue as one of four major adverse reactions requiring attention with beta-blocker therapy 2
• Sotalol's beta-blocking properties depress CNS activity, which is a primary mechanism by which medications cause fatigue 3

Carvedilol

• Carvedilol causes fatigue through its beta-blocking effects, though the FDA label does not list specific incidence rates for fatigue as a standalone adverse event 4
• The ACC/AHA guidelines note that fatigue is multifactorial and "perhaps the hardest symptom to address with confidence" when managing beta-blocker therapy 2
• Before attributing fatigue to carvedilol, clinicians should evaluate for other causes including sleep apnea, overdiuresis, or depression 2

Clinical Management of Beta-Blocker-Related Fatigue

• Fatigue from beta-blockers should not automatically lead to discontinuation, as these medications reduce morbidity and mortality in heart failure and post-MI patients 2
• The guidelines emphasize that even if symptoms like fatigue do not improve, long-term treatment should be maintained to reduce the risk of major clinical events 2
• Consider alternative explanations before dose reduction: sleep disorders, volume depletion from excessive diuresis, or concurrent depression 2

Losartan and Fatigue

• Losartan (an angiotensin II receptor blocker) has no established association with fatigue 2
• Studies show losartan had no effect on cardiovascular function indices when compared to carvedilol, but did not report fatigue as an adverse effect 5
• ARBs like losartan can cause hypotension, dizziness, and falls, but fatigue is not a recognized adverse effect 2

Finasteride and Fatigue

• No evidence links finasteride to afternoon fatigue or fatigue in general based on the available literature
• Finasteride is not mentioned in comprehensive reviews of medications causing fatigue 6, 3, 7

Mechanism of Beta-Blocker-Induced Fatigue

• Beta-blockers cause fatigue through CNS depression by decreasing excitatory activity 3
• The reduction in sympathetic tone and heart rate response may contribute to exercise intolerance and perceived fatigue 2
• Medications that depress the CNS, including beta-blockers, are among the most common pharmaceutical causes of fatigue 3, 7

Clinical Pitfalls to Avoid

• Do not assume all fatigue in patients on beta-blockers is drug-related—the symptom is multifactorial 2
• Avoid abrupt withdrawal of beta-blockers even if fatigue is present, as this can lead to clinical deterioration 2
• Consider timing of administration: administering beta-blockers and ACE inhibitors at different times during the day may minimize hypotension-related symptoms that could be confused with fatigue 2
• In elderly patients, polypharmacy increases the risk of hypotension and related symptoms that may manifest as fatigue 2, 8