Many people with excessive sweating (= hyperhidrosis) have never been offered medication by a doctor to reduce their excessive sweating. However, several medications are available.
Studies have tested their effectiveness and side effects.
Oxybutynin (Ditropan) is the most commonly prescribed and used medication in France.
For those for whom oxybutynin did not have a sufficient effect or for whom the side effects were too unpleasant, there is an alternative: glycopyrrolate (Robinul, Avert).
Relatively unknown and not commercially available in France or other countries (but still obtainable without a prescription).
Here is all the information you need to know about this medication for hyperhidrosis.
💬 The comment section is there for you! Feel free to share your experiences, as they can be valuable to others.
♻️ Last update: september 2023
Disclaimer: Amazon Affiliate Links. Written by Nelly Darbois, physical therapist and scientific writer (more about me)
What is glycopyrrolate (Robinul, Avrt) ?
Glycopyrrolate (also known as glycopyrronium bromide) is the name of a substance used to manufacture medications.
What type of substance is glycopyrrolate?
Glycopyrrolate is an anticholinergic, which means it reduces the effects of acetylcholine (👉 see other anticholinergic medications for hyperhidrosis).
Acetylcholine is a substance secreted in the brain that:
- Acts on the parasympathetic nervous system (the one responsible for excessive sweating or PMS).
- Increases the production of saliva and other secretions, such as sweat.
In other words, glycopyrrolate reduces secretions from certain parts of the body. That’s why it is used to:
- Decrease saliva secretion during anesthesia in surgical procedures, in both animals and humans.
- Reduce the quantity of secretions from the lungs in certain diseases.
In what forms does glycopyrrolate exist?
In France, United-States and a lot of countries, glycopyrrolate can be found:
- For inhalation, for individuals with pulmonary problems.
- For subcutaneous injection, for animals.
However, it is not available in capsule or tablet form (oral route) or for topical application on the skin (topical route; topical glycopyrronium).
Nevertheless, it is still possible to obtain it as a medication, as we will see in this article. I will write an article in a few weeks about gels or creams containing glycopyrrolate for excessive sweating. This article only covers oral medication.
In the United States, glycopyrrolate has been authorized and marketed since the 1960s, but not for hyperhidrosis.
Dartisla ODT tt’s the first FDA-approved orally disintegrating tablet of glycopyrrolate (in 2022). Dartisla ODT is FDA-approved as an additional treatment to alleviate symptoms of peptic ulcers. Healthcare providers may also prescribe it off-label for patients experiencing excessive sweating.
Dartisla ODT is available in the form of freeze-dried tablets that dissolve quickly in the mouth and are absorbed by the mucous membranes.
Each Dartisla ODT tablet contains 1.7mg of glycopyrrolate, which is equivalent to 2mg of traditional oral glycopyrrolate tablets.
Patients should be advised to handle Dartisla ODT tablets with dry hands, as they will disintegrate upon contact with moisture. Blister packs allow for easy dosing by opening a dose and placing it in the mouth.
Different Trade Names of Glycopyrrolate
Here are the various trade names for glycopyrrolate, in all its forms:
- Lonhala Magnair
- Seebri Neohaler
Oxybutynin, another medication for hyperhidrosis, is also an anticholinergic medication. However, it acts slightly differently. That’s why it is mainly used to reduce urinary secretions, not salivary or pulmonary secretions.
How does glycopyrrolate/Robinul work against sweating?
Glycopyrrolate probably works like other anticholinergics: it reduces the amount of acetylcholine secreted in the body. As a result, the brain sends fewer nerve impulses to the sweat glands, instructing them to produce less sweat.
But glycopyrrolate is different from other anticholinergics. It affects certain receptors less and crosses the blood-brain barrier less. This probably reduces its side effects.
Hence the theoretical interest in testing it in people who have experienced too many side effects with oxybutynin (Ditropan).
Glycopyrrolate for Sweating Reviews: Does glycopyrrolate really reduce sweating?
There are fewer studies that assess the effectiveness of glycopyrrolate against sweating compared to oxybutynin.
These studies are conducted on fewer patients and are of lower quality.
Here is a table summarizing the important information from these studies. They all have in common that they tested the effect of oral glycopyrrolate intake (medication to swallow) in individuals with excessive sweating.
|Number of People||Dosage (Glycopyrrolate)||Glycopyrrolate Effectiveness||Side Effects||Country||Reference|
|49||2mg/day for 6 weeks||76% had at least a 2-point reduction in HDSS severity||94% experienced dry mouth and throat||India||Vyas 2020|
|58||2 to 6 mg/day for 3 to 12 months||76% had at least a 2-point reduction in HDSS 3 months after treatment initiation; 74% after 12 months (among the 52% who continued)||Ineffective for 24% of patients||Spain||Del Boz 2020|
|23||2 to 9 mg/day for 3 to 12 months||65% had at least a 2-point reduction in HDSS at 3 months||78% experienced side effects, mainly dry mouth, but also: dry nose, nosebleeds, headache, dry eyes, diarrhea, tachycardia, anxiety Only 3 patients discontinued treatment due to side effects, while 13 out of 23 patients had discontinued oxybutynin due to side effects||Spain||Del Boz 2017|
|12 children and adolescents||Approximately 1 mg/day for 18 months||1/3 had a significant improvement, 92% showed improvement||7/12 reported side effects||United States||Kumar 2014|
|19, with compensatory hyperhidrosis||2 to 8 mg/day||Reduction in sweating for 89% of patients||Seen in 42% of patients||Korea||Gong 2013|
|31 children||Approximately 2 mg/day on average||90% showed improvement 71% had a major improvement (-2 points on HDSS)||Present in 29% of patients, more common with higher dosages||United States||Paller 2012|
|66, primary hyperhidrosis||2 to 8 mg/day||Reduction in sweating for 75% of patients Decreased anxiety||Present in 36% of patients||Korea||Lee 2012|
In answer to the question “Does glycopyrrolate really reduce excessive sweating?” based on this information, the response is:
- Glycopyrrolate reduces sweating in 9 out of 10 people who take it.
- This reduction in sweating is considered significant for about 7 out of 10 people. This means they have an HDSS score 2 points lower after taking glycopyrrolate for several weeks.
How to Procure Glycopyrrolate/Robinul? + Dosage
The doses used in the studies range from 1mg per day to 9mg per day. In all cases, dose escalation is gradual over several weeks. It is suggested to take:
- 1 to 4mg/day for children and adolescents,
- 2 to 8mg/day for adults;
- 1.5mg/day in winter, 5mg per day in summer.
For example, start with 1mg/day in the first week, 2mg in the second week, 4mg in the third week, and so on. If the effect is sufficient at 1 or 2mg per day, there is no need to increase the dosage!
The doses can be taken:
- Once a day, in the evening or morning;
- Twice a day;
- Three times a day.
It is recommended to take it away from meals:
- 1 hour before eating or;
- 2 hours after eating.
How to Obtain Glycopyrrolate ?
Discuss it with your doctor
First and foremost, discuss your desire to try glycopyrrolate with a “sweating healthcare professional” who is open to your request. No doctor in France or United-States can prescribe it since it is not commercially available in tablet/capsule form.
However, the healthcare professional can discuss with you:
- Possible contraindications for you to take this treatment. Commonly described contraindications include gastroesophageal reflux, glaucoma, difficulty urinating, heart failure. In other words, there are considered significant risks in taking glycopyrrolate if you have one or more of these conditions;
- Ways to obtain it;
- How to assess the effectiveness and side effects of the treatment on you;
- Alternatives to try that may be more suitable for you (iontophoresis, botox injections, oxybutynin, etc.);
- Whether you have primary or secondary hyperhidrosis.
This is an ideal situation. In reality, people with hyperhidrosis rarely come across doctors who conduct their consultations in this way.
Some are closed to the idea of discussing a product not commercialized in France; others listen discreetly and do not say a word. Some even go so far as to “forbid” the patient from obtaining such a product.
Thanks to people who frequent the Hyperhidrosis Observatory, I have been aware in recent years of various websites that sell glycopyrrolate capsules without a prescription (a big thank you to them!).
Here is the address of the website that, to this day (September 2023), allows you to buy glycopyrrolate for hyperhidrosis from France and United-STates (and other countries): pharmacy.ca.
The recommended daily doses by the manufacturer for the initial doses are:
- 1 mg for people under 57 kg;
- 1.5 mg for people 67 to 68 kg;
- 2 mg for people over 68 kg.
The contraindications described by the manufacturer are:
- Pregnancy, breastfeeding, or the anticipation of pregnancy;
- Hypersensitivity to glycopyrrolate or lactose.
Through this site, the price of glycopyrrolate is:
- $65.75 for 100 tablets of 1 mg (equivalent to about 1.5 months at a rate of 2 mg/day);
- Additionally, $45 for shipping to France.
There is no reimbursement possible by health insurance or mutual insurance. Expect to receive the product in about 1 week.
Glycopyrrolate for Sweating: Side Effects
I have previously listed the main side effects described in each study testing glycopyrrolate against excessive sweating.
The main reported side effects are:
- Dry throat
- Dry mouth
- Dry eyes and nose
These effects occur in 30 to 90% of patients according to the studies. In some people, this does not prevent them from continuing to take the medication for several years. In others, it leads them to stop or reduce their intake.
Everything suggests that these side effects occur less frequently than with oxybutynin (Ditropan). In fact, some people who stopped Ditropan due to side effects later took glycopyrrolate and were able to take it for several months without being too bothered by its side effects.
Other described side effects of glycopyrrolate include:
- Diarrhea or constipation
- Difficulty urinating
- Sleep disturbances
These occur less frequently, and it is not possible to provide a precise frequency.
Is Glycopyrrolate/Robinul the Most Effective Medication for Hyperhidrosis?
The current state of knowledge does not allow for a precise answer to this question.
What can be said based on the current state of knowledge is that:
- Oxybutynin (Ditropan) is the most studied medication against hyperhidrosis, the one with the most data available.
- Oxybutynin can be prescribed and reimbursed in France.
- Therefore, oxybutynin is reasonably the first medication to try against hyperhidrosis for people looking for a solution that treats sweating on all parts of the body simultaneously.
However, glycopyrrolate may be of interest to two types of people:
- Those who had to stop or reduce oxybutynin doses due to side effects.
- Those for whom oxybutynin did not have enough effect.
Can Glycopyrrolate Be Used in Forms Other Than Oral Medication (Pill)?
Yes! For people who want to target sweating in a specific area of the body, such as the armpits, feet, forehead, or hands, it is possible to use glycopyrrolate in the form of a gel or cream: it is topical glycopyrrolate.
Again, this treatment is not widely available in most countries. I am currently researching it in-depth to create a comprehensive article for the Hyperhidrosis Observatory blog.
You can subscribe for free to be informed of its upcoming publication!
Do you have any comments or questions? Your comments are welcome 🙂 !
You may also like:
Vyas K, Singh R, Kumari A, Balai M. Evaluation of Efficacy and Safety of Low Dose Glycopyrrolate in Management of Primary Hyperhidrosis—An Open Label Single Arm Study. Indian Dermatol Online J. 2020;11(6):1012-1013. Published 2020 Nov 8. doi:10.4103/idoj.IDOJ_179_20
Del Boz J, García-Souto F, Rivas-Ruiz F, Polo-Padillo J. Survival study of treatment adherence by patients given oral glycopyrrolate for hyperhidrosis following treatment failure with oral oxybutynin. Dermatol Ther. 2020 Nov;33(6):e14210. doi: 10.1111/dth.14210. Epub 2020 Sep 7. PMID: 32827198.
Del Boz J, Millán-Cayetano JF, Rivas-Ruiz F, de Troya-Martín M. Oral glycopyrrolate after the failure of oral oxybutynin in the treatment of primary hyperhidrosis. Br J Dermatol. 2017 Mar;176(3):821-823. doi: 10.1111/bjd.14876. Epub 2017 Jan 22. PMID: 27436700.
Kumar MG, Foreman RS, Berk DR, Bayliss SJ. Oral glycopyrrolate for refractory pediatric and adolescent hyperhidrosis. Pediatr Dermatol. 2014 Jan-Feb;31(1):e28-30. doi: 10.1111/pde.12236. Epub 2013 Nov 25. PMID: 24266878.
Gong TK, Kim DW. Effectiveness of oral glycopyrrolate use in compensatory hyperhidrosis patients. Korean J Pain. 2013 Jan;26(1):89-93. doi: 10.3344/kjp.2013.26.1.89. Epub 2013 Jan 4. PMID: 23342216; PMCID: PMC3546219.
Paller AS, Shah PR, Silverio AM, Wagner A, Chamlin SL, Mancini AJ. Oral glycopyrrolate as second-line treatment for primary pediatric hyperhidrosis. J Am Acad Dermatol. 2012 Nov;67(5):918-23. doi: 10.1016/j.jaad.2012.02.012. Epub 2012 Mar 7. PMID: 22405644.
Lee HH, Kim DW, Kim DW, Kim C. Efficacy of glycopyrrolate in primary hyperhidrosis patients. Korean J Pain. 2012 Jan;25(1):28-32. doi: 10.3344/kjp.2012.25.1.28. Epub 2012 Jan 2. PMID: 22259713; PMCID: PMC3259134.
Side effects, contraindication https://www.drugs.com/mtm/glycopyrrolate.html
Written by Nelly Darbois
I founded this website in 2012. Since then, I’ve been providing information and positive support to people suffering from excessive sweating. I’m also a physical therapist and science writer, living in French Alps 🌞❄️.