Oral Medications for Hyperhidrosis

Hyperhidrosis, or excessive sweating, is a common disorder that is estimated to affect between 2 to 3 percent of Americans. This condition disrupts the most normal of daily activities, like shaking hands, wearing nice clothes, or properly hold onto the steering wheel of a car. Worse, heavy sweating affects social and romantic relationships, causing anxiety and embarrassment.

Although certain triggers and conditions may cause hyperhidrosis, many cases have no identifiable cause, and some sweat 24 hours a day no matter what the temperature. Once a diagnosis is made, various forms of treatment for sweating are available to control this disorder and improve quality of life.

For those patients without a treatable underlying cause, hyperhidrosis treatment usually begins with prescription-strength antiperspirants. In cases where these antiperspirants fail to control symptoms, oral medications for excessive sweating may be employed. There are a number of prescription hyperhidrosis medication options available, allowing treatment to be tailored to the individual’s needs. 

Oral medications work to reduce the stimulation of sweat glands and decrease overall sweating.

The best candidates for oral medications include those experiencing:

• Excessive facial sweating (cranio-facial hyperhidrosis)
• Generalized hyperhidrosis (all over heavy sweating)
• Failure using other therapies like clinical strength antiperspirants, iontophoresis, Botox, or a customized combination of these

Types of Hyperhidrosis Medications

Anticholinergics

The most common medications used to manage excessive sweating are anticholinergics, including but not limited to:

• Glycopyrrolate (Robinul)
• Oxybutynin (Ditropan)
• Benztropine
• Propantheline bromide

How they work

These prescription medications work by blocking the chemical messenger acetylcholine as it attempts to travel to receptors on the sweat glands that are responsible for triggering sweating. Anticholinergics do not affect the central nervous system (the brain and spinal cord). These medications are systemic, meaning they affect the entire body. 

Advantages

• Up to a 75 percent reduction in sweating for glycopyrrolate
• Often covered under prescription benefit plans
• Glycopyrrolate for sweating is usually effective at suppressing focal or generalized hyperhidrosis, and most patients can find a dose that is effective without having too many side effects (see below). Oxybutynin (Ditropan) is more effective in some patients but generally with more reported side effects.

Disadvantages/side effects

• Dry mouth, constipation, impaired taste, blurred vision, urinary retention, and heart palpitations (may be managed by adjusting the dose)
• Overheating – because the medication decreases sweating over the entire body, this can effect the ability to cool down.  
• May lose their effectiveness over time in some patients
• Anticholinergics are contraindicated in patients with the following conditions:
  • Glaucoma (especially narrow-angle glaucoma)
  • Impaired gastric emptying
  • History of urinary retention

Alternatives to Oral Medication

For people who have tried oral medications without success, or those put off by the potential side-effects, there are safe, effective procedures available. Those with axillary hyperhidrosis should consider miraDry. miraDry is a noninvasive procedure that uses thermal energy to permanently eliminate sweat and odor glands (and underarm hair), often with just one treatment. 

Endoscopic thoracic sympathectomy (ETS) is the most effective treatments for palmar hyperhidrosis. ETS works by dividing a bundle of nerves called the sympathetic chain resulting in the immediate resolution of sweating in the hands. This safe, time-proven same-day-surgical procedure has also shown to improve hyperhidrosis in the feet and underarms in many patients.

If you are experiencing symptoms of hyperhidrosis and would like to discuss your treatment options, please contact the Hyperhidrosis Center at Thoracic Group today.