HH Medications

When topical antiperspirants aren´t enough, medications in the anticholinergic category are tried. Oral medications such as Pro-Banthine 1.5 mg/kg every 24 hours may be used. As with all anticholinergic agents, potential side effects include dry mouth, and possibly blurred vision may occur.

Excessivesweating.org reports the medical treatments, and the physiology of sweating. Some physicians recommend using a small dose of a drug known as a beta blocker, such as propranolol (Inderal®) for sweating from stagefright.

Beta-blockers are often used for high blood pressure, angina, heart disease, and migraines, but must be used very carefully, especially by people with asthma, diabetes or lung diseases, and are only available by prescription. Physicians have often found the combination of Robinul® and propranolol to be very effective.

Medication may be taken internally that works to block the neurotransmitter, acetylcholine, from stimulating the sweat glands. Some of the more useful medications include the anticholinergics (such as glycopyrrolate or atropine), some antihistamines, some antidepressants, and some of the tranquilizers.

However, these medications will also affect other parts of the body, and may lead to possible side effects, including dry mouth, drying of other secretions, constipation, or other side effects. For hyperhidrosis, the most commonly used drugs are the anticholinergics and the antidepressants glycopyrrolate (Robinul® and Robinul® Forte), atropine, propantheline bromide (ProBanthine®) and oxybutynin (Ditropan®). All require prescription in the United States. None of these drugs are formally indicated for use in hyperhidrosis, but many physicians have found them to be extremely helpful by blocking the acetylcholine neurotransmitter, they cut down on the nerve impulses to the sweat glands, thus lowering the amount of perspiration produced.

Glycopyrrolate (Robinul® and Robinul® Forte) tablets come in two different strengths (Robinul® 1mg and Robinul® Forte 2 mg), so the dose can be easily adjusted. The tablets can also be crushed up and given mixed with soft foods such as applesauce, pudding, ice cream, etc., or made into a liquid form by a pharmacist, if swallowing tablets are a problem. Glycopyrrolate is usually taken 1 to 3 times a day, in doses of 1 or 2 mg at a time, depending on the severity of the sweating. Side effects are few and usually very mild and not that bothersome. Some patients may develop a dry mouth. Patients who tend to get diarrhea frequently may find that the glycopyrrolate tends to help control that, as it is used for diarrhea in other countries. Glycopyrrolate does not cross the blood-brain barrier, therefore Central Nervous System (CNS) side-effects are virtually non-existent.

Atropine tends to have more side effects than the others do; because it gets into the brain very easily, it is more likely to produce drowsiness, restlessness, irritability, or even mental confusion. It is the shortest acting of the four anticholinergics, and needs to be taken every 4-6 hours. Oxybutynin is often used to help calm down bladder spasms and an overactive bladder, while propantheline bromide is used for stomach ulcers as well as for bladder spasms. However, they need to be taken 2-5 times a day, and the propantheline tablets cannot be split. Usually, the best way to adjust these medications is by trial and error. Multiple medications and schedules may be tried before finding a treatment that works best for that individual patient. The anticholinergics are much less likely to cause rashes and skin irritation than the antiperspirants, and the dose can be adjusted fairly easily. Some people may need only a fraction of one tablet a day to control their hyperhidrosis, while others may need higher doses. Some physicians have used these anticholinergics by iontophoresing them into the skin, in a manner similar to the tap-water electrophoresis described before, but scientific studies have shown that they also work well when formed into topical skin preparations. Topical gels, lotions and creams containing anticholinergics such as Robinul® (glycopyrrolate) can be compounded up fairly easily by many pharmacists, and so they may be applied onto the skin at particularly bothersome sites, as was reported in the papers on gustatory sweating in diabetes or Frey's syndrome of course, for people who suffer from hyperhidrosis throughout their entire body, topical cream treatment is probably not as desirable as oral tablet therapy.

The ability to control excessive sweating by taking a simple tablet may make the other treatments seem less desirable.

Ask Dr. Weil - Q&A: Soaking in Sweat? I would definitely avoid coffee, tea and other stimulants. They increase the activity of apocrine sweat glands -- special glands in hairy parts of the body that produce strong-smelling, musky secretions. These drugs arouse your body's fight-or-flight response, increasing any anxiety you may already have.

Do drink lots of water, because you're going to need to replenish the fluid you've lost. Avoid environmental stimuli that can trigger your sympathetic nervous system into an alarm response -- such as loud music, lots of interruptions at work (try closing the door) or even annoying people who get on your nerves (we all know some of those!). Practice my breathing exercise, especially when you feel yourself getting tense. You may also want to try meditation. And be sure to keep up your exercise. You're lucky -- sweat is sort of a badge of honor among the fitness crowd because people in good shape tend to sweat more. Their bodies have been trained to cool themselves efficiently. If you think stress may be part of the problem, biofeedback is an excellent way to learn how to relax your sympathetic nervous system and lower tension in your body. I also would try hypnosis or go to a Chinese medical practitioner to see if they can help. You also may be losing quite a bit of zinc with your sweat -- as much as 3 mg a day. Zinc is important for protein and DNA synthesis, blood stability and brain and immune function. You may want to take 30 milligrams of zinc a day to compensate.

Muscle cramps may sometimes be due to excessive sweating, which causes a loss of salt from the body. So you may need to supplement with electolytes to maintain balance when you're sweating a lot.