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Scottish Palliative Care Guidelines print pdf

Sweating

Introduction

Excessive sweating occurs in 10 to 20% of patients with advanced cancer, occurs more at night and may require a change of clothes, bedding or both.

Assessment

There are multiple causes including:

  • infection (check patient is not at risk of neutropeanic sepsis)
  • lymphoma
  • disseminated cancer (particularly with liver metastases)
  • medication
    • SSRI (selective serotonin reuptake inhibitor) antidepressants
    • hormone therapies (tamoxifen, aromatase inhibitors, gonadorelin analogues)
    • opioids
  • endocrine
    • oestrogen deficiency (natural or treatment-related menopause)
    • androgen deficiency (surgical or hormone treatment)
    • hypoglycaemia
    • hyperthyroidism
  • autonomic neuropathy.

Management

  • Treat any underlying cause, including infection (if appropriate).
  • Reduce room temperature, remove excess bedding, increase ventilation, use a fan.
  • Wear loose cotton clothing.
  • Cool with tepid sponging.
  • Maintain fluid intake to avoid dehydration.
  • Review medication and prescribe an alternative if possible.
  • Consider opioid switch. (see choosing and changing opioids guideline)

Medication

Sweating with pyrexia:

  • paracetamol 500mg to 1g (depending on body weight), 6 hourly
  • non-steroidal anti-inflammatory drug (NSAID).

Sweating without pyrexia (associated with tumour):

  • NSAID
  • antimuscarinic (amitriptyline 10 to 50mg at night)
  • cimetidine 400 to 800mg once daily. (Check British National Formulary (BNF) for drug interactions)
  • venlafaxine under specialist advice, initiate at 37.5mg (modified release once daily) and increase to 75mg (modified release once daily) if tolerated.

Sweating with hormone insufficiency:

  • seek advice from an oncologist about hormone replacement therapy.

References