Glycopyrrolate is an anticholinergic medicine used to treat certain types of excessive sweating. But swallowing the pills can be tough for kids – forcing parents to try all sorts of tricks to get the right therapeutic dose into a child. A new liquid formulation (Cuvposatm, Glycopyrrolate Oral Solution) for pediatric patients could change that. Recently approved by the FDA, Cuvposa can help the hyperhidrosis medicine go down.
Crushed into Jello, slipped into ice cream, or my childhood favorite -- squeezed into a square of chocolate. Parents will try all sorts of tricks to get a necessary pill into a child who’s unable, or unwilling, to swallow it whole. The trouble with these methods is that kids can often still taste the medicine so they don’t take it all and get a less-than-optimal dose.
For kids with hyperhidrosis, and their parents, a liquid form of glycopyrrolate medicine for pediatric patients brings new hope. Cuvposa (Glycopyrrolate Oral Solution) is a flavored oral solution that is easier to administer and easier to adjust (in dose-size) so that each patient can get just the right amount. Cuvposa is marketed by Shionogi Pharma Inc. of Osaka, Japan.
Recently the FDA approved Cuvposa to reduce severe, chronic drooling in pediatric cerebral palsy patients. Although an application for the use of Cuvposa to treat hyperhidrosis has not been filed with the FDA, Cuvposa and other forms of the anticholinergic glycopyrrolate are often used “off-label” to treat excessive sweating. In fact, physicians have been safely using glycopyrrolate to treat excessive sweating for many years.
According to Dr. David M. Pariser, (Secretary and Founding Member of the International Hyperhidrosis Society, Professor, Department of Dermatology, Eastern Virginia Medical School, and 2009 President, American Academy of Dermatology) a liquid anticholinergic will be another treatment option for the youngest hyperhidrosis patients and will be immediately useful. “This is a welcome addition to the therapeutic choices for treating children,” he says. “I had an 8-year-old child just last week who couldn't swallow the tablets, no matter how crushed or mixed with food. Here’s a great solution. And because this new medicine is approved for children ages 3 – 16, it gives reassurance to patients of all ages who have safety concerns with this therapy.”
“Treating the very young patient with hypehidrosis poses many unique challenges,” adds pediatric dermatologist Dr. Adelaide Hebert, also a Founding Member of the International Hyperhidrosis Society as well as Professor of Dermatology and Pediatrics at The University of Texas Medical School – Houston. “Finding an agent that will be tolerated by the child and be effective is the first hurdle. The medication needs to be palatable or the child may refuse it or spit it out. Parents, meanwhile, may have reservations about giving a child a medication on an ongoing basis for a non-life threatening disorder. Fortunately, Cuvposa is FDA-approved for children as young as three years who have drooling related to cerebral palsy. In this era of very conservative approvals by the FDA, this drug received approval for a population that is considered ‘vulnerable;’ a testament to safety in the pediatric age group. Physicians who manage children with hyperhidrosis may wish to consider this medication for those patients who can benefit from an oral medication.”
“I regularly use oral anticholinergic medications in children,” says Dr. Samantha Hill, a frequent faculty member of the IHHS and a pediatric dermatologist with 'Specially for Children, a pediatric sub-specialty medical group in the Austin/Round Rock area of Texas, “often because they cannot tolerate other treatment modalities. Until now I have been limited in my choices for oral medication because only one other anticholinergic sometimes used for hyperhidrosis comes in a liquid formulation. I am happy to have another option that is a suspension, as the tolerance among the different medications can vary somewhat.”
Like other oral prescription medications used to manage excessive sweating, glycopyrrolate (including Cuvposa) works within the body to prevent the stimulation of sweat glands and thus limit overall sweating. Called “anticholingerics,” these medications work by blocking transmission of the chemical messenger (acetylcholine) responsible for sweating. Oral medications are not for every kind of hyperhidrosis, however. They are best suited for patients with certain types of excessive sweating—people with excessive facial sweating, cranio-facial hyperhidrosis, generalized hyperhidrosis, and those who have not had success using other first-line therapies (or who can’t use other therapies). For more information about first-line hyperhidrosis treatments visit SweatHelp.org’s Treatment Overview page.
There can be a range of side effects from anticholingeric therapy such as: dry mouth, constipation, impaired taste, blurred vision, urinary retention, and heart palpitations. But these may be managed by adjusting dosages (something that is easier to do with a liquid formulation). Dr. Pariser characterizes the side effects of anticholingeric treatments as “predictable, manageable and usually mild.”
Dr. Dee Anna Glaser (President and Founding Member of the International Hyperhidrosis Society and Professor of Dermatology and Vice Chairman, Department of Dermatology, Saint Louis University School of Medicine) does, however, caution patients and especially the parents of young patients by saying: “When taking anticholingerics, the body may have more difficulty keeping itself cool with the sweat mechanism ‘turned off.’ Therefore, athletes, people who participate in sports, and anyone who may potentially cause themselves injury by becoming overheated must use extra care when considering these treatments.” Another consideration is the potential sugar content of Cuvposa, says Dr. Herbert. Some sweet medications, taken on an ongoing basis can raise concerns about tooth decay. Parents and physicians may need to stay on top of a child’s dental health, with parents being diligent about tooth brushing, flossing, dental check-ups, and other recommended cavity-fighting tactics.
If you are interested in learning more about using oral medications to treat excessive sweating, find a healthcare provider who is well-versed in hyperhidrosis care and oral medications in the IHHS’s Physician Finder database. And please pass the Jello. It’s good to get back to dessert being just dessert.