Fatigue or tiredness may be due to advanced disease. Start by determining if the tiredness could be due to reversible causes.

Reversible causes

Start by determining if the cause is reversible:

  • pain or dyspnea
  • insomnia
  • anemia
  • hypothyroidism
  • medication side-effects
  • distress: depression/anxiety


Modafinil: 100mg p.o. in am and at noon. Max dose 200mg bid. Over 65 years: 100mg p.o. in AM. Max dose 100mg p.o. in AM and Noon. Evidence quality is poor

Consider small dose dexamethasone:  2-4mg p.o. in am. If no benefit stop within 2 weeks to avoid needing to taper dose

Buproprion – systematic review of 584 patients showed improvement in fatigue with buproprion

Other therapies

  • encourage exercise, if possible
  • pace level of activity: prioritize activities so energy is available for most meaningful ones, and limit visitors
  • transfuse if anemic (but do not repeat if there’s no benefit)