What medications are used to treat hyperhidrosis?

From the Guidelines

Several medications are used to treat hyperhidrosis, a condition characterized by excessive sweating, with topical antiperspirants containing aluminum chloride being the first-line treatment. The treatment of hyperhidrosis typically involves a step-wise approach, starting with topical treatments and progressing to more invasive options as needed.

• Topical antiperspirants containing aluminum chloride (such as Drysol, Certain Dri, or Xerac AC) are typically the first-line treatment, applied nightly to dry skin until sweating reduces, then used 1-2 times weekly for maintenance.
• Oral anticholinergics like glycopyrrolate (1-2mg twice daily), oxybutynin (5-10mg daily), and propantheline (15-30mg daily) work by blocking acetylcholine, which activates sweat glands, and can cause side effects including dry mouth, blurred vision, and urinary retention.
• For localized hyperhidrosis, botulinum toxin (Botox) injections provide temporary relief lasting 4-12 months by blocking nerve signals to sweat glands.
• Iontophoresis, which uses a mild electrical current to temporarily block sweat glands, is effective for palmar and plantar hyperhidrosis.
• In severe cases unresponsive to other treatments, oral medications like clonidine, propranolol, or diltiazem may be prescribed. The evidence provided does not directly address the treatment of hyperhidrosis, but the general approach to treating this condition is well-established in the medical literature 1. Treatment choice depends on the severity and location of hyperhidrosis, with combination therapy often providing the best results.

From the FDA Drug Label

BOTOX is also injected into the skin to treat the symptoms of severe underarm sweating (severe primary axillary hyperhidrosis) when medicines used on the skin (topical) do not work well enough BOTOX Cosmetic is a prescription medicine for adults that is injected into muscles and used for a short period of time (temporary) No definitive serious adverse event reports of distant spread of toxin effect associated with dermatologic use of BOTOX/BOTOX Cosmetic at the labeled dose of ... 100 Units (for severe primary axillary hyperhidrosis) have been reported.

Medications for Hyperhidrosis:

• Botulinum toxin (IM) is used to treat severe underarm sweating (severe primary axillary hyperhidrosis) when topical medicines do not work well enough 2 2. Key Points:
• Botulinum toxin is injected into the skin to treat hyperhidrosis.
• It is used when topical medicines are not effective.
• The labeled dose for severe primary axillary hyperhidrosis is 100 Units.

From the Research

Medications for Hyperhidrosis

Medications used to treat hyperhidrosis include:

• Topical agents such as aluminum chloride hexahydrate 3, glycopyrrolate 4, 5, 6
• Oral anticholinergic medications like oxybutynin 5, methantheline bromide 5, and glycopyrrolate 5, 6
• Botulinum toxins, including OnabotulinumtoxinA, AbobotulinumtoxinA, and IncobotulinumtoxinA 7

Topical Therapies

Topical therapies are often used as first-line treatments for hyperhidrosis. These include:

• Aluminum chloride hexahydrate, which can be used in combination with botulinum toxin type A for moderate to severe hyperhidrosis 3
• Glycopyrrolate, which has been shown to be effective in treating gustatory hyperhidrosis 4

Oral Therapies

Oral anticholinergic medications can be used to treat hyperhidrosis, but may have side effects such as dry mouth. These include:

• Oxybutynin, which has been shown to improve symptoms in an average of 76.2% of patients 5
• Methantheline bromide, which has been associated with a 41% reduction in axillary sweating 5
• Glycopyrrolate, which has been used as a second-line treatment for primary pediatric hyperhidrosis 6

Botulinum Toxins

Botulinum toxins are a highly effective treatment for hyperhidrosis, with a long-lasting effect of 3-9 months after one injection session 7. These include:

• OnabotulinumtoxinA, which has been shown to be effective in treating axillary and palmar hyperhidrosis 7
• AbobotulinumtoxinA, which has also been shown to be effective in treating axillary and palmar hyperhidrosis 7
• IncobotulinumtoxinA, which has been shown to be possibly effective in treating axillary hyperhidrosis 7