Can Xywav Cause Night Sweating?
Yes, Xywav (calcium, magnesium, potassium, and sodium oxybates) can cause hyperhidrosis (excessive sweating), including night sweating, as a recognized adverse effect of oxybate medications. 1
Evidence for Hyperhidrosis with Oxybate Treatment
The American Academy of Sleep Medicine specifically addresses hyperhidrosis as a side effect requiring management in patients taking Xywav and other oxybate formulations. 1 This sweating can be significant enough to warrant specific treatment interventions while continuing the medication due to its strong efficacy for narcolepsy symptoms. 1
Common Adverse Effects Profile
Oxybate medications, including Xywav, are associated with several common adverse events that have been documented across clinical trials:
- Documented side effects include nausea, dizziness, nocturnal enuresis, headache, and sleep disturbances, with hyperhidrosis (excessive sweating) being a recognized adverse effect. 2, 3
- Weight loss, vomiting, decreased appetite, and nasopharyngitis are also commonly reported. 2
Clinical Management Approach
When hyperhidrosis occurs with Xywav, the American Academy of Sleep Medicine recommends continuing the medication and treating the sweating symptom directly, given the strong evidence supporting oxybate for narcolepsy treatment. 1
Recommended Treatment Algorithm for Xywav-Induced Sweating:
- First-line therapy: Initiate topical aluminum chloride solution 1
- Second-line therapy: If topical treatment fails, proceed to botulinum toxin A injections 1
- Continue Xywav: Maintain oxybate therapy throughout, as benefits substantially outweigh this manageable side effect 1
Context: Risk-Benefit Consideration
The American Academy of Sleep Medicine issues a STRONG recommendation for sodium oxybate (the active moiety in Xywav) for treating narcolepsy in adults, based on moderate-quality evidence demonstrating clinically significant improvements in cataplexy, excessive daytime sleepiness, and disease severity. 1, 3 The benefits of treatment substantially outweigh manageable side effects like hyperhidrosis. 1
Important Safety Monitoring
- Xywav carries an FDA black box warning as a CNS depressant that may cause respiratory depression and is a Schedule III controlled substance. 2
- Regular follow-up is necessary to assess both treatment efficacy and adverse effects, including evaluation for respiratory depression. 2
- The medication is only available through the REMS program using certified specialty pharmacies due to safety considerations. 3