Can trazodone (antidepressant) cause excessive sweating?

Trazodone and Excessive Sweating

Yes, trazodone can cause excessive sweating as a side effect, particularly when used at higher doses for depression treatment. According to clinical guidelines, sweating is recognized as one of the typical side effects of serotonergic antidepressants including trazodone 1.

Mechanism and Prevalence

Trazodone belongs to the class of Serotonin Receptor Antagonists and Reuptake Inhibitors (SARIs). Its serotonergic activity is associated with several side effects including:

• Sweating (hyperhidrosis)
• Headache
• Somnolence/sedation
• Dizziness
• Dry mouth

The American Academy of Family Physicians guidelines note that serotonergic medications like trazodone commonly cause sweating as part of their side effect profile 1. This occurs through serotonin's effect on thermoregulation and autonomic nervous system function.

Dose-Related Considerations

The risk of experiencing excessive sweating with trazodone appears to be dose-dependent:

• At lower doses (25-100mg) commonly used for insomnia, sweating is less frequently reported 2
• At higher doses (150-400mg) used for depression treatment, sweating is more commonly experienced 3

Management Strategies

If a patient experiences problematic sweating while taking trazodone, consider:

1. Dose adjustment: Reducing the dose may help minimize sweating while maintaining therapeutic benefit
2. Timing of administration: Taking the medication at bedtime may help patients sleep through some of the side effects
3. Alternative medications: For insomnia, consider other options if sweating is problematic, as the American Academy of Sleep Medicine suggests not using trazodone as first-line treatment for insomnia anyway 1, 2
4. Gradual discontinuation: If switching medications, taper trazodone gradually over 10-14 days to limit withdrawal symptoms 1

Clinical Context

When prescribing trazodone, it's important to weigh the benefits against potential side effects:

• For depression treatment: Sweating may be an acceptable side effect if the patient is responding well to trazodone's antidepressant effects
• For insomnia treatment: Since trazodone is used off-label for insomnia and the American Academy of Sleep Medicine suggests against its use for this indication 1, sweating may be an unnecessary side effect to tolerate when other options exist

Other Important Side Effects to Monitor

While discussing sweating, be aware of other potentially more serious side effects:

• Orthostatic hypotension (particularly in elderly patients)
• Cardiac arrhythmias (rare)
• Priapism (rare but serious)
• Serotonin syndrome (when combined with other serotonergic medications)

Bottom Line

Excessive sweating is a recognized side effect of trazodone that appears to be related to its serotonergic activity. The effect is more common at higher antidepressant doses than at lower doses used for insomnia. If sweating becomes problematic, dose adjustment or medication change should be considered, particularly when the drug is being used off-label for insomnia rather than for its primary indication of depression.