From the Guidelines
Medications that can cause anhidrosis, or the inability to sweat, include anticholinergic drugs, such as antihistamines, tricyclic antidepressants, antipsychotics, and medications for overactive bladder, as well as certain blood pressure medications like beta-blockers and calcium channel blockers. These medications can interfere with sweating by blocking acetylcholine receptors or disrupting sympathetic nervous system function, which normally stimulates sweat glands. According to the most recent evidence available, specifically the 2018 guideline for the prevention, detection, evaluation, and management of high blood pressure in adults 1, beta-blockers like propranolol can cause anhidrosis. Additionally, other medications like botulinum toxin injections can also cause localized anhidrosis. It is essential for patients taking these medications to be cautious during hot weather or intense physical activity, stay hydrated, seek air-conditioned environments when possible, and consult their healthcare provider if they notice decreased sweating, especially if accompanied by symptoms of overheating like dizziness, weakness, or confusion. Some key medications to watch out for include:
- Antihistamines like diphenhydramine
- Tricyclic antidepressants like amitriptyline
- Antipsychotics like chlorpromazine
- Medications for overactive bladder like oxybutynin
- Beta-blockers like propranolol
- Calcium channel blockers like verapamil
- Antiparkinsonian drugs like benztropine
- Botulinum toxin injections Patients should be aware of these potential side effects and take necessary precautions to avoid heat-related illnesses.
From the FDA Drug Label
Since benztropine mesylate contains structural features of atropine, it may produce anhidrosis For this reason, it should be administered with caution during hot weather, especially when given concomitantly with other atropine-like drugs to the chronically ill, the alcoholic, those who have central nervous system disease, and those who do manual labor in a hot environment. Anhidrosis may occur more readily when some disturbance of sweating already exists If there is evidence of anhidrosis, the possibility of hyperthermia should be considered. Severe anhidrosis and fatal hyperthermia have occurred. anhidrosis; hyperthermia;
Medications that can cause anhidrosis include:
- Benztropine mesylate, an anticholinergic-type antiparkinsonism drug, due to its structural features of atropine 2 Key points:
- Anhidrosis may occur more readily when some disturbance of sweating already exists
- If there is evidence of anhidrosis, the possibility of hyperthermia should be considered
- Severe anhidrosis and fatal hyperthermia have occurred 2
- Benztropine mesylate overdose can also cause anhidrosis and hyperthermia 2
From the Research
Medications that can Cause Anhidrosis
- The following medications have been associated with anhidrosis (inability to sweat) or hypohidrosis (reduced sweating) as adverse events:
- Antiepileptics 3
- Drugs for urinary frequency and incontinence 3
- Antidepressants 3
- Glycopyrronium 3
- Solifenacin 3
- Oxybutynin 3
- Botulinum toxin type A 3
- Topiramate 3
- Zonisamide 3
- Agalsidase beta 3
- Finasteride 3
- Metformin 3
- Lamotrigine 3
- Citalopram 3
- Ciprofloxacin 3
- Bupropion 3
- Duloxetine 3
- Aripiprazole 4, 3
- Prednisolone 3
- Risperidone 3
- These medications may be potential candidates for treating hyperhidrosis (excessive sweating) due to their association with hypohidrosis or anhidrosis adverse events 3.
Mechanism of Anhidrosis
- Anhidrosis can be caused by a variety of factors affecting sweat glands directly or indirectly through alterations in their nerve supply 5.
- Cholinergic urticaria has been associated with some cases of acquired idiopathic generalized anhidrosis 5.
- The onset time of drug-associated hypohidrosis or anhidrosis can vary, and some medications may have a higher risk of causing these adverse events 3.