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Do you Suffer from Excess Local Sweating? (Focal Hyperhidrosis)?

  • Which drips and embarrasses
  • Which requires clothing  changes
  • Which leaves wet marks, limits colours, and stains
  • Which leaves wetness on ink, paper, and computers
  • Which affects  hand shaking, interviews, fine dexterity
  • Which messes hair style, smears glasses, and stings eyes
  • Which imprints floors, slips in sandals and on marble tiles
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Systemic Treatments (pills – anticholinergics)

Acetylcholine, which is released from fine nerve endings, stimulates sweat glands to produce sweat. Glycopyrrolate pills are anti-cholinergic and help prevent this release. They work well for all local areas;- and particularly well for generalized sweating. Common side effects  (dose related) are dry mouth (the major issue), blurred vision, dilated pupils, headaches, nervousness, urinary retention, constipation, sedation, and rapid heartbeat. Continued dry mouth may increase dental cavities. Use in pregnancy has not been studied. Two recent articles suggest that  side effects are well tolerated by about 50% of patients. Some use for short-term emergency use. Chewing sugarless gum may help dryness. Take care with hot weather exercise when sweating required. Glycopyrrolate is worth a  trial!    

Glycopyrrolate has limited availability. It was  used for decades to treat stomach ulcers, but  more effective treatments replaced it. Trade names are Avert (Canada) and Robinul (USA). These non-prescription pills are available at in 0.5mg, 1mg, 1.5mg and 2mg tablets. Individual response  varies. Start slowly with 0.5 mg, Gradually increase to 1 to 2mg two to three times a day as tolerated. They can also be used, with care, in children. Other anti-cholinergic drugs such as prescription oxybutynin (Ditropan 5 mgms) 1-2x a day are available. Comparative articles are not available but glycopyrrolate is the most recommended.  Propanolol 5-10 mgms is sometimes used by performers and others to reduce anxiety induced sweating and tremor but it has no specific role in hyperhidrosis.