For more information, you can:

• Use your Counter Intelligence Plus training guide
• FInd out more about tiredness and fatigue via NHS Choices
• Look at information provided by the Royal College of Psychiatrists
• Find out more about healthy eating via NHS Choices.

When to refer

Certain symptoms should ring warning bells, so get your pharmacist involved if a customer reports any of the following alongside tiredness:

• Significant and unintentional weight loss
• Signs that could indicate a neurological problem (e.g. loss of vision or coordination)
• Symptoms of malignancy (e.g. a lump, rectal or postmenopausal vaginal bleeding, difficulty swallowing or vomiting blood) or an infection (e.g. night sweats or a fever)
• Suspected carbon monoxide poisoning (symptoms would include headache, dizziness, nausea, breathlessness and a raised heart rate)
• Anything that indicates an undiagnosed chronic condition (e.g. breathing difficulties suggests COPD, while tiredness that is worse in the morning hints at depression)
• Persistent or recurrent fatigue (although not lifelong) that might point towards chronic fatigue syndrome.

Tiredness can be a side effect of many medicines – from prescription drugs such as painkillers, sedatives and blood pressure medication to over-the-counter remedies for hayfever and herbal products – so ask your pharmacist to step in if someone is complaining of fatigue and tells you they are taking any medicines at all.