Anticholinergic drugs in management of sweating

Anticholinergic drugs act directly on the nerves in the sweat glands to show a perspiration suppression effect (1)

• anticholinergic drugs suppress the sympathetic nervous system, so symptoms such as oral dryness, palpitations, constipation, dysuria, digestive problems, dizziness, and headaches can occur, and this method cannot be used in patients with underlying diseases such as cataracts or urologic disease (1)
  • despite these disadvantages, anticholinergic drugs are a relatively frequently selected oral medication for the treatment of hyperhidrosis outside the UK (1)
    
    
    • propanthelene bromide is the only licensed systemic product for primary hyperhidrosis in the UK (2)
      • start at a low dose of 15 mg once to twice a day, increasing as tolerated to 30 mg tds
        
        
    • the anticholinergic drug that is used the most often is glycopyrrolate (glycopyrronium bromide) ((1)
      • has fewer central side effects, such as drowsiness or headache, than other anticholinergic drugs, and it has a superior perspiration suppression effect, so it has been widely used overseas as the initial medication in hyperhidrosis treatment (3)
      • there is evidence from a small study (1) that glycopyrrolate is an effective initial method of treating primary hyperhidrosis that, reduces anxiety and improve patients' quality of life
      • glycopyrrolate has been used successfully in the management of antidepressant-associated sweating (4)
        
        
    • oxybutynin has also been used for the treatment of hyperhidrosis (5,6)
      • in these trials the initial dose was 2.5mg od in the evening and this was gradually titrated up to a maximum dose of 5mg bd
    • during the first week, patients received 2.5 mg of oxybutynin once per day; from the 8th to the 42nd day, 2.5 mg twice per day; and from the 43rd day to the end of the 12th week, 5 mg, twice per day.
    • 80% of the patients experienced an improvement in axillary hyperhidrosis; 36.3% of them presented a great improvement, and half of the patients showed improvements at all hyperhidrosis sites (4)
    • side effects were minor, with dry mouth being the most frequent (5,6)

Reference:

• 1) Lee HH et al. Efficacy of glycopyrrolate in primary hyperhidrosis patients. Korean J Pain. 2012 Jan;25(1):28-32.
• 2) Primary Care Dermatological Society. Hyperhidrosis (accessed 19/7/14)
• 3) Ali-Melkkila T, Kanto J, Iisalo E. Pharmacokinetics and related pharmacodynamics of anticholinergic drugs. Acta Anaesthesiol Scand. 1993;37:633-642
• 4) Mago R.Glycopyrrolate for antidepressant-associated excessive sweating. J Clin Psychopharmacol. 2013 Apr;33(2):279-80.
• 5)Wolosker N et al. The use of oxybutynin for treating axillary hyperhidrosis. Ann Vasc Surg. 2011 Nov;25(8):1057-62.
• 6) Wolosker N et al. An alternative to treat palmar hyperhidrosis: use of oxybutynin.Clin Auton Res. 2011 Dec;21(6):389-93.