Is sweating a side effect of Pristiq (desvenlafaxine)?

Sweating is a Common Side Effect of Pristiq (Desvenlafaxine)

Yes, sweating (hyperhidrosis/diaphoresis) is a well-established and common adverse effect of Pristiq (desvenlafaxine), occurring in 10-21% of patients depending on the dose. 1

Evidence from FDA Drug Labeling

The FDA-approved prescribing information for desvenlafaxine explicitly lists sweating as one of the most common side effects:

• Hyperhidrosis (excessive sweating) occurred in 4-21% of patients in clinical trials, with incidence increasing at higher doses (4% at 50 mg, 10% at 100 mg, 11% at 200 mg, and 18-21% at 400 mg daily) 1
• Sweating is listed among the most common side effects alongside nausea, dizziness, problems sleeping, constipation, and decreased appetite 1
• Sweating is also a recognized symptom of serotonin syndrome, a potentially life-threatening condition that can occur with desvenlafaxine, particularly when combined with other serotonergic medications 1
• Sweating may occur as part of discontinuation syndrome when stopping desvenlafaxine abruptly 1

Class Effect of SNRIs

Desvenlafaxine belongs to the SNRI (serotonin-norepinephrine reuptake inhibitor) class, and sweating is a recognized adverse effect across this entire medication class:

• Diaphoresis (sweating) is explicitly listed as a common adverse effect of SNRIs in pediatric and adolescent populations, and this extends to adults 2
• The mechanism involves both serotonergic and noradrenergic effects on central thermoregulation and peripheral sympathetic nervous system activity 3

Comparison to Other Antidepressants

Sweating is not unique to desvenlafaxine but is common across multiple antidepressant classes:

• SSRIs commonly cause sweating, tremors, nervousness, insomnia, and gastrointestinal disturbances 2
• Second-generation antidepressants (SSRIs, SNRIs, and tetracyclic agents) cause sweating as one of the commonly reported adverse effects, along with diarrhea, dizziness, dry mouth, fatigue, headache, sexual dysfunction, tremor, and weight gain 2
• In studies of premature ejaculation treatment with SSRIs, serotonergic syndrome can include sweating, headache, nausea, and dizziness 2

Clinical Significance and Management

Antidepressant-induced excessive sweating (ADIES) occurs in 5-14% of patients taking antidepressants, usually persists throughout treatment, and can cause subjective distress and functional impairment 4. The sweating commonly affects the scalp (62%), face (95%), neck (48%), and chest (57%), and typically occurs either episodically or with episodic bursts (82%) 4.

Important Caveats:

• Sweating can be a sign of serotonin syndrome, which requires immediate medical attention if accompanied by agitation, confusion, fast heart rate, changes in blood pressure, dizziness, flushing, high body temperature, tremors, stiff muscles, loss of coordination, or seizures 1
• The sweating side effect appears dose-dependent, with higher rates at doses above 50 mg daily 1
• If sweating becomes problematic, terazosin (an alpha-1 blocker) has shown efficacy in treating antidepressant-induced excessive sweating in clinical trials, though this is an off-label use 4
• Do not abruptly discontinue desvenlafaxine as sweating can also be part of withdrawal syndrome; taper slowly under medical supervision 1