Medication For Sweating (Hyperhidrosis): Benefits & Side-Effects

Are you looking for an medication for sweating, in the form of a pill or tablet? Oral meds for hyperhidrosis, to reduce sweating or even completely stop sweating in certain parts of the body?

Many of you are researching this topic online. Sometimes, it can be challenging to obtain information from your doctor or dermatologist because some may not be aware of all the available medications for excessive sweating (hyperhidrosis).

This article aims to compile a list of all the medications currently available to reduce sweating. Their effectiveness and side effects will also be detailed, along with the recommended dosage.

You will also learn how to obtain these medications, usually through a prescription. And whether there are more effective options based on the affected body part or the type of hyperhidrosis (primary or secondary), whether it’s stress-related or not.

To create this article, I have relied on my weekly review of medical literature dedicated to the treatment of excessive sweating.

Additionally, I draw from my 10 years of experience assisting people with excessive sweating through teleconsultations. You will find all the sources of the scientific studies I reference at the end of the article.

Of course, I recommend seeking the advice of a doctor who is familiar with your complete medical history, including your medical records, before considering any of the medications discussed here.

💬 The comment section is there for you! Feel free to share your experiences, as they can be valuable to others.

♻️ Last update: september 2023
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Summary

When were medications for sweating first introduced?

Oxybutynin is the most extensively studied medication for sweating. It was probably given to people with hyperhidrosis for the first time in the late 1990s. In any case, the first publication regarding the potential use of oxybutynin for excessive sweating dates back to 1998.

It’s important to know that the medications used for hyperhidrosis are not designed to combat hyperhidrosis itself but to treat other conditions. These treatments often leverage the side effects of these medications (drying effect).

In 2023, it has been more than 20 years since the efficacy of certain medications against excessive sweating was tested in clinical studies.

When should you use medication to reduce sweating?

In France, there are no specific recommendations or guidelines for hyperhidrosis. However, such guidelines exist in other countries.

They generally state that medications should never be the first-line treatment.

Other treatments should be tried first, particularly antiperspirants and iontophoresis (depending on the affected area) because they carry fewer side effects. Even injections of botulinum toxin can be considered.

Medications should be tried before considering surgery for hyperhidrosis, such as thoracic sympathectomy or lumbar sympathectomy, as the latter carries a risk of compensatory hyperhidrosis and is not reversible.

Medications should be tried after antiperspirants, iontophoresis, or botulinum toxin injections.

What are the different types of medications for sweating?

There are several prescription oral medications that can be used to help manage certain types of excessive sweating, either alone or (most often) in combination with other treatments.

They reduce stimulation of the sweat glands by the parasympathetic nervous system, which reduces sweating throughout the body.

It often takes some time to reach the optimal level, where they provide assistance without causing unmanageable side effects.

That’s why it’s recommended to start with a low dose and increase it as needed until the right balance is achieved. Doses can also be adjusted based on seasons and weather conditions.

When starting to take medication to help with sweating, the effects are typically felt after three to five doses.

Some of these medications have been studied in clinical trials involving people with hyperhidrosis. However, these trials were almost never controlled with another medication or a placebo.

This means that they didn’t compare the effectiveness of two different molecules: one group taking one medication, another group taking another.

That’s why they don’t have marketing authorization in France or the United States for hyperhidrosis (although they can be obtained), but rather for other indications.

Their use is not officially recommended for hyperhidrosis.

Anticholinergic Medications for Sweating

The most studied medications for hyperhidrosis are anticholinergics.

The two most commonly prescribed and studied anticholinergics for hyperhidrosis are:

oxybutynin (Ditropan);
and glycopyrrolate (Avert/Robinul).

I have dedicated articles to them, and I recommend reading them for more specific information.

Oxybutynin for sweating

Glycopyrrolate for sweating

Methantheline bromide (often known by its brand name, Vagantin®) is another anticholinergic, but it is less commonly used and studied than glycopyrrolate and oxybutynin.

Benefits of Anticholinergics for Sweating

A Brazilian publication provides information on the long-term effect of oxybutynin against sweating (Wolosker 2020). It concludes that:

Over 70% of people described a moderate or optimal improvement in their discomfort due to hyperhidrosis after treatment.
This was even more pronounced in people primarily bothered by craniofacial hyperhidrosis (face, forehead, skull): 81% of them described a moderate or optimal improvement.
66% of people experienced an improvement of at least 2 points out of 4 on their HDSS score (a score used to assess the subjective severity of hyperhidrosis).

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

Regarding glycopyrrolate (Vyaz 2020, Del Boz 2020):

It reduces sweating in 9 out of 10 people who take it.
This reduction in sweating is considered significant for approximately 7 out of 10 people.

medication for sweating: glycopyrrolate — An exemple of glycopyrrolate pills for sweating

As for methantheline bromide, it was given at a daily dosage of 50 mg in a trial involving 23 people with palmar and/or axillary hyperhidrosis (excessive sweating in hands or feet). The other 19 participants received a placebo.

The research team found that people who received methantheline bromide sweated less than those taking the placebo in the measurements they conducted four weeks after starting the treatment.

However, the difference in reduction was not that significant: respectively, for armpit and hand sweating, 25%/14% in the medication group compared to 17%/10% in the placebo group.

But when patients were asked about their satisfaction with the treatment’s effectiveness, half of each of the two groups was satisfied!

Several people who took the medication complained of dry mouth, while none in the placebo group did.

Researchers believe that the molecule was less effective on hands because they do not contain sebaceous glands, unlike armpits. The methantheline is excreted by these sebaceous glands (Hund 2004).

Side Effects, Precautions, and Contraindications of Anticholinergics fir sweating

It’s worth noting that studies (in JAMA Neurology 2016 and JAMA Internal Medicine 2015) have reported a potential link between the development of dementia and/or brain atrophy and the long-term use of high-dose anticholinergics in elderly individuals.

Patients aged 65 years or older (or close to this age) may want to discuss these studies before starting or continuing anticholinergic treatment for excessive sweating.

Among the available anticholinergics, glycopyrrolate may be the most suitable for elderly sweating people because it is the least likely to cross the blood-brain barrier.

Furthermore, glycopyrrolate is not listed on the Beers Criteria for Potentially Inappropriate Medication Use in Older Adults published by the American Geriatric Society, making it the only anticholinergic not included on this list.

Apart from perhaps the elderly population (and further studies are needed in this regard), anticholinergics generally do not affect the central nervous system (the brain and spinal cord).

They typically act more peripherally by blocking the chemical messenger acetylcholine when it tries to reach the sweat gland receptors responsible for triggering sweating.

However, similar receptors are located in many areas of the body, so anticholinergic treatment can lead to a range of side effects such as:

dry mouth,
constipation,
altered taste,
blurred vision,
dry eyes,
urinary retention,
and heart palpitations.

These side effects can usually be managed by adjusting the individual’s dose. Carrying a water bottle to sip from, using mouthwashes, or taking other medications to combat dry mouth can also be alternatives.

There are eye drops to combat dry eyes, and constipation can often be treated with dietary modifications.

When taking anticholinergics, the body may have more difficulty cooling down when the sweating mechanism is “disabled.”

Therefore, athletes, people who engage in sports, individuals who work outdoors, and anyone who could potentially overheat must exercise great caution when considering these treatments.

Patients or parents of children taking this medication should remain vigilant about temperature, water intake, exertion, and any symptoms of overheating such as pale skin, dizziness, muscle cramps, weakness, headaches, and nausea.

Additionally, patients with glaucoma (especially narrow-angle glaucoma) and those with gastric emptying disorders or a history or symptoms of urinary retention should not use anticholinergic treatment.

Beta-Blockers for Sweating

Propranolol is perhaps the oral medication I’ve seen most commonly prescribed in France for hyperhidrosis after oxybutynin. It’s a beta-blocker: it works by “blocking” the physical manifestations of anxiety.

Propranolol has been used, even in small babies (for another medical reason), since the 1970s.

Propranolol “calms” the body, slows down heart rate, and can help reduce sweating when you know you’ll be agitated or nervous.

Beta-blockers act on the central nervous system and are better suited for patients with episodic hyperhidrosis or stress-induced sweating (such as excessive sweating triggered by job interviews or conferences).

Propranolol, for example, tends to work when taken 30 to 60 minutes before an event rather than on a regular basis, often at a dose of 10 or 20 mg (and sometimes less, depending on the patient’s overall condition).

Side effects limit their long-term use. It can have a sedative effect (Glaser 2014).

Other Medications Sometimes Suggested for Sweating

Clonidine for Sweating

Clonidine appears to be particularly useful for helping manage sweating at specific times (situational sweating, as mentioned with propranolol above) – for example, if you have an important meeting, a wedding, or need to speak in public. Like propranolol, in that regard.

Clonidine is part of a class of medications called central alpha-agonist hypotensive agents. Clonidine is also used for high blood pressure, menopause-related sweating, and sweating that is a side effect of other medications (such as anxiolytics or antidepressants).

Clonidine seems to be particularly suitable for cranial (head/face) sweating, although experts don’t know exactly why.

It must be taken regularly if used for this purpose. In one study, clonidine was given at a dosage of 0.1 mg twice a day to 13 people with primary hyperhidrosis. Six patients saw an improvement in their hyperhidrosis without any side effects requiring discontinuation.

Three saw no effect, and 7 had drops in blood pressure. In this small retrospective study, there was no significant difference in effectiveness or side effects between clonidine and glycopyrrolate.

Dr. Anna Glaser, one of the leading international experts on hyperhidrosis, explains that she particularly prescribes it for people who suffer from blushing (erythrophobia) in addition to hyperhidrosis.

Benzodiazepines (Anxiolytics) for Sweating

Benzodiazepines are sometimes mentioned as a treatment for hyperhidrosis and anxiety.

However, they can create dependence, in addition to sedative effects. Diazepam, at a dose of 5 to 20 mg per day, is preferable, but there is no real literature evaluating the effectiveness of this medication in patients with hyperhidrosis.

If a person’s anxiety seems to be their main issue, it’s better to consult a psychiatrist for cognitive therapy or anxiety treatment.

Diltiazem, Indomethacin, Gabapentin, Probantheline

A few other substances have been used even more anecdotally. This can be useful to know for very specific situations or when all other therapies have not provided satisfactory improvement.

Diltiazem relieved palmar sweating in two family members with autosomal dominant emotional hyperhidrosis.

A woman with “lifelong generalized hyperthermia” reported resolution of sweating during treatment with indomethacin for her arthritis. Gabapentin, used with propantheline, improved sweating in a child with hyperthermia after a spinal cord injury.

Oxybutynin and glycopyrrolate, two anticholinergics, are the two most studied medications for sweating. When hyperhidrosis is more related to stress, propranolol or clonidine may be preferred.

How to Obtain Medication for Sweating?

It will depend on the country you reside in. Here, I’ll focus on France and United-States, as 80% of my readers come from this countries.

You can obtain all the medications mentioned in this article from France or United-States. They all require a prescription from a doctor (general practitioner, dermatologist, or other specialist). You can then get them from a pharmacy, just like any other medication.

Only one of these medications is not available in pharmacies. That is glycopyrrolate. I explain in the article dedicated to glycopyrrolate for sweating how to obtain it from France or United-States.

The prescription is then optional, although a medical opinion is strongly recommended, at least to check that you have no contraindications.

If you have already tried various therapies and they have not resolved your problems, you can perhaps ask the doctor who is treating you for your hyperhidrosis what they think of these treatments and discuss with them which one might be best for you.

Self-medication can be very dangerous; ask your doctor for advice on the maximum dosage in your case. Also, question whether the first treatment your doctor recommends is this one; there are other things to try first!

Most of these pills for sweating can be purchased at a pharmacy with a prescription. One of them can be ordered online without a prescription, although a medical opinion is recommended.

Can These Pills Completely Stop Sweating?

No, that is not the goal. It is essential for our bodies to sweat to cool down. Without it, after a certain time, our organs would no longer function.

The medications aim only to reduce sweating or regulate it (make it more constant).

They do not allow you to target one part of the body over another: sweating will be reduced all over the body. But never completely stopped (provided, of course, that you follow the dosages).

Medication for Facial Sweating: Which One to Prefer?

Some people are particularly bothered by excessive facial sweating. Two medications appear to be more effective in addressing this part of the body (even though sweating remains reduced throughout the body):

Oxybutynine
Clonidine (taken “as needed,” especially for sweating induced by stressful situations).

What Are the Alternatives to Medications for Sweating?

There are many other treatments for sweating. You will find numerous articles on the Hyperhidrosis Observatory website dedicated to these various treatments, especially based on the parts of your body where you sweat the most.

Even if you are taking medications, it may be necessary to combine these medications with local treatments such as iontophoresis or antiperspirants to optimize their effectiveness.

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

Medication For Sweating (Hyperhidrosis): Benefits & Side-Effects of Pills

When were medications for sweating first introduced?

When should you use medication to reduce sweating?