Medications are used to treat illnesses, manage symptoms, and improve quality of life. But, like all interventions, they come with side effects. Two relatively common and disruptive side effects of certain medications can be excessive sweating (hyperhidrosis) and coughing.

Excessive sweating is when the body produces more sweat than it needs to regulate temperature. Sweating is a normal response to heat or stress, but sweating caused by medications is not related to environmental or emotional factors. It can be localised to specific areas like the palms or underarms or it can be all over the body. Medication-induced coughing is dry and persistent, caused by irritation of the throat, airway, or lungs. It can disrupt sleep, daily activities, and overall well-being.

Medications that can cause sweating

Some medications can disrupt the autonomic system or directly stimulate sweat glands and cause excessive sweating. Many antidepressants, especially those that affect serotonin (hormone), cause sweating. Selective serotonin reuptake inhibitors (SSRIs) like Fluoxetine (Prozac) and sertraline (Zoloft) are common offenders - people taking SSRIs have complained of excessive sweating.¹ Tricyclic antidepressants (TCAs) like Amitriptyline and Nortriptyline can also make you sweat.¹ Hormone-altering medications can cause sweating due to their effect on the hypothalamus, the brain’s temperature-regulating centre. These include hormonere placement therapy, used during menopause, which can cause hot flashes and sweating in some people,² and testosterone therapy, high levels of testosterone can overstimulate sweat glands. Antipyretics, drugs used to treat a fever, and painkillers like aspirin and paracetamol help reduce fever by making you sweat, which is a natural cooling mechanism of the body.³ Opioid drugs like morphine and oxycodone can make you sweat profusely, often as a response to their effect on the central nervous system.⁴ Cardiovascular medications like beta-blockers (e.g., propranolol) are used for high blood pressure and anxiety; these drugs can make you sweat by increasing sweat gland activity as they slow down your heart rate and calcium channel blockers (e.g., nifedipine) rarely cause sweating as a side effect. Stimulants like amphetamines and medications for attention-deficit/hyperactivity disorder (ADHD) make you sweat due to their stimulant effect on the nervous system.

Medications that can cause coughing

Coughing may be due to medications that irritate the throat or drugs that cause respiratory effects. Angiotensin-converting enzyme (ACE) inhibitors are widely prescribed to treat hypertension and heart failure and patients experience a persistent dry cough as a side effect.⁵ These include enalapril (Vasotec), lisinopril (Zestril), and ramipril (Altace). The cough is thought to be due to a buildup of bradykinin and substance P in the lungs. Beta-blockers can cause bronchospasm or wheezing, especially in asthmatic patients or people with chronic obstructive pulmonary disease (COPD). Inhaled Medications like corticosteroids (e.g., fluticasone) are used for asthma and COPD and they can cause throat irritation and coughing, even when not used with a spacer. Bronchodilators (e.g., salbutamol) can sometimes cause throat irritation and coughing during or after use. Certain medicines that are employed in cancer therapy (e.g., bleomycin, methotrexate) can damage the lung and cause cough as a side effect. Medications for GERD (gastroesophageal reflux disease) relax the lower oesophagal sphincter, like some antacids or muscle relaxants, which can contribute to acid reflux, which may result in a chronic cough.⁶

Why do these side effects occur? Mechanisms behind excessive sweating

The autonomic nervous system activation, certain drugs have a sympathetic nervous system effect, which is responsible for sweating. Medications that alter hormone levels can disrupt the thermoregulation of the body. Drugs acting on neurotransmitters (such as serotonin) have a potential effect on sweat gland function. ACE inhibitors cause bradykinin build-up in the lungs, which irritates airways. Some medications can be irritating to the throat or lungs if inhaled or swallowed through direct contact. Some drugs that can trigger slight inflammatory responses in the airways.

Who is at higher risk?

For excessive sweating, patients on high doses of medications, and individuals with hyperhidrosis history is at high risk for developing symptoms such as excessive sweating and coughing after taking certain medication. For those who are at a high risk of developing a cough, those suffering from asthma or chronic obstructive pulmonary disease (COPD) patients on β blockers or inhaled steroids are a high-risk group. Individuals who are sensitive to ACE inhibitors and cancer patients undergoing chemotherapy are also another high-risk group.

How can this be managed?

Strategies for excessive sweating include lifestyle changes, wearing breathable fabrics, using antiperspirants or prescription-strength options, and medication adjustments. If sweating is excessive, talk to the doctor to switch to alternative drugs. In the severe form, treatment including Botox injection is used to constrict the sweating.
Strategies for coughing include switching medications considering ACE inhibitor-induced cough, angiotensin II receptor blockers (ARB) such as losartan may be used as a substitute, proper hydration can soothe the throat, inhalation techniques like using spacers with inhaled drugs to minimize irritation, cough suppressants and over-the-counter medications may help manage symptoms temporarily. Patients with severe or long-lasting side effects should discuss these with their physician. Warning signs include profuse sweating unmanageable with home remedies, a cough that disrupts sleep or daily activities and associated symptoms like chest pain, fever, or weight loss.

Summary

Although pharmaceuticals are useful to regulate disease, they can generate undesirable side effects, for example, excessive sweating and coughing. Learning which medicines are known to cause those reactions and how they happen can enable patients and physicians to manage them jointly in a more effective manner. Close monitoring with the treating physician is essential to detect treatment efficacy and tolerable side effects levels.