Hyperhidrosis Medication

Updated: Apr 19, 2019
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: William D James, MD  more...
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Medication

Medication Summary

The goals of pharmacotherapy for hyperhidrosis are to reduce morbidity and prevent complications. Control of palmar hyperhidrosis with a new dry-type iontophoretic device has been described. [74] Dry-type iontophoresis may reduce palmar sweating more conveniently than other conventional methods. [75]  Although usually an oral preparation, oxybutynin transdermal may be beneficial in selected patients with hyperhidrosis. [76] Similarly, oxybutynin 3% gel has been used successfully for the primary focal hyperhidrosis in adolescents and young adults. [77]  Use of glycopyrronium tosylate topical for primary axillary hyperhidrosis in adults and children aged 9 years or older is also a consideration. [26, 27]

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Aluminum Compounds

Class Summary

These agents are antiperspirants that are used in the management of hyperhidrosis.

Aluminum chloride topical (20% Drysol)

Certin-Dri and Xerac are over-the-counter products at low concentrations. These work best if applied to a dry area and covered with plastic overnight. Aluminum chloride should be washed off in the morning. Effects should be noted within 1 month.

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Anticholinergic Agents

Class Summary

Topical glycopyrronium tosylate for primary axillary hyperhidrosis is available, allowing for a more tolerable route of administration. Orally administered anticholinergics are usually avoided because they are poorly tolerated at the required doses when given systemically. Acetylcholine is the preglandular neurotransmitter for sweat secretion. These drugs inhibit the binding of acetylcholine to the cholinergic receptor. Clinical effects usually occur within days.

Glycopyrronium tosylate topical (Qbrexza)

This is a topically applied anticholinergic agent that inhibits the action of acetylcholine on sweat glands. It is indicated for primary axillary hyperhidrosis in adults and children aged 9 years or older. It is applied using single-use, premoistened cloth to clean, dry skin on the underarm areas only, no more frequently than once every 24 hours.

Propantheline (Pro-Banthine)

Propantheline blocks the action of acetylcholine at postganglionic parasympathetic receptor sites.

Glycopyrrolate (Robinul)

Glycopyrrolate acts in the smooth muscle, CNS, and secretory glands to block the action of acetylcholine at parasympathetic sites.

Benztropine (Cogentin)

Benztropine blocks striatal cholinergic receptors; it may help balance cholinergic and dopaminergic activity in the striatum.

Oxybutynin (Ditropan)

Oxybutynin inhibits the action of acetylcholine on smooth muscle and has direct antispasmodic effects on smooth muscles. Although usually an oral preparation, its transdermal use for hyperhidrosis may be beneficial in selected patients.

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Neuromuscular Blocking Agents

Class Summary

These agents inhibit the transmission of nerve impulses at the neuromuscular junction of skeletal muscle and/or autonomic ganglia.

OnabotulinumtoxinA (BOTOX®)

OnabotulinumtoxinA prevents calcium-dependent release of acetylcholine and produces a state of denervation at the neuromuscular junction and postganglionic sympathetic cholinergic nerves in the sweat glands.

Each injection produces an area of anhydrosis approximately 1.2 cm in diameter. Treatment reportedly results in anhydrosis lasting 4-12 monts.

Injections of botulinum toxin must be repeated at varying intervals to maintain long-term results.

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