It sounds simple: take a pill; stop sweating. But this therapy is a bit more complex than that…To begin with, oral hyperhidrosis medications are not for every kind of hyperhidrosis. 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 such as clinical strength antiperspirants, iontophoresis, Botox, or a combination of these. People who have compensatory sweating from ETS surgery or sweating secondary to a medication or medical condition can also have success with oral medications in many cases.
The most commonly used medications for managing excessive sweating are anticholingerics. These include medicines such as glycopyrrolate, oxybutynin, benztropine, propantheline, and others. Because the drugs used to control excessive sweating have not been studied in controlled trials, their use is based primarily on years of anecdotal evidence. While these oral therapies have not been approved by the US Food and Drug Administration (FDA) specifically for the treatment of hyperhidrosis, these medications have a substantial history of off-label use and are safe when used as directed. Some, such as glycopyrrolate and oxybutynin, have also been found to be safe in young children. Many medical professionals and hyperhidrosis patients experience great success with them.
Anticholingerics do not affect the central nervous system. They work by blocking transmission of the chemical messenger (acetylcholine) to the receptors on the sweat glands that are responsible for triggering sweating. Because similar receptors are located in multiple areas of the body, 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. These side effects may be managed by adjusting the individual’s dose. David M. Pariser, MD International Hyperhidrosis Society (IHHS) founding board member and an expert in treating patients with hyperhidrosis, characterizes the side effects of anticholingeric treatments as “predictable, manageable and usually mild.”
That said, there are some hyperhidrosis patients who need to be very cautious when using anticholingerics. Dee Anna Glaser, MD, president and founding board member of the International Hyperhidrosis Society, treats hundreds of hyperhidrosis patients a year and is well versed in their use. She cautions her patients, or, in the case of pediatric patients, their parents, 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, people who work outdoors and anyone who may potentially cause themselves injury by becoming overheated must use extra care when considering these treatments.” Because anticholinergic medications work systemically and cannot target any one area in particular, they decrease sweating over the entire body, even those locations not sweating too much at baseline. This overall decrease in sweating can put the patient at risk for overheating. Patients or parents of children taking the medication must remain aware of temperature, water intake, exertion, and any symptoms of overheating such as pale skin, dizziness, muscle cramping, weakness, headache, and nausea.
Further, patients with glaucoma (especially narrow-angle glaucoma) and those who have impaired gastric emptying or a history or symptoms of urinary retention should not use anticholingeric therapy.
Two of the most commonly prescribed anticholinergic medications are available in liquid formulations, which is important for parents and their children who suffer from hyperhidrosis. The FDA recently approved a liquid form of the anticholinergic glycopyrrolate (brand name, Cuvposa) to reduce drooling in pediatric cerebral palsy patients. This new formulation of a commonly used anticholinergic medication offers an excellent alternative for children who are unable or unwilling to swallow the pills. Oxybutynin is also available in a liquid formulation and is approved for use in young pediatric patients for certain bladder and urinary conditions.
Oral medications in liquid form provide safe and more easily administered treatment options for the young segment of our hyperhidrosis population. Dr. Pariser said its benefits would be immediate.
“I had an 8-year-old child who couldn't swallow the tablets, no matter how crushed or mixed with food. Here’s a great solution. And because this medicine is approved for children it gives reassurance to patients of all ages who have safety concerns with this therapy.”
There are other oral medications that are successful in treating patients with specific types of hyperhidrosis. Beta blockers (propranolol) and benzodiazepines work by “blocking” the physical manifestations of anxiety.
These drugs act on the central nervous system and are best for patients who experience episodic or event-driven hyperhidrosis (such as excessive sweating brought on by job interviews or presentations). Side effects limit their long-term use: Benzodiazepines can be habit-forming and many patients cannot tolerate the sedative effects caused by both of these drug therapies.
There have also been single-case or small samples of patients with specific types of hyperhidrosis who responded to a variety of other oral medications. Agents such as Clonidine, Indomethacin, gabapentin, and multiple others have shown effectiveness in very specific cases of hyperhidrosis.
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.
We like to remind readers that there are always positive or innovative developments on the horizon of hyperhidrosis care; but there are also great treatments available right now. Maybe systemic oral medication isn't right for you but...in the future? Who knows what may become available!
Here is another promising use for oral anticholinergic medications. Some physicians and their patients have had great success treating sweaty palms and sweaty feet by adding a crushed anticholinergic tablet to the water used during iontophoresis. Learn more about iontophoresis and how anticholinergics can make the process even more effective.
Have you talked to your doctor about excessive sweating? If not, now is the time! Learn more about how you and your doctor can work together to find the right treatment, or combination of hyperhidrosis treatments, to manage your hyperhidrosis.
If you’re considering an oral medication to treat excessive sweating, please know that experts in the field recommend that you try antiperspirants, iontophoresis, or Botox injections first. Click on the links provided to learn more about the usefulness of these treatments.
And remember, because hyperhidrosis is a serious medical condition - you deserve insurance coverage and reimbursement for your doctor’s visits and treatments! We’ve got tips to help you navigate the health insurance realm and receive coverage.