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Systemic Medication
Systemic medication can be used for the treatment of generalized
or focal hyperhidrosis.[145]
Many of the drugs reported useful for hyperhidrosis have not
been studied in controlled trials, their use being based only
on anecdotal evidence. Furthermore, at the doses likely to
inhibit hyperhidrosis, side effects can be limiting.[134]
In addition many of these drugs are not approved by the US Food and Drug Administration specifically for the treatment of hyperhidrosis.
The most commonly used agents are anticholinergics, which
block the sympathetic stimulation of eccrine glands by inhibiting
the action of acetylcholine at the synapse.[19]
Use of these drugs is limited, however, by the common side
effects of the anticholinergic class—dry mouth, urinary
retention, constipation, and visual disturbances such as mydriasis
and cycloplegia.[9,19]
Anticholinergics used for hyperhidrosis include propantheline,
glycopyrronium bromide, oxybutynin, and benztropine.[19]
When stressful situations are a trigger for hyperhidrosis,
use of an anticholinergic agent or a benzodiazepine prior
to an event likely to provoke anxiety may be helpful.[19]
Long-term use of benzodiazepines such as diazepam is limited
by development of dependency,[9]
and many patients cannot tolerate the sedative effects of
these drugs.[34]
Some patients are able to take diazepam 5 mg at bedtime for
several weeks to get used to its sedating effect and then
use it as needed for anxiety-provoking events.[34]
There are many reports of single cases or small series
of patients with specific types of hyperhidrosis responding
to a variety of systemic medication. Medications used include:
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