Can citalopram (selective serotonin reuptake inhibitor) be used to treat night sweats?

Citalopram for Night Sweats

Citalopram can be effective for treating night sweats, particularly in menopausal women, but may paradoxically cause sweating as a side effect in some patients. This creates a complex risk-benefit consideration when using it specifically for night sweat management.

Mechanism and Evidence

Selective serotonin reuptake inhibitors (SSRIs) like citalopram affect the central thermoregulatory system through serotonergic pathways. While they can help manage vasomotor symptoms including night sweats in some patients, they can also induce sweating as a side effect.

According to clinical guidelines for managing menopausal symptoms after breast cancer 1, SSRIs including citalopram have been used to treat vasomotor symptoms (hot flashes and night sweats). The evidence shows that:

• SSRIs can reduce the frequency and severity of vasomotor symptoms
• The doses required for this indication are typically lower than those needed for depression
• Response to treatment is usually faster than when treating depression

Dosing Considerations

When using citalopram for night sweats:

• Start with a low dose (10 mg daily) 1
• The maximum recommended dose is 40 mg daily 1
• Some patients experience nausea and sleep disturbances with citalopram 1
• Increased sweating is paradoxically listed as a common side effect of citalopram 2

Important Precautions

Drug Interactions

If the patient is taking tamoxifen (for breast cancer), caution is warranted:

• Pure SSRIs, particularly paroxetine, can inhibit CYP2D6, potentially reducing tamoxifen's effectiveness 1
• While citalopram has less effect on drug metabolism compared to other SSRIs 1, this interaction should still be considered

Side Effect Profile

Citalopram may cause several side effects, including:

• Increased sweating (paradoxical effect) 2
• Nausea, dry mouth, somnolence, tremor, diarrhea 2
• Sexual dysfunction 2

Alternative Options

If citalopram is ineffective or poorly tolerated, consider:

1. Other SSRIs/SNRIs:

   • Venlafaxine may have a dose-dependent effect on sweating - potentially reducing sweating at lower doses (up to 75 mg daily) while increasing it at higher doses 3

2. Anticonvulsants:

   • Gabapentin and pregabalin have shown efficacy for vasomotor symptoms 1
   • These may be particularly useful when given at bedtime in patients whose sleep is disturbed by night sweats 1

3. Alpha-adrenergic agents:

   • Clonidine has shown efficacy in reducing hot flashes and night sweats 1

4. Non-pharmacological approaches:

   • Acupuncture, exercise, yoga, lifestyle modifications, weight loss, hypnosis, and cognitive behavioral therapy may help manage vasomotor symptoms 1

Monitoring and Management

• Assess response after 4-8 weeks of treatment 1
• If excessive sweating occurs as a side effect, consider:
  1. Dose reduction
  2. Switching to an alternative agent
  3. Adding an agent to control sweating (benztropine or cyproheptadine have been reported to help) 4

Conclusion

When prescribing citalopram for night sweats, start with a low dose (10 mg daily), monitor for both therapeutic effect and paradoxical sweating as a side effect, and be prepared to adjust therapy based on individual response. The risk-benefit profile should be carefully considered, especially in patients taking tamoxifen or those with a history of adverse reactions to SSRIs.