Oral or systemic prescription medications are sometimes considered by physicians for the treatment of hyperhidrosis. Some of the medications that have been tried are anticholinergics, beta blockers, and clonidine hydrochloride (specific drug names include Propantheline, Glycopyrronium bromide, Benztropine, Diazepam, Diltiazem, Indomethacin, Oxybutynin, and Glycopyrrolate/Robinul.) Theoretically, these medicines could help treat excessive sweating because they prevent the stimulation of all sweat glands and thus may limit overall sweating, but long-term use is not recommended because of serious side effects. In fact, many physicians are not convinced that systemic anticholinergic drugs and other oral medications are appropriate for the treatment of primary focal hyperhidrosis (excessive sweating that is not linked to another medical condition and is localized to the hands, feet, face, and/or underarms)..
Healthcare experts and hyperhidrosis patients find that anticholinergic therapy works extremely well. It should be noted, however, that anticholinergics have not, to date, been evaluated in clinical trials for hyperhidrosis specifically. As far as hyperhidrosis is concerned, their use is “off-label.” It has even been established that certain anticholinergics, such as oxybutynin and glycopyrrolate, are safe for young children. Liquid versions of two common anticholinergic medications are regularly prescribed for children with hyperhidrosis.
Although the optimal doses of these drugs are still being researched, the following are frequently used in clinical practice: Oxybutynin 5–7.5 mg two times a day, glycopyrrolate 1–2 mg two times a day, and methantheline bromide 50 mg two times a day. Side effects might be extremely debilitating. Dry mouth, urinary hesitancy, blurred vision, dizziness, confusion, and tachycardia are just a few of the side effects. Those with pyloric stenosis, myasthenia gravis, paralytic ileus, and narrow-angle glaucoma should not take this medication. In addition, patients having glaucoma, obstruction, cardiac insufficiency, gastric reflux disease, or bladder outflow therapy should be treated with extreme caution.
Clonidine (0.1 mg twice a day) is used to treat hypertension. Clonidine works by increasing alpha-adrenergic receptors’ function and inhibiting sympathetic output. Dry mouth, constipation, dizziness, drowsiness, and symptomatic reduction in blood pressure are some of the side effects of this medication.
There are other oral drugs available besides anticholinergics. These are effective in treating patients with certain forms of hyperhidrosis. Anxiety medications like beta-blockers (such as propranolol) and benzodiazepines act by “blocking” the physical signs of the condition. These medications work by acting on the central nervous system. They are most effective in treating people who suffer from event-driven or episodic hyperhidrosis (for example, excessive sweating caused by anxiety due to a job interview). Side effects prevent them from being used for an extended period. For example, benzodiazepines have the potential to become addictive, and many patients are unable to endure the sedative effects induced by either of these therapies.
In some cases of individuals with specific forms of hyperhidrosis, oral medicines had a positive effect. Successful treatments for hyperhidrosis included drugs such as indomethacin, clonidine, and gabapentin.
Healthcare providers may have various therapeutic options to offer their patients, including calcium channel blockers, beta-blockers, anticholinergics, and nonsteroidal anti-inflammatory medications. However, long-term use of oral drugs carries the risk of undesirable side effects. Therefore, these should only be used should other treatments fail to decrease sweating.
There is no promising use for anticholinergics, however. Some physicians and their patients have had great success treating sweaty palms and sweaty feet by adding a crushed anticholinergic tablet to the water used during iontophoresis.