Glycopyrrolate for Excessive Sweating: What to Know

Key Takeaways

Hyperhidrosis, excessive sweating that is not related to heat or exercise, can be treated with medications such as glycopyrrolate.
Glycopyrrolate is generally tolerated, but possible side effects can include dry mouth, constipation, taste changes, dry eyes, blurred vision, urinary retention, and heart palpitations.
Hyperhidrosis can have a negative impact on quality of life, and finding the best treatment for your hyperhidrosis often takes some trial and error.

Hyperhidrosis is a condition in which there is excessive sweating that is not related to heat or exercise. Excessive sweating can lead to complications such as skin irritation and skin infections, as well as affect a person’s mental health. A medication called glycopyrrolate may be used for treating hyperhidrosis symptoms. Please continue reading to find out more.

What are the different types of hyperhidrosis?

Hyperhidrosis is not the result of the size of sweat glands or how many are there in the body. Rather, excessive sweating occurs due to a dysfunction of the autonomic nervous system that causes the sweat glands to be overstimulated. There are three main types of hyperhidrosis:

Primary focal hyperhidrosis which affects only certain areas of the body, for example, the underarms (primary axillary hyperhidrosis), hands (primary palmar hyperhidrosis), or feet (primary plantar hyperhidrosis).
Generalized idiopathic hyperhidrosis in which excessive sweating involves widespread areas of the body.
Secondary generalized hyperhidrosis that occurs as a result of other conditions such as menopause, diabetes, overactive thyroid, certain cancers, infections, or medication side effects.

What are the options to treat hyperhidrosis?

Options for treating excessive sweating in primary hyperhidrosis patients include:

Topical treatments

Prescription or over-the-counter (OTC) antiperspirants such as Xerac AC and Drysol
Prescription creams such as glycopyrrolate for facial hyperhidrosis
Prescription wipes such as glycopyrronium tosylate (Qbrexza) for axillary hyperhidrosis (underarm sweating)

Oral medications

Anticholinergic drugs that block nerve signals to the sweat glands
Antidepressants to relieve anxiety if excessive sweating is triggered by extreme emotions

Other treatments for excessive sweating symptoms

Iontophoresis for excessive sweating of the hands and feet
Laser therapy
Botulinum toxin (Botox) injections
miraDry
Brella SweatControl Patch for excessive underarm sweating

Surgery

Surgical removal of eccrine glands (sweat glands) from the underarms can be done using excision, liposuction, curettage, or laser surgery.
Sympathectomy can be done to destroy the sympathetic nerves and stop nerve signals to the sweat glands in the palms.

Notably, sympathectomy or endoscopic thoracic sympathectomy (ETS) is a minimally invasive surgery that divides the sympathetic nerve chain; the goal of ETS is to reduce the nerve stimulation that causes excessive sweating of the palms. While ETS is generally well-tolerated by most people, one of the side effects post-ETS is compensatory sweating.
Compensatory sweating can be very bothersome as it causes excessive sweating of the back, abdomen, thighs, and lower legs. The degree of this side effect ranges from mild to severe, and it can occur in a lot of people after undergoing ETS; however, only 3 to 5% of patients experience the severe form of this side effect.

What is glycopyrrolate?

Glycopyrrolate belongs to a group called anticholinergic medications. It is FDA-approved to treat peptic ulcer disease. This medicine is also used to reduce saliva production in children who have certain conditions like cerebral palsy that cause severe, chronic drooling.

Glycopyrrolate is used off-label to reduce sweat production in people with hyperhidrosis. Oral glycopyrrolate is available under the brand names Cuvposa and Robinul. The other anticholinergic drug that is sometimes used for managing excessive sweating is oxybutynin (Ditropan), which is medication for overactive bladder.

How effective is glycopyrrolate for sweating?

Experts at the International Hyperhidrosis Society say that many people with hyperhidrosis find anticholinergic drugs to be effective in controlling excessive sweating, especially when these drugs are used in combination with other techniques to reduce sweat production.

Oral anticholinergic medications have not, however, been studied in controlled clinical trials specifically for the treatment of hyperhidrosis. The use of anticholinergic agents as hyperhidrosis treatments is, therefore, off-label and is based on studies involving other medical conditions.

What is the success rate of glycopyrrolate?

Some small studies have shown that 75% of patients report a decrease in sweating after taking glycopyrrolate. Glycopyrrolate is typically one of the first treatments for craniofacial hyperhidrosis (excessive sweating of the face and head) and the second or third treatment for palmar, plantar, or axillary hyperhidrosis (excessive sweating of the palms, soles, and armpits). The use of an oral medication such as glycopyrrolate with other non-drug methods to treat hyperhidrosis can increase the success rate.

Does glycopyrrolate have any side effects?

Anticholinergic medications such as glycopyrrolate work by blocking the action of a chemical messenger called acetylcholine. Acetylcholine receptors are present in many different parts of the body, and therefore, anticholinergic drugs can have a wide range of systemic side effects.

Glycopyrrolate-induced adverse effects include dry mouth, constipation, taste changes, dry eyes, blurred vision, urinary retention, and heart palpitations. These side effects are usually predictable and can be managed by adjusting the dose. Drinking more water, sucking on mints, using eye drops, and increasing fiber intake can help combat glycopyrrolate side effects.

More serious adverse effects include an allergic reaction. You should call your doctor immediately or seek emergency medical attention if you develop a skin rash, hives, itching, swelling of the tongue or throat, or difficulty breathing or swallowing after taking glycopyrrolate.

What are the risks of hyperhidrosis treatment with glycopyrrolate?

Glycopyrrolate tablets can increase the risk of heat stroke due to decreased sweating in hot conditions. Call your doctor immediately if you develop signs and symptoms of heat stroke (high body temperature, changes in mental state, nausea, vomiting, flushed skin, fast heartbeat, and fast breathing) while on this medicine.

Glycopyrrolate may not be right for people with certain medical conditions such as intestinal obstruction, paralytic ileus, colostomy or ileostomy, urinary bladder blockage, congestive heart failure, heart disease, abnormal heart rhythms, hiatal hernia or gastroesophageal reflux disease (GERD), high blood pressure, hyperthyroidism (overactive thyroid), liver disease, kidney disease, nerve problems, enlarged prostate, glaucoma, ulcerative colitis, and myasthenia gravis.

Side effects of oral glycopyrrolate include drowsiness and blurred vision, which can be dangerous while driving or doing other hazardous activities. Do not engage in activities that require mental alertness or clear vision until you know how glycopyrrolate affects you.

The safety and efficacy of glycopyrrolate have not been established in pregnant women, nursing mothers, and children. This medicine should be used with caution in elderly patients.

What are the pros and cons of treating hyperhidrosis with oral glycopyrrolate?

Glycopyrrolate is an anticholinergic medication that can effectively treat excessive sweating in many people and, as a result, improve the quality of life. The main advantage of using oral glycopyrrolate to treat hyperhidrosis is that the pill form is easy to take, and generic glycopyrrolate is available.

However, the effects of glycopyrrolate on sweating are dose-dependent. Many patients are limited in how much of the medicine they can take due to side effects. Adverse effects usually increase as the dose is increased. Many patients have to stop treatment because side effects hinder treatment. While glycopyrrolate is available as a generic medication, this medication can be expensive for people who do not have insurance.

What is the best medication for excessive sweating?

Craniofacial hyperhidrosis

Your health care professional may start by prescribing topical medications, such as a medicated wipe, topical gel, or glycopyrrolate topical cream for excessive facial sweating. If topical creams do not help in reducing sweat production, they may consider other treatment options, such as systemic therapy with an oral medication (glycopyrrolate tablets) to decrease sweat production. If medical treatments, including systemic medications, do not work, your provider may recommend botulinum toxin injections. If your hyperhidrosis symptoms are severe, your healthcare professional may consider surgery to treat hyperhidrosis and provide relief from excessive sweating.

Axillary hyperhidrosis

Topical glycopyrrolate and other topical treatments are usually tried first, followed by botulinum toxin injections, oral medications, and local surgery to destroy sweat glands. Endoscopic thoracic sympathectomy (ETS) is the last resort.

Palmar and plantar hyperhidrosis

Topical creams are prescribed first, followed by oral glycopyrrolate 1-2 mg once or twice daily and/or iontophoresis and botulinum toxin injections. Sympathectomy surgery may be considered for palmar hyperhidrosis but is not usually recommended for plantar hyperhidrosis.

Finding the best treatment for hyperhidrosis (excessive sweating) may require some trial and error. Different people can have different treatment outcomes. One medication may work better for you than another to decrease sweating. Your healthcare professional will work with you to find the most appropriate treatment for hyperhidrosis with the most tolerable side effects.

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