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Oral Therapies For Hyperhidrosis: What The Current Literature Reveals

Oral glycopyrrolate is reportedly an effective treatment for hyperhidrosis.1 An anticholinergic drug, glycopyrrolate acts on the nerves innervating sweat glands to decrease sympathetic stimulation and thus decrease sweat production.1

In a study in which feet were the second most common area to be affected, Lee and colleagues assessed glycopyrrolate and found that 75 percent of patients with primary hyperhidrosis had an actual decrease in the amount of sweating, and patients also reported a decrease in discomfort in their everyday lives.1 Thirty-six percent of patients experienced some side effects, such as oral dryness, palpitations and headache.1

This medication is effective in decreasing sweat production without causing a plethora of central side effects since it is a highly polar molecule that does not pass through lipid membranes to the central nervous system.1 In regard to dosing, clinicians can prescribe one milligram twice per day, and potentially increase this to 8 mg per day.1  

Oxybutynin is another oral medication that researchers have explored for the treatment of hyperhidrosis due to its antimuscarinic effects.2 In a study of children under the age of 14 with palmar and plantar hyperhidrosis, 91 percent reported moderate or great improvement in their level of sweating, and almost 95 percent reported an improvement in their quality of life.2 Ninety-one percent of these patients reported plantar hyperhidrosis.2

In this study, patients received 2.5 mg twice a day for the first seven days, 2.5 mg twice a day the next seven days and then 5 mg twice a day from day 22 to six months.2 The most common side effect was dry mouth but at six weeks, all patients reported moderate or great improvement in sweating levels, and 91 percent reported the same at six months.2 Of those that had plantar sweating, 90.6 percent reported moderate or great improvement at six months.2  

In another study of the long-term effects of oxybutynin on plantar hyperhidrosis by Wolosker and coworkers of a sample of patients ranging in age from 9 to 71, of the patients that continued to follow-up for six months, 84.7 reported moderate or great improvement in self-perceived plantar sweating.3

The main contraindication for using this medication is glaucoma.3 Also, one should advise patients that with an oral medication such as oxybutynin, it can take up to three weeks from the start of the medication for the patient to see improvement in symptoms.3

References

1. Lee HH, Kim DW, Kim DW, Kim C. Efficacy of glycopyrrolate in primary hyperhidrosis patients. Korean J Pain. 2012;25(1): 28–32.
2. Wolosker N, Tievelis MP, Krutman M, et al. Long-term efficacy of oxybutynin for palmar and plantar hyperhidrosis in children younger than 14 years. Pediatr Dermatol. 2014; 32(5): 663–667.
3. Wolosker N, Tievelis MP, Krutman M, et al. Long-term results of the use of oxybutynin for the treatment of plantar hyperhidrosis. Int J Dermatol. 2015;54(5): 605–611.

Editor’s note: This blog is an excerpt from a forthcoming feature article, “Current Concepts In Diagnosing And Treating Hyperhidrosis,” which will be published in the June 2019 issue of Podiatry Today.

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