Systemic drugs for hyperhidrosis

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Hyperhidrosis and Facial Blushing


- Hyperreactivity of the Sympathetic Nervous System -

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Systemic drugs


Anticholinergics

Effect
There are a number of drugs that reduce perspiration due to their inhibiting effect on the action of the neurotransmitter acetylcholine. These anticholinergic agents compete with the neurotransmitter by occupying the receptors on the cell surface of the sweat gland. While acetylcholine stimulates the sweat gland to produce and expel sweat, anticholinergics have no effect on the gland and therefore perspiration is reduced.

Acetylcholine (yellow) diffuses to the sweat gland

Acetylcholine linking to the receptor (blue) and activating the sweat gland

Anticholinergic (red) - is bound to the receptor (can not activate the sweat gland)

Acetylcholine blocked, sweat secretion inhibited


Side effects
Unfortunately, anticholinergics do not exclusively block the sweat glands, but exert an inhibitory action on all organs controlled by the neurotransmitter acetylcholine. These include, inter alia, the salivary glands, the digestive tract, the urinary bladder, the heart. The inhibitory effect of anticholinergics may therefore lead to dryness of the mouth, blurred vision, constipation, weak urine flow, increased heart rate. Often, these side effects are so unpleasant that they require interruption of treatment before a sufficient inhibition of perspiration is achieved. For this reason, these drugs rarely provide an acceptable long-term solution, but may be used occasionally to suppress sweating in situations, where sweating would be particularly embarrassing.

Substances and products
Most of the medications listed below are made available for the treatment of other conditions. Their inhibitory side effect on the sweat glands is used to treat hyperhidrosis, though this indication is usually not explicitly declared ("off-label" treatment).

  • methantelinium bromide (Vagantin)
  • propantheline bromide (Pro-Banthine)
  • glycopyrrolate (Robinul)
  • oxybutynine (Ditropan) - Main indication: overactive / neurogenic bladder dysfunction
  • benztropine (Cogentin)
  • bornaprine (Sormodren) - Main indication: Parkinson

NB: some of these drugs are not approved or available in all countries.

Other substances

Antifungals (antimycotics)
Skin fungus often play an important role in bromhidrosis, especially on the feet. By appropriate treatment, the odor problem may significantly improve.