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: