What is the role of medications in axillary hyperhidrosis treatment?

Updated: Feb 12, 2019
  • Author: Richard H S Karpinski, MD, FACS; Chief Editor: Gregory Gary Caputy, MD, PhD, FICS  more...
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Administration of anticholinergic agents and beta-blockers can be quite helpful in mild cases of hyperhidrosis. Glycopyrronium bromide (Robinul), atropine, propranolol, and a host of anxiolytic (eg, Klonopin) and psychotherapeutic (eg, Prozac) medications have been used in the treatment of this disorder, with varying degrees of success.

Based on two replicate randomized, double-blind, vehicle-controlled, 4-week, phase 3 trials (ATMOS-1 and ATMOS-2), Glaser et al reported that primary axillary hyperhidrosis can be effectively treated topically with glycopyrronium tosylate 3.75%, administered daily. The severity of sweating, as assessed using the Axillary Sweating Daily Diary, and the production of sweat, as evaluated gravimetrically, were both reduced over the 4-week period. [9] In June 2018, the US Food and Drug Administration approved glycopyrronium tosylate 2.4% (Qbrexza) for the topical management of primary axillary hyperhidrosis in adults and in children aged 9 years or older. [10]

Unfortunately, in all but the mildest cases of hyperhidrosis, the doses of medications required to truly control abnormal sweating often cause significant adverse effects, including drowsiness, dry mouth, dilated pupils, photophobia, blurred vision, acute glaucoma, impaired micturition, reduced bronchial secretions, constipation, confusion, nausea, vomiting, giddiness, tachycardia, palpitations, and arrhythmias. Thus, many patients are forced to discontinue this avenue of treatment.

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