Oxybutynin (Ditropan) for Sweating – Dose, Side Effects, Alternatives

What is oxybutynin (Ditropan)?

Are you looking to:

• Stop sweating or reduce sweating from one or more parts of your body?
• Sweat less from one or more parts of your body?
• Achieve this through a tablet, pill, or swallowable medication.

Chances are, you have hyperhidrosis, and you may have already tried other hyperhidrosis treatments that didn’t work or weren’t effective enough.

During your research, you may have come across medications for hyperhidrosis, particularly oxybutynin, which is marketed in France or United-States under the brand name Ditropan.

What type of substance is oxybutynin?

Oxybutynin is an anticholinergic molecule. What does this mean? When you take it:

• It has an effect on a hormone that we all have in our bodies, acetylcholine.
• It reduces the effect of this hormone.
• This has an impact on certain functions controlled by our brain, primarily on the parasympathetic nervous system.

🧠 Now, the parasympathetic nervous system is involved in regulating sweat secretion.

In what forms does oxybutynin exist?

Oxybutynin is primarily used for people who have urinary incontinence issues.

In France, this medication is authorized for this indication (urinary incontinence problems) and not for hyperhidrosis.

It is available in the following forms:

• Swallowable tablets 💊 (pills).
• Syrup (currently not marketed in France).
• For bladder injection (currently not marketed in France).

For over 10 years, several studies have shown that oxybutynin taken in tablet form also has an effect against excessive sweating.

Different brand names for oxybutynin

Here are the various brand names for oxybutynin, in all its forms:

• Ditropan.
• Driptane (discontinued).
• Oxybutynin Accord.
• Oxybutynine Biogaran.
• Oxybutynine EG.
• Oxybutynine Mylan (discontinued).
• Oxybutynine Teva.

Each of these is a 5mg scored tablet 💊 (which can be cut to take 2.5 mg). All these medications require a doctor’s prescription in United-States.

How does oxybutynin work against sweating?

When you take oxybutynin, you reduce activity in the sympathetic ganglia (in the spinal cord):

• of acetylcholine (a hormone);
• of alpha-7 nicotinic receptors.

Now, in people with hyperhidrosis, the expression of this hormone and these receptors is increased. By reducing their activity, you increase your chances of sweating less: these mechanisms mean that the sweat glands receive fewer signals to produce sweat from your nervous system.

Is oxybutynin really effective against hyperhidrosis?

Oxybutynin was likely first given to people with hyperhidrosis in the late 1990s. In fact, the first publication on the potential benefits of oxybutynin for excessive sweating dates back to 1998.

A Brazilian research team (Wolosker 2020) explains that they have been using oxybutynin in their service to treat hyperhidrosis since the 2000s. Prior to that, they could only offer surgical operations (thoracic and lumbar sympathectomy) to limit excessive sweating. The main problem with these operations is the risk of compensatory hyperhidrosis, which is why they sought alternative treatments.

🇧🇷 Due to its latitude, Brazil is one of the countries with the highest number of studies on hyperhidrosis, as the climate exacerbates sweating.

Oxybutynin was initially used for people with compensatory hyperhidrosis. Clinical studies showed that this medical treatment was quite effective, both in the short and long term. Doctors also started using it as a first-line treatment for primary hyperhidrosis. Instead of recommending sympathectomy surgery, they began to offer oxybutynin more frequently.

This study aimed to investigate the long-term effectiveness and satisfaction (over several months) of individuals who received oxybutynin as a first-line treatment for their excessive sweating, without resorting to thoracic or lumbar sympathectomy.

The idea behind this study is to assess the impact of oxybutynin on the 1,658 people who consulted this service over a period of 12 years.

Oxybutynin was used for people suffering from hyperhidrosis in various parts of the body, single or multiple areas, mainly:

• Hands.
• Feet.
• Armpits.
• Face, scalp, forehead, or the whole head.

While these results? Here they are:

• Over 70% of individuals reported moderate or optimal improvement in their discomfort due to hyperhidrosis after treatment.
• This was even more pronounced for those primarily bothered by craniofacial hyperhidrosis (face, forehead, scalp), with 81% of them reporting moderate or optimal improvement.
• 66% of individuals showed an improvement of at least 2 points out of 4 in their HDSS score (a score used to assess the subjective severity of hyperhidrosis).

However, in this Brazilian study, oxybutynin intake is not compared to taking a placebo. This can lead to an overestimation of the positive effects of oxybutynin.

When comparing oxybutynin to a placebo (Schollhammer 2015), it was found that:

• 60% of people taking oxybutynin had a decrease of at least 1 point out of 4 in their HDSS score.
• 27% of people taking a placebo also had a decrease of at least 1 point out of 4.

By taking oxybutynin, you can hope to see your hyperhidrosis decrease by at least 1 point out of 4, especially if you sweat from your face or scalp.

In the United Kingdom, NHS relies on this type of study to determine the reimbursement of oxybutynin for sweating.

How much oxybutynin should you take per day (dose) ?

Here are the dosages from the protocol followed by most people with hyperhidrosis taking oxybutynin:

• 2.5 mg of oxybutynin once a day in the evening for 1 week.
• 2.5 mg of oxybutynin twice a day during the second week.
• 5 mg of oxybutynin twice a day starting from the third week.

🧒 For children weighing less than 40 kilograms, the protocol was the same, but the maximum doses remained at 2.5 mg twice a day at most. (🔗 See hyperhidrosis/excessive sweating in children.)

Then, follow-up visits were regularly scheduled with doctors to adjust the treatment. The minimum proposed doses were 5 mg twice a day, and the maximum doses were 15 mg per day, with a minimum interval of 6 hours and a maximum interval of 24 hours.

The medical community and research teams emphasize the importance of gradually increasing the dosage of oxybutynin. This serves several purposes:

• Gradually acclimating your body to assimilate this new substance.
• Limiting side effects.
• Finding the minimal effective dose with the best effectiveness-to-side effects ratio for you.

You can take from 2.5 mg to 15 mg per day. Gradually increase the dosage until you find the minimal dose with the best effectiveness-to-side effects ratio for you.

How to obtain this medication from United-States?

Some people have difficulty obtaining oxybutynin. Indeed, this requires a prescription from a doctor. Here are some tips.

Discuss it with your general practitioner or dermatologist

The first step in getting a prescription for oxybutynin is to discuss your hyperhidrosis with a doctor, regardless of their specialty (general medicine, dermatology, neurology, etc.).

These two articles should help you find a “good” doctor:

• Find a specialist in excessive sweating/hyperhidrosis.
• Find a dermatologist who specializes in excessive sweating/hyperhidrosis.

Some doctors will spontaneously suggest trying oxybutynin, especially if you have already tried other treatments. Others may not be aware that this molecule can be effective in treating hyperhidrosis and may not necessarily prescribe it for you.

I will give you some advice if you encounter this type of problem: a doctor “refuses” to prescribe oxybutynin for your hyperhidrosis.

My doctor doesn’t want to prescribe it to me: solutions

Here are various arguments you can present to a doctor who does not want to prescribe you oxybutynin (or Ditropan):

• Oxybutynin has been given for this indication since the 1980s.
• There are more than 50 studies published in the international scientific literature on the subject (tell them they can search for oxybutynin and hyperhidrosis on PubMed to verify).
• You have researched the subject extensively and are aware that there are also side effects to oxybutynin.
• There are studies that have followed more than 1,000 people taking oxybutynin for hyperhidrosis, sometimes for several years.
• You can propose doing a one-month test only and then returning to evaluate with them the risk-benefit balance.
• The Belgian evidence-based medical journal Minerva recommends, in some cases, the use of oxybutynin for hyperhidrosis, even if the substance is not authorized for marketing in Belgium.
• This is also the case for the Swiss medical journal.

In patients with severe hyperhidrosis with an HDSS score ≥ 2, treatment with oxybutynin at a dose of 7.5 mg per day may be considered. However, it is important to have ruled out all etiologies of hyperhidrosis beforehand and to ensure that there are no contraindications to anticholinergics.

Minerva

Once you have obtained a prescription, visit a pharmacy.

Purchase it online through pharmacy.ca

The Canadian and English-language website pharmacy.ca (see below) also offers oxybutynin for purchase in 5 or 10 mg tablets. However, you will also need a prescription.

Contact pharmacy.ca directly (they are very friendly and responsive) to find out the exact shipping arrangements.

What are the side effects of oxybutynin for sweating?

In the Brazilian study:

• 25% of people experienced intense dry mouth (the most frequent side effect).
• 13 out of 90 people discontinued its use due to a lack of effectiveness (oxybutynin for sweating stopped working), and 5 had to increase the dose to see an effect. For some, the effect diminishes over months.
• In other sources, it can also be read that 1 in 10 people experience constipation, nausea, dry mouth, headaches, drowsiness, blurred vision, or dry skin.

⚠️ There are certain contraindications for taking oxybutynin, which is an anticholinergic medication. Consult a doctor to evaluate the presence of these contraindications in your case.

⚠️ In elderly people, the use of anticholinergic medications (oxybutynin is such a medication) has been associated in some studies with early cognitive impairments. The Brazilian research team explains that this association was not known when they began prescribing oxybutynin and that this information should be considered to reevaluate the risk-benefit balance of oxybutynin.

I have written a more detailed article on the side effects of Ditropan (soon in English).

Are there alternatives to oxybutynin for hyperhidrosis?

No study directly compares the effectiveness of oxybutynin to other treatments for hyperhidrosis. On my website, you can find many other treatments for excessive sweating (soon in English), depending on the parts of the body affected.

Examples include:

💪 Aluminum chloride and other antiperspirants for hyperhidrosis.
😷 Sympathectomy for hands, facial sweating, or feet sweating.
🤖 Miradry for excessive underarm sweating.
💉 Botox injections in the armpits, less commonly in the hands, feet, or other body parts.
⚡ Iontophoresis for hands or feet.
⚡ Iontophoresis for armpits.
💊 Glycopyrrolate/Robinul for generalized hyperhidrosis (an other medication).

Summary: Review of oxybutynin for excessive sweating

Oxybutynin is a treatment for hyperhidrosis affecting various parts of the body that can bring satisfaction to those taking it. Doses and their frequency of intake can be adjusted over time, remaining between 5 mg and 15 mg per 24 hours.

Some individuals have been taking oxybutynin for several years to manage their hyperhidrosis. The main reported side effect is the sensation (sometimes very bothersome) of dry mouth. If the side effects are too strong, there is another medication for hyperhidrosis, glycopyrrolate, with fewer side effects.

When a forum on hyperhidrosis existed (atoute.org), many people sought the opinions of those already taking oxybutynin to benefit from their experiences. This forum has closed. If you want to directly access the opinions of people taking oxybutynin for sweating, I recommend taking a look at this article: websites, blogs, internet links, forums on hyperhidrosis.

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Do you have any comments or questions? Your comments are welcome 🙂 !

You may also like:

• My blog on hyperhidrosis

 📚 SOURCES

• Delort S, Marchi E, Corrêa MA. Oxybutynin as an alternative treatment for hyperhidrosis. An Bras Dermatol. 2017;92(2):217-220.
• Wolosker, N., Kauffman, P., de Campos, J. R. M., Faustino, C. B., da Silva, M. F. A., Teivelis, M. P., & Puech‐Leão, P. (2020). Long‐term results of the treatment of primary hyperhidrosis with oxybutynin: follow‐up of 1,658 cases. International Journal of Dermatology. 
• Del Boz Gonzalez J, Rodríguez Barón D, Millán-Cayetano JF, de Troya Martin M. Tolerance of oral oxybutynin in the treatment of hyperhidrosis. Dermatol Ther. 2020 Nov;33(6):e14197.
• Kamikava DYF, Wolosker N, Silva MFAD, Campos JRM, Puech-Leão P. Symptoms of anxiety and depression in patients with primary hyperhidrosis and its association with the result of clinical treatment with oxybutynin. Clinics (Sao Paulo). 2021 Jun 28;76:e2892.
• Schollhammer M, Brenaut E, Menard-Andivot N, Pillette-Delarue M, Zagnoli A, Chassain-Le Lay M, Sassolas B, Jouan N, Le Ru Y, Abasq-Thomas C, Greco M, Penven K, Roguedas-Contios AM, Dupré-Goetghebeur D, Gouedard C, Misery L, Le Gal G. Oxybutynin as a treatment for generalized hyperhidrosis: a randomized, placebo-controlled trial. Br J Dermatol. 2015 Nov;173(5):1163-8.
• Pharmacy.ca (to buy Oxybutynin)
• NICE Summary evidence about hyperhidrosis and oxybutynin