Are any of these medications associated with hyperhidrosis?

Medications Associated with Hyperhidrosis

Duloxetine (Cymbalta) is the only medication in the provided list that is associated with hyperhidrosis as a common side effect. 1

Medication Review for Hyperhidrosis Association

Confirmed Hyperhidrosis-Associated Medication

• Duloxetine (CYMBALTA) - Hyperhidrosis is listed as one of the most common adverse reactions, occurring in approximately 6% of patients taking duloxetine compared to 1% in placebo groups 1. The FDA label specifically identifies hyperhidrosis as one of the most commonly observed adverse reactions in duloxetine-treated patients across all populations 1.

Medications with Potential Autonomic Effects but Not Specifically Associated with Hyperhidrosis

• Spironolactone (ALDACTONE) - While it can cause various side effects, hyperhidrosis is not listed among its common adverse effects 2.
• HydrOXYzine (ATARAX) - This medication is more commonly associated with anticholinergic effects like dry mouth rather than hyperhidrosis 2.
• BusPIRone (BUSPAR) - Not associated with hyperhidrosis in the provided evidence 2.
• TraZODone (DESYREL) - Not associated with hyperhidrosis in the provided evidence 2.

Medications Used to Treat Hyperhidrosis

Interestingly, some medications in the list are actually used to treat hyperhidrosis:

• Glycopyrrolate (not in the patient's list but mentioned in guidelines) is used as a systemic treatment for hyperhidrosis 3, 4.
• Clonidine (not in the patient's list but mentioned in guidelines) can be used for craniofacial hyperhidrosis 3, 4.

Clinical Considerations for Duloxetine-Associated Hyperhidrosis

Incidence and Presentation

• Hyperhidrosis occurs in approximately 6% of duloxetine-treated patients versus 1% in placebo groups 1.
• It is one of the most commonly reported adverse effects along with nausea, dry mouth, somnolence, constipation, and decreased appetite 1.
• The sweating is typically generalized rather than focal 1.

Management Options for Medication-Induced Hyperhidrosis

If the patient is experiencing hyperhidrosis related to duloxetine:

1. Dose adjustment - Consider lowering the dose if clinically appropriate 1.

2. Topical treatments:

   • Aluminum chloride solutions (20-25%) as first-line treatment for focal hyperhidrosis 3, 4.
   • Glycopyrrolate topical formulations for craniofacial sweating 4.

3. Systemic adjunctive medications if hyperhidrosis is severe but duloxetine must be continued:

   • Oral anticholinergics like glycopyrrolate (1-2 mg once or twice daily) 3, 4.
   • Clonidine (0.1 mg twice daily) may be helpful 3.

4. Alternative antidepressant - If hyperhidrosis is intolerable, consider switching to an alternative antidepressant with lower rates of hyperhidrosis 1.

5. Other interventions for persistent cases:

   • Iontophoresis for palmar and plantar hyperhidrosis 4, 5.
   • Botulinum toxin injections for focal hyperhidrosis 4, 6.

Monitoring and Follow-up

• Patients should be advised that hyperhidrosis may occur as a side effect of duloxetine 1.
• Discontinuation of duloxetine may be associated with hyperhidrosis as a withdrawal symptom 1.
• Patients should not abruptly stop taking duloxetine without consulting their healthcare provider 1.

Conclusion

Among the medications listed in the patient's regimen, only duloxetine (Cymbalta) is associated with hyperhidrosis as a documented side effect. If the patient is experiencing troublesome sweating, this medication should be considered as the likely cause, and appropriate management strategies should be implemented.