Sweating: Information for clinicians

This information is sourced from Scottish Palliative Guidelines and Dr Ros Taylor a senior palliative physician

Drenching sweats are often worse at night, can disturb sleep, cause severe discomfort, fatigue and affect quality of life. Patients often complain of needing to change the bedding in the middle of the night.

Differentiate from hot flushes - an intense feeling of warmth and erythema, but without sweating.

Red flags

Ask about recent chemotherapy - sweats may be a sign of neutropaenic sepsis.

Common causes 

Infection

Especially an abscess

Paraneoplastic

Caused by cancer - common with sarcoma, lymphoma, leukaemia, liver mets from any tumour

Medication

  • Opioids - especially fentanyl - may need to switch to an alternative
  • Hormone blockers - eg letrozole, exemestane, Zoladex, Prostap

Endocrine

Oestrogen deficiency e.g. treatment-induced menopause for breast and ovarian cancer

Testosterone deficiency e.g. surgical or hormone treatment for prostate cancer

Hyperthyroidism

Autonomic neuropathy

Diabetes and Parkinsons are the commonest causes

Non Pharmacological Treatment
  • Loose cotton clothes
  • Fan and tepid sponging may help
  • Ensure oral hydration as a lot of fluid can be lost with sweats
  • Avoid spicy food, alcohol and coffee
Pharmacological Management
  • With fever
    • Paracetamol or NSAIDS plus antibiotics for infection
  • Without fever - trial of anticholinergics may help - they often reduce sweating due to non-malignant causes, and may help in cancer
    • Amtriptyline 10mg - 25mg
    • Oxybutinin 2.5mg bd
    • Hyoscine patches (Scopoderm)
  • Last resort
    • Cimetidine 400mg per day¬†
    • Gabapentin 100mg tds
    • Clonidine - watch out for hypotension
    • Hormones - discuss safety of hormone replacement with oncologist

Sources

Scottish Palliative Care Guidelines - Sweating

Published 18th September 2023

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