Suboxone® and sweating: why it happens and what can help

Some people sweat all over. Others notice it mostly on the face, scalp, or palms. However it shows up for you, sweating more than usual since starting Suboxone® (buprenorphine-naloxone) is more common than you’d think.

Sweating is a recognized side effect of buprenorphine, and there are ways to manage it if it’s bothering you. Understanding why it may happen is a good place to start.

Is sweating a common side effect of Suboxone?

Yes. Sweating, known clinically as hyperhidrosis, is listed as a side effect on Suboxone’s FDA label, and it’s something some patients bring up with their QuickMD doctors.

In one clinical trial, about 14% of people on Suboxone reported sweating over four weeks. That’s close to the 13% who reported it on buprenorphine alone, and not far off the 10% who reported it on a placebo. A separate trial looked at buprenorphine by itself at several doses: about 1 in 8 people reported sweating, no matter the dose.

The sweating appears to be a side effect of buprenorphine, not naloxone. This suggests sweating can also happen with medications that contain buprenorphine, such as Subutex.

So what does this mean for you? Sweating is a recognized side effect of buprenorphine and is included on the Suboxone label. While one study found similar rates of sweating across different doses, other research suggests that sweating may become more common at higher buprenorphine doses, especially above 16 mg per day. 

Why does Suboxone make you sweat?

There’s a name for sweating more than your body needs to cool down: hyperhidrosis. A number of medications can cause it, and opioid medications are among them, including buprenorphine. Researchers don’t know exactly why it happens, but there are three main possibilities:

• Changes in how your body controls temperature: Buprenorphine affects opioid receptors involved in regulating body temperature and other automatic functions, which may trigger more sweating.
• Changes in blood flow: Buprenorphine can widen blood vessels. This may contribute to sweating, flushing, and feeling warm.
• Your dose: Sweating may become more common at higher doses of buprenorphine, particularly above 16 mg per day. However, it can happen at lower doses too.

Researchers have also looked at why similar sweating happens with other opioid medications. For example, research on methadone suggests it may affect nerve signals that help control sweating.

If sweating is bothering you, there are ways to manage it. Your QuickMD doctor can also help you decide what makes sense based on your symptoms and treatment.

Is it the medication, or is it withdrawal?

Sweating can happen as a side effect of Suboxone, but it can also happen during opioid withdrawal. Looking at your other symptoms can help you understand what may be going on.

Withdrawal sweating rarely shows up alone. Early withdrawal symptoms include agitation, anxiety, muscle aches, watery eyes, trouble sleeping, a runny nose, sweating, and yawning. Symptoms that tend to show up later include stomach cramping, diarrhea, dilated pupils, goosebumps, nausea, and vomiting.

Mention it to your QuickMD doctor if:

• Sweating shows up alongside anxiety, muscle aches, chills, a runny nose, trouble sleeping, or nausea.
• Sweating is happening completely on its own, with no other symptoms.
• Sweating is getting in the way of your sleep. (Read more in our guide to sleep changes on Suboxone for more on that.)

Some people also feel warm and sweaty one minute and chilled the next.

New, heavy sweating can also come from something other than Suboxone or withdrawal, including a thyroid condition, diabetes, an infection, or anxiety on its own. Your QuickMD doctor will consider all of that, not just the medication.

What if you sweat at night or before your next dose?

If your sweating happens right around your next dose, or overnight when the medication in your system is at its lowest, it’s easy to assume that means withdrawal. It doesn’t always work that way.

One case report described a patient who had sweating only in the early morning, which seemed like withdrawal. Their doctor raised the dose based on that assumption. Instead of easing, the sweating increased and spread. It turned out to be medication-related sweating, not withdrawal.

So timing alone may not tell you whether sweating is from Suboxone or withdrawal. Pay attention to when it happens, how often it happens, and whether you have other symptoms. Those details can help your doctor better understand what may be causing it.

And if the sweating, whenever it happens, is wrecking your sleep, mention that too. Poor sleep shows up early in treatment for plenty of reasons, and it’s worth a look together.

How long does sweating on Suboxone last?

For most people, side effects like sweating tend to ease within the first few weeks as the body adjusts to the medication.

It doesn’t always follow that pattern, though. In the case report mentioned above, the sweating started about a month into treatment and didn’t go away on its own. It eventually improved with a prescription medication for sweating.

If you’re early in treatment, give it a little time. But if you’ve been dealing with it for weeks, it’s not letting up, or it’s getting in the way of your daily life, bring it up with your QuickMD doctor instead of waiting it out.

What can help with sweating on Suboxone

A few everyday changes can help first. If those aren’t enough, your doctor has other options too, from a closer look at your dose or timing to medication that treats the sweating directly.

Everyday changes that may help

A few simple changes to your daily routine may help.

• An over-the-counter, clinical-strength antiperspirant
• Breathable, moisture-wicking layers you can change easily
• Keeping your room cool with a fan running at night
• Staying well hydrated to replace what you’re losing through sweat
• Cutting back on common triggers like alcohol, caffeine, and spicy food

When your doctor may look at your dose or timing

If you’re still dealing with sweating and it’s not letting up, your QuickMD doctor may want to take a closer look at your Suboxone dose, your timing, or anything else you’re taking. That’s a conversation to have together, not something to adjust on your own. Don’t lower, split, or skip a dose without talking to your doctor first. Doing that can bring back withdrawal symptoms or cravings, even if it seems like it would help with the sweating.

You can bring up a side effect without putting your prescription at risk. It’s a normal part of every visit, and your doctor would rather know.

Medications a doctor may consider

If everyday changes aren’t enough, ask your QuickMD doctor about next steps. There are medications used to treat hyperhidrosis they may recommend. Your doctor can help you figure out whether it’s worth asking about, and whether that means a referral to someone who treats it directly.

Other reasons your doctor may check for

New, excessive sweating isn’t always due to the medication. Your doctor will think through other possible causes, including:

• Thyroid conditions
• Diabetes or low blood sugar
• An infection
• Anxiety on its own
• Other medications you’re taking, including some antidepressants
• Other substance use or withdrawal
• Hormone changes, especially for women (perimenopause and menopause can both cause new sweating and hot flashes)

It’s worth having this conversation with your QuickMD doctor even if you feel it’s the Suboxone. Ruling things out is part of getting the right answer. If you’re taking anything else, mention it. You can read about how Suboxone interacts with what else you’re taking if you’d like to learn more.