Night Sweats in Patients on GLP-1 Receptor Agonists
Night sweats are not a recognized adverse effect of GLP-1 receptor agonists based on current clinical evidence and guidelines. The comprehensive adverse effect profiles documented in recent guidelines do not list night sweats as a known complication of these medications 1.
Documented Adverse Effects of GLP-1 Receptor Agonists
The established adverse effects of GLP-1 receptor agonists include 1:
- Gastrointestinal effects (most common): nausea, vomiting, diarrhea, dyspepsia, constipation, and gastroesophageal reflux
- Cardiac effects: arrhythmia/tachycardia (heart rate typically increases by ~5 bpm) 1
- Gallbladder disorders (usually asymptomatic) 1
- Rare complications: acute pancreatitis (particularly with exenatide) 1
Clinical Approach to Night Sweats in GLP-1 Users
Since night sweats are not attributable to GLP-1 receptor agonists, investigate alternative etiologies:
Evaluate for hypoglycemia
- Check nocturnal glucose levels with continuous glucose monitoring or fingerstick testing during symptomatic episodes 2, 3
- GLP-1 receptor agonists have a low intrinsic risk of hypoglycemia, but when combined with insulin or sulfonylureas, hypoglycemia risk increases 1, 2
- If hypoglycemia is confirmed, reduce doses of concurrent insulin or insulin secretagogues 1
Consider metabolic changes from weight loss
- GLP-1 receptor agonists cause substantial weight loss (6.1-17.4% in non-diabetic patients, 4-6.2% in diabetic patients) 1
- Rapid weight loss can temporarily alter thermoregulation and cause transient night sweats unrelated to the medication itself
Investigate other causes
- Infection or malignancy (standard workup based on clinical presentation)
- Thyroid dysfunction (particularly important given the diabetes population)
- Medication interactions with other drugs the patient may be taking
- Autonomic neuropathy from underlying diabetes (not caused by GLP-1 agonists but may be unmasked)
Management Recommendation
Do not discontinue the GLP-1 receptor agonist for night sweats alone, as this symptom is not causally related to the medication and these agents provide significant cardiovascular and renal benefits 1. Instead, pursue a systematic evaluation for the actual cause of night sweats while continuing the GLP-1 therapy unless another contraindication emerges.