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Oral Medications for Hyperhidrosis – When We Can’t Use Botox

Posted Sep 15 2010 2:30pm

There is a variety of oral prescription medications used to manage excessive sweating for people with certain types of hyperhidrosis; each works systemically but through different mechanisms. In the end, they each work by preventing the stimulation of sweat glands and thus limit overall sweating.

It sounds simple: take medicine; 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 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 also can have success with oral medications.

The most commonly used medications for managing excessive sweating are anticholingerics . These include medicines such as propantheline, glycopyrrolate, oxybutynin, benztropine, 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. 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) responsible for excessive sweating. 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. But these may be managed by adjusting the individual’s dose.

That said, there are some hyperhidrosis patients who need to be very cautious when using anticholingerics.

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.

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.

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, and gabapentin have shown effectiveness in very specific cases of hyperhidrosis.

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