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Medications can make you hot
I’ve been lucky this summer. Most of the rest of the country is suffering from high temperatures that are breaking records, but we’ve been spared most of the worst of it here
in the northern Midwest.
But even though we haven’t had the dangerously high heats, it’s summertime and I still have to worry about my patients getting overheated.
Every year all of my patients get a lecture from me about keeping cool. I do this because the kinds of medications I prescribe can really affect how people handle the heat.
I don’t just talk about drinking lots of water. I also talk about why they’re so sensitive to heat so they’ll understand just how important it is for them to take care of themselves when the weather is at its hottest.
There are actually many kinds of medications that affect how the body responds to the heat, not just psychiatric medications like I prescribe. Most people don’t know this, though.
So I’d like to take some time to do that now, and also talk about ways to keep cool.
Sweating may not mean you're hot
When I say that medications can make you hot, this isn’t the same as having a medication that makes you sweat a lot.
You can sweat a lot and not be hot.
In fact, there are some medications like Zoloft ®(sertraline) that can make you sweat. I have patients on some medications like that who tell me they’re waking up soaked at night.
They’ll sweat through their pajamas, their bedsheets and the covers.
But they’re cold when they wake up. They actually feel chilled because they’re so wet. They wake up shivering.
It can be miserable to sweat and get chilled because of it. But it’s a lot more dangerous when a medication makes it so you don’t sweat as much as usual, or even stops your ability to sweat at all. And you may not even be aware of it.
Sweating is one of the ways that the body cools itself. And when you can’t sweat, your body temperature can rise.
And if your temperature rises high enough, you can have seizures or even die because your body just doesn’t function at really high temperatures.
Medications that can make you hot.
I’m going to mention several families of medications that can do this, but I won’t cover them all. If you think you might not be handling the heat as well as you should or as well as you’re
used to, be sure and check to see if these could be due to any medications you’re on.
Antihistamines are medications that we usually use for allergies. These include medications like diphenhydramine (Benadryl®) or hydroxyzine (Vistaril® or Atarax®) as well as others.
These medications are supposed to dry up your itchy eyes and runny nose that come with being allergic to things.
But they don’t just dry up your eyes and nose and throat. They can dry up the rest of your body too, so you don’t sweat as much. This means these medications can make you feel super hot.
Blood pressure (bp) medications (antihypertensives). Not all bp meds make you hotter. But those that do work in one of two ways.
The medications known as diuretics cause you to pee more. Examples of these are hydrochlorothiazide and chlorthalidone. If you pee more, you lose more body water and your body temperature can go up.
There are other blood pressure medications that make you hot by changing how quickly the blood vessels in your skin open up or close.
When you get hot, usually your skin gets flushed. Blood helps regulate your body temperature. When you’re hot, the blood vessels open up to let some of the heat out and make you feel cooler.
Some blood pressure medications, though, don’t let the blood vessels to the skin open up to let off heat. This makes you much more sensititive to the heat. Metropolol (Toprol®) is one of these, but there are others.
Attention Deficit Disorder (ADD) medications like methylphenidate (Ritalin®) or dextroamphetamine/ amphetamine (Adderall®). These medications make your body work harder and faster. This of course makes heat and you feel hotter. You might find that you just can’t tolerate the sun the way you used to.
Diabetes medications: Many of the medications in this group of medications can make you hotter and more sensitive to the heat. Plus, one symptom of low blood sugar can be sweating. Like with the person I mentioned above on sertraline, this may not make you hotter, but it can be confusing if you’re sweating heavily but getting chilled because of the moisture drying on your skin
Psychiatric medications including antipsychotics like Zyprexa® (olanzapine) and Latuda® (lurasidone); and antidepressants like Prozac® (fluoxetine), Effexor® (venlafaxine) and others – medications that I prescribe all the time, can make you hot.
These medications can be a lot more subtle than the ones I mentioned before when it comes to how they change your body’s heat. If you're not physically active you may not realize that you body temperature is rising because you aren’t sweating or peeing all the time.
Even stranger - some of these meds fool your brain into thinking your body is supposed to have a temperature higher than the normal human temp of 98.6.
Even though this isn’t true, that you’re still supposed to be under 99 degrees, your body is convinced it’s supposed to be higher.
This means your body doesn’t even try to cool itself. Your temperature rises even higher. And this can result in seizures and even death, like I talked about at the beginning.
So people on these types of medication have to be even more careful and more creative in how they try to keep cool.
Ways to keep cool in the summer
Most houses around here don’t have air conditioning. It just wasn’t needed before the climate started heating things up so much. I’ve spoken with people who don’t remember ever seeing the thermometer hit 90.
But that’s changed. And it’s much harder to keep cool.
So I mention some things that can be helpful for staying cool and staying safe in the heat.
Fluids: It’s always good advice to drink lots of water and avoid going out in the worst heat of the day. This seems pretty obvious, but I mention it anyway because it’s the easiest, simplest thing to do.
It’s also good to point out that caffeinated beverages like colas and energy drinks can make you pee a lot. If you lose a lot of extra fluid when you’re already hot this isn’t a good thing, and it isn’t going to make you cooler.
The same is true for alcohol. Alcohol makes you pee so you lose fluid more easily and feel dehydrated. Incidentally – this is why after you’ve had a few you find yourself more thirsty, not less.
Water is still the best.
Limit physical activity: at least during the hottest part of the day. While this is good for everyone, it's particularly important if you're on medication that can make you even more sensitive to the heat.
Clothing: Again, this is all stuff you've probably read before, but it can't hurt to remind everyone: loose clothing – preferably white or pale. Dark fabrics absorb light and keep you warmer.
“Hoosier air conditioning.” People in other states may have picked up on this one too. But I was born and raised in Indiana and we had no central air. So when I was a kid this is how we kept cool.
Put a fan in an open window if possible. It should be facing in, toward you. If you don’t have a window or can’t open it, still put the fan nearby, blowing in your direction.
Put a bowl of ice between you and the fan and let the fan blow cool, moist air at you. It’s amazingly good for making you cool.
Then you put a cold wet rag on the back of your neck and just close your eyes.
And while you have the ice, cold water and rags out, put a damp cold cloth behind your knees, in your armpits and between your legs. All these places help keep the heat in, so cooling them makes your whole body more comfortable.
Take care of yourself in the heat
I'm giving you the same lecture about staying cool that I give my patients. DON'T ignore your body
Find out if your medications can make it hard for your body to handle the heat
If your medications do change how you're affected by the high temperatures ALWAYS take precautions.
Some medications make it so you aren't even aware that your body is too hot. This means DO NOT ignore the temperature outside. If you're on medications ALWAYS keep water handy, clothes loose, and activity lower in the worst of the heat. Your life may depend on it.
Thermometer illustration by @CanStockPhoto Inc/iqoncept
Cart of pills illustration by @CanStockPhoto Inc/merznatalia
Window fan blowing by @CanStockPhoto Inc/mgequivalents