What are the alternatives to Prozac (fluoxetine) for patients experiencing hyperhidrosis (excessive sweating) as a side effect?

From the Guidelines

Patients experiencing excessive sweating as a side effect of Prozac (fluoxetine) may consider alternative selective serotonin reuptake inhibitors (SSRIs) such as sertraline (Zoloft) or paroxetine (Paxil), as these have been shown to be effective in managing premature ejaculation with potentially lower rates of sweating 1. When evaluating alternatives to Prozac, it's essential to consider the patient's specific needs and medical history. SSRIs like sertraline and paroxetine have been studied in the context of premature ejaculation, with dosages ranging from 5 to 20 mg/day for fluoxetine, 10 to 40 mg/day for paroxetine, and 25 to 200 mg/day for sertraline 1. Some key points to consider when switching medications include:

• Tapering off Prozac gradually (typically over 2-4 weeks) to minimize discontinuation symptoms
• Starting the new medication at a low dose and titrating as needed
• Monitoring for potential side effects, such as nausea, dry mouth, drowsiness, and reduced libido
• Considering the patient's frequency of sexual activity and adjusting the dosing regimen accordingly It's also important to note that the adverse event profiles of SSRIs may differ among patients depending on the regimen prescribed, with continuous daily dosing and situational dosing potentially having different side effect profiles 1. In terms of specific alternatives, sertraline (Zoloft) may be a good option, as it has been shown to be well-tolerated and have less effect on the metabolism of other medications 1. Ultimately, the decision to switch medications should be made in consultation with a healthcare provider, taking into account the patient's individual needs and medical history.

From the FDA Drug Label

Autonomic Nervous System Disorders Sweating Increased 8% (Major Depressive Disorder/Other*) 3% (OCD) 6% (Panic Disorder) 4% (PTSD) 2% (PMDD Daily Dosing) <1% (PMDD Luteal Phase Dosing) 1% (Social Anxiety Disorder) 7% (Combined)

Alternatives to Prozac for patients experiencing excessive sweating may include:

• Sertraline, as the incidence of sweating increased is lower in some indications, such as OCD (3%) and PMDD Luteal Phase Dosing (<1%) 2
• Other SSRIs with potentially lower incidence of sweating increased, although this is not directly stated in the provided label
• Non-SSRI antidepressants, which may have a different side effect profile, although this is not directly stated in the provided label

Note: The provided label does not directly compare the incidence of sweating increased among different antidepressants, and the decision to switch medications should be made on a case-by-case basis, considering individual patient factors and medical history. 2

From the Research

Alternatives to Prozac for Excessive Sweating

• Patients experiencing excessive sweating due to Prozac (fluoxetine) may consider alternative treatments, such as dose reduction or substitution with another antidepressant 3.
• Agents like benztropine and cyproheptadine have been reported to be successful in controlling sweating symptoms in some patients 3.
• Terazosin, an alpha-blocker, has been shown to be effective in reducing excessive sweating in patients taking antidepressants, with 22 out of 23 patients responding to treatment 4.
• Oxybutynin, an anticholinergic medication, has also been found to reduce sweating in patients treated with sertraline, another SSRI 5.

Antidepressant Options

• Selective serotonin reuptake inhibitors (SSRIs) like fluoxetine, sertraline, and paroxetine are commonly associated with excessive sweating 6.
• Serotonin-norepinephrine reuptake inhibitors (SNRIs) also carry a risk of hyperhidrosis, similar to SSRIs 6.
• Some antidepressants, such as fluvoxamine, bupropion, and vortioxetine, may have a lower risk of hyperhidrosis 6.
• Clomipramine, a tricyclic antidepressant, is another option for treating obsessive-compulsive disorder, but may also cause sweating as a side effect 7.

Treatment Approaches

• A patient-specific approach is recommended for managing antidepressant-induced sweating, considering factors like dose reduction, antidepressant substitution, and addition of agents to control sweating 3.
• Treatment options like terazosin and oxybutynin may be considered for patients who experience persistent excessive sweating despite other interventions 4, 5.