What medications can cause night sweats?

Medications That Cause Night Sweats

Several classes of medications can cause night sweats as a side effect, with antidepressants being among the most common culprits. Here is a comprehensive list of medications known to cause night sweats:

Antidepressants

• Selective Serotonin Reuptake Inhibitors (SSRIs):

  • Fluoxetine (Prozac) 1, 2
  • Paroxetine (Paxil) 1, 3
  • Sertraline (Zoloft) 1, 2
  • Citalopram (Celexa) 1, 2
  • Fluvoxamine (Luvox) 1

• Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs):

  • Venlafaxine (Effexor) - listed specifically as causing night sweats in FDA labeling 4, 5
  • Desvenlafaxine 1

• Tricyclic Antidepressants:

  • Desipramine (Norpramin) 1
  • Nortriptyline (Pamelor) 1
  • Amitriptyline 3

• Other Antidepressants:

  • Bupropion (Wellbutrin) 1, 3
  • Mirtazapine (Remeron) 1
  • Nefazodone (Serzone) 1

Hormonal Medications

• Thyroid hormone supplements 2
• Hormone replacement therapy 1

Cardiovascular Medications

• Angiotensin Receptor Blockers (ARBs) 2
• Calcium channel blockers 1

Other Medications

• Antipsychotics:

  • Aripiprazole 6
  • Thioridazine 7
  • Quetiapine 1
  • Olanzapine 1

• Opioids and opiates 1

• Lithium 1

• Nonsteroidal anti-inflammatory drugs (NSAIDs) with prolonged use 1

Mechanism and Management

Night sweats caused by medications often occur through different mechanisms:

• SSRIs and SNRIs likely cause sweating through their effects on serotonergic and noradrenergic pathways that regulate body temperature 5
• At lower doses (up to 75mg daily), venlafaxine may actually reduce sweating due to its serotonergic effects, while at higher doses it increases sweating as its noradrenergic effects become more prominent 5

For patients experiencing medication-induced night sweats, management options include:

• Dose reduction of the causative medication 3
• Switching to an alternative medication within the same class or a different class 3
• Adding medications to control sweating, such as benztropine or cyproheptadine, if discontinuation is not an option 3

Special Considerations for Older Adults

In older adults, SSRIs are particularly associated with night sweats, with one study showing an odds ratio of 3.01 (95% CI 1.26-7.19) for experiencing night sweats while taking these medications 2. When prescribing for older adults, preferred antidepressants include citalopram, escitalopram, sertraline, mirtazapine, venlafaxine, and bupropion, though all can potentially cause sweating 1.

The 2019 AGS Beers Criteria® recommends avoiding paroxetine and fluoxetine in older adults due to higher rates of adverse effects, which may include night sweats 1.