Medications That Cause Excessive Sweating
Selective serotonin reuptake inhibitors (SSRIs) are the most common medication class causing excessive sweating, with sertraline, paroxetine, fluoxetine, citalopram, and fluvoxamine all documented to cause this side effect in 7-11% of patients—significantly higher than placebo rates of 2%. 1, 2, 1
Antidepressants
SSRIs (Most Common Culprits)
- Sertraline (Zoloft): Causes increased sweating in 7-11% of patients across multiple indications (major depression, OCD, panic disorder, PTSD, social anxiety disorder) compared to 2% with placebo 1
- Paroxetine (Paxil): Documented sweating rates across all studied conditions, with excessive sweating being one of the most common side effects leading to treatment discontinuation (>1% discontinuation rate) 2
- Fluoxetine (Prozac): Listed as causing sweating, tremors, and nervousness as typical SSRI side effects 3, 4
- Citalopram (Celexa) and Fluvoxamine (Luvox): Both cause sweating as documented side effects 3, 4
SNRIs
- Venlafaxine: Causes sweating particularly at higher doses due to increasing noradrenergic activity; at doses above 75 mg/day, the noradrenergic component increases sweating risk 3, 5
- Duloxetine: Frequently reported to cause sweating, with documented cases of excessive sweating when combined with other agents 6
- Desvenlafaxine: Reported to cause night sweats 4
Tricyclic Antidepressants
Other Antidepressants
- Bupropion (Wellbutrin), Mirtazapine (Remeron), and Nefazodone (Serzone): All documented to cause night sweats 3, 4
Cholinergic Medications
- Pilocarpine: Causes excessive sweating in over 40% of patients at doses of 5 mg four times daily, with 2% of patients discontinuing due to this side effect 3
- Cevimeline: Binds to muscarinic receptors and stimulates sweat gland secretion, though may have fewer systemic side effects than pilocarpine 3
Cardiovascular Medications
- Calcium channel blockers (amlodipine, diltiazem, nifedipine): Associated with drug-induced photosensitivity and sweating 3
- Beta-blockers (metoprolol succinate ER): Can occasionally cause sweating, though less commonly than other medication classes 4
Other Medication Classes
Antipsychotics
- Quetiapine and Olanzapine: Both documented to cause night sweats 4
Mood Stabilizers
Pain Medications
- Opioids and opiates: Documented to cause night sweats 4
Anti-inflammatory Medications
- NSAIDs: Can cause night sweats with prolonged use 4
Clinical Management Considerations
When Serotonin Syndrome Must Be Ruled Out
Monitor for the triad of mental status changes (confusion, agitation), neuromuscular hyperactivity (tremors, clonus, hyperreflexia), and autonomic hyperactivity (hypertension, tachycardia, diaphoresis, shivering, diarrhea) when patients on serotonergic medications report sweating 3. This medical emergency requires immediate discontinuation of all serotonergic agents and hospital-based supportive care 3.
Treatment Strategies for Medication-Induced Sweating
When sweating is problematic but not part of serotonin syndrome:
- Dose reduction: Consider lowering the antidepressant dose as first-line approach 7
- Medication substitution: Switch to an alternative antidepressant with lower sweating risk 7
- Pharmacological management:
- Terazosin (1-6 mg/day): Demonstrated 95% response rate (22/23 patients) in the only clinical trial for antidepressant-induced excessive sweating, with CGI-Severity improving from median 5 to median 2 8
- Benztropine or cyproheptadine: Alternative agents reported successful in controlling sweating 7
- Mirtazapine: Can be added to reduce SSRI-induced sweating through its serotonin antagonistic properties 9
Special Population Considerations
In older adults taking SSRIs (citalopram, escitalopram, sertraline, mirtazapine, venlafaxine, bupropion), monitor closely for night sweats 4. Avoid paroxetine and fluoxetine in older adults due to higher adverse effect rates, with an odds ratio of 3.01 (95% CI 1.26-7.19) for experiencing night sweats 4.