Pharmacological Culprits of Hyperhidrosis: An Updated Review of Incidence, Mechanisms, and Management

ABSTRACT Background Drug‐induced hyperhidrosis (DIH) is an underrecognized adverse effect that can impair quality of life and reduce treatment adherence. While prior reviews have addressed known causes, the emergence of new agents and evolving use of established drugs require ongoing identification of additional culprits and updated synthesis of previously implicated classes. This study aims to identify the growing body of evidence on DIH, focusing on implicated drug classes, underlying mechanisms, and management strategies to support early recognition and optimal care. Methods A comprehensive literature review was conducted across three databases (PubMed, Scopus, and Google Scholar) from January 2007 to April 2025. Search terms included “drug‐induced hyperhidrosis,” “secondary hyperhidrosis,” and related variations. Studies were eligible if published in English and reported on the incidence, pathophysiology, or treatment of DIH. References were manually screened by two reviewers, with disagreements resolved by a third reviewer. Results Antipsychotics, opioids, acetylcholinesterase inhibitors, antidepressants, and stimulants were the most frequently implicated drug classes. Proposed mechanisms include cholinergic overstimulation, serotonergic or dopaminergic dysregulation, and sympathetic overactivity. Newly implicated classes include cholinergic agonists, triptans, and antimicrobials. Management approaches include dose reduction or drug discontinuation, microneedling procedures, and pharmacologic adjuncts such as anticholinergics, adrenergic blockers, or botulinum toxin. Conclusion DIH is relatively common and associated with an expanding range of medications. Maintaining a low threshold for clinical suspicion, along with ongoing vigilance and prompt identification, is essential to optimize management, improve adherence, and reduce unnecessary diagnostic workups.