Is Your MS Fatigue Getting Worse? Check Your Bladder Medications

How Your Bladder Medications May Worsen Your MS-Related Fatigue

A sign depicting urinary incontinence.
A sign depicting urinary incontinence. Peter Dazeley/Getty Images

If you have multiple sclerosis (MS), you're probably used to pinning your fatigue on the disease itself—and rightfully so. This symptom occurs in about 80-percent of people with MS and is often debilitating. But if your fatigue seems to be worsening, there may be another culprit inside your medicine cabinet. Many bladder medications prescribed for MS-related bladder dysfunction list tiredness and drowsiness as potential side effects.

Unfortunately, while helping you with one problem, these drugs can compound the "walking-through-molasses" feeling you already have.

People with MS experience many different types of bladder dysfunction. They are all slightly different in nature, and therefore require different types of medications to address them. In fact, some drugs originally created to be antidepressants or reduce high blood pressure are very effective when treating urinary and bladder problems caused by MS.

Multiple Sclerosis and Secondary Fatigue

If you take bladder medications, the great news is that tweaking or changing your medications may help relieve some of your fatigue. Those of us with MS know the disease process and MS-related heat intolerance can make us tired enough, so it's important to identify any potential drains on our energy that can be modified. Here's a list of drugs that may be wiping you out and how to fight the fatigue they cause.

Note To Those Living Outside the U.S.: The list below includes brand names of drugs prescribed in the US. For people in other countries, please refer to the generic name of the medication (which may be spelled slightly differently, depending on the country). Thanks for your understanding.

Medications for Urinary Frequency and Urgency

Oxybutynin (Ditropan): An anticholinergic (antispasmodic) drug, which is available as syrup, skin patch and tablets.

Desmopressin (DDAVP): A hormone that is given to control frequent urination found in a certain kind of diabetes, after head injuries or surgery, which is available as an injection, nose spray, rhinal tube nose solution or tablets.

Medications for Urinary Urgency and Incontinence

Tolterodine (Detrol): A drug that works by preventing or reducing bladder contractions, and is available as tablets or extended-release capsules.

Carbamazepine (Tegretol, Carbatrol): An anticonvulsant drug which works by reducing abnormal activity or excitement in the brain, which is also used to treat trigeminal neuralgia and manic episodes. It is available as extended-release tablets or capsules, oral suspension, tablets or chewable tablets.

Imipramine (Tofranil): A tricyclic antidepressant that is also used to treat bedwetting. It is available as capsules, injections or tablets.

Bethanechol (Urecholine): A drug that helps the bladder to empty all the way. It is available as tablets or injections.

Medications for Urinary Hesitancy

Phenoxybenzamine (Dibenzyline): An antihypertensive drug (to treat high blood pressure) which is available as capsules.

Terazosin (Hytrin): An alpha-blocker that relaxes muscles in the bladder and prostrate (for men), as well as lowering blood pressure. It is available as capsules.

Medications for Spastic Bladder

Propantheline (Pro-Banthine): An anticholinergic (antispasmodic) drug, available as tablets.

Oxybutynin (Ditropan): An anticholinergic (antispasmodic) drug, which is available as syrup, skin patch or tablets.

Hyoscyamine (Symax): An anticholinergic primarily used for irritable bowel syndrome, available as biphasic tablets or sustained-release capsules or tablets, elixir or solution, injection, oral disintegrating tablets, tablets or capsules.

Baclofen (Lioresal): An antispasmodic drug, which is available as disintegrating tablets, injections or tablets.

Diazepam (Valium): A benzodiazepine that is available as an injection, oral solution, rectal gel or tablets. Labeled as an antianxiety medication, but also used as an anticonvulsant.

Medications for Overactive Bladder

Trospium (Sanctura): An anticholinergic, which is available as extended-release capsules or tablets.

Solifenacin (Vesicare): An anticholinergic, available as tablets.

Darifenacin (Enablex): An antimuscarinic, available as an extended-release tablet.

Tamsulosin (Flomax): An alpha-blocker, which is to relax muscles in the bladder and site of prostate enlargement. It is for men only. It is available as capsules.

Terazosin (Hytrin): An alpha-blocker that relaxes muscles in the bladder and prostrate (for men), as well as lowering blood pressure. It is available as capsules.

Prazosin (Minipress): An alpha-blocker, used for high blood pressure, which works by relaxing blood vessels. Available as capsules.

Imipramine (Tofranil): A tricyclic antidepressant that is also used to treat bedwetting. It is available as capsules, injections or tablets.

But What If “Fatigue” Isn’t Listed as a Side Effect of My Drug?

Most of the medications listed below list "fatigue" or "tiredness" as side effects—but other potential reactions they list, such as "lightheadedness" or "weakness," can make you feel very tired as well. Others have side effects such as “sweating,” “trembling,” “difficulty breathing,” “flushing,” “confusion,” “nausea/vomiting” or “fainting spells," any of which may be enough to tip the balance between a good day and a bad day, fatigue-wise, for someone already battling MS-related fatigue.

How to Manage Your Drug-Induced Fatigue

Just because it looks like one of your medications may be contributing to your fatigue, it doesn’t necessarily mean the end of this drug for you—or if it is, that you can't find a suitable replacement. Ask your doctor for help figuring this out. Here are some ways you can work together to fight drug-induced fatigue.

Troubleshoot Your Medication. Your doctor may have some ideas about taking it at a different time of day or taking it with food—maybe splitting the dose would reduce the side effects or perhaps it comes in a different form, like a time-released version, that might be better for you. If none of these things seem to be working, your doctor can suggest another medication or other types of therapy.

Think About Drug Interactions. Maybe your medication wouldn’t cause fatigue if you didn’t take it at the same time as your other medications. Or perhaps you're not supposed to consume alcohol while taking it, but you weren't aware. Ask your doctor about these things.

Keep a Fatigue Log. When you are trying to pinpoint possible causes or contributors to your fatigue, it is important to keep a record of what you are experiencing so that you can discuss it with your doctor. Keep a notebook and log your level of fatigue each day. Make sure that you include your medications and when you took them.

Take Note Of ALL Medications You're On. Even if your drug is not in tablet or injection form, it can still cause fatigue. Remember: patches, eye drops, nasal sprays and other methods of delivering medications are still getting the active ingredients into your bloodstream in most cases. Simply put, if it can help a symptom and have a positive effect, it can also have side effects.

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