Can medications cause hyperhidrosis?

Medications as a Cause of Hyperhidrosis

Yes, multiple medications can cause hyperhidrosis (excessive sweating) as a side effect. This is well-documented in clinical guidelines and medication labels.

Common Medication Classes Associated with Hyperhidrosis

Antidepressants

• Selective serotonin-norepinephrine reuptake inhibitors (SNRIs): Duloxetine is specifically noted to cause hyperhidrosis as a side effect 1
• Tricyclic antidepressants: Amitriptyline and nortriptyline can cause excessive sweating 1

Anticholinesterases

• Pyridostigmine: Can increase salivation, lacrimation, and sweating 1

Antipsychotics

• Atypical antipsychotics: Aripiprazole has been reported to cause hyperhidrosis 2

Antiretrovirals

• Efavirenz: Associated with nocturnal hyperhidrosis that is dose-dependent 3

Mechanism of Drug-Induced Hyperhidrosis

Drug-induced hyperhidrosis typically occurs through several mechanisms:

1. Central nervous system effects: Medications that affect serotonin or norepinephrine pathways can disrupt the hypothalamic thermoregulatory center 3

2. Peripheral autonomic effects: Drugs may directly stimulate cholinergic receptors at eccrine sweat glands 4

3. Hormonal changes: Some medications alter hormone levels that influence sweating 5

Diagnosis of Drug-Induced Hyperhidrosis

To determine if hyperhidrosis is medication-induced:

1. Temporal relationship: Onset of sweating coinciding with starting a new medication
2. Dose-response relationship: Sweating that increases with higher doses
3. Resolution with discontinuation: Sweating that improves when the medication is stopped or dose reduced 3

Management Approach

When medication-induced hyperhidrosis is suspected:

1. Evaluate necessity of the medication causing hyperhidrosis
2. Consider dose reduction if clinically appropriate (as demonstrated with efavirenz) 3
3. Switch to alternative medication in the same class with lower risk of hyperhidrosis
4. Treat symptomatically if medication cannot be changed:
   • Topical aluminum chloride for focal hyperhidrosis 4
   • Topical glycopyrrolate for craniofacial sweating 5
   • Oral anticholinergics like glycopyrrolate (1-2 mg once or twice daily) 4
   • Botulinum toxin injections for persistent focal hyperhidrosis 4, 5

Special Considerations

Severity Assessment

• Use the Hyperhidrosis Disease Severity Scale to grade impact on quality of life and guide treatment decisions 5

Secondary Causes

• Always rule out other causes of secondary hyperhidrosis (medical conditions) before attributing to medications 1, 5

Patient Education

• Inform patients about potential sweating side effects when prescribing medications known to cause hyperhidrosis
• Advise patients to avoid overheating in hot environments when taking medications that affect sweating 6

Common Pitfalls to Avoid

1. Overlooking medication as a cause: Many clinicians fail to consider medications when evaluating hyperhidrosis
2. Misattributing to anxiety: Drug-induced sweating may be incorrectly attributed to anxiety or stress
3. Inappropriate management: Adding more medications to treat hyperhidrosis without addressing the causative medication
4. Abrupt discontinuation: Some medications (particularly antidepressants) require gradual tapering to prevent withdrawal symptoms 1

Remember that medication-induced hyperhidrosis can significantly impact quality of life and may lead to medication non-adherence if not properly addressed 2.