ANTI-CHOLINERGICS

These drugs are also prescribed for a wide range of other conditions, such as urinary difficulties or an overactive bladder, and are taken daily. Anti-cholinergics are often deemed unsuitable for long-term use for the treatment of hyperhidrosis, due to the uncomfortable side effects. These include dry mouth and extreme thirst, drowsiness, urinary retention, increased body temperature, constipation, blurred vision and difficulty eating or swallowing. Not everyone experiences side effects, but it is important to note that they are widely reported. These medications can also cause heat problems, such as heat stroke. If the body cannot sweat, it is difficult for your system to lower your core body temperature. Many people have experienced good results in relieving sweating; however these medications do not completely eradicate the problem. Physicians will start patients off at a small dose and increase as needed. This is not a cure.

Robinul (Glycopyrromium Bromide)

Supplied on a 'named patient' basis, this is taken daily in tablet form starting with 2mg daily and slowly increasing to 5mg twice a day if necessary. Glycopyrromium Bromide tablets can be prescribed by your GP, but they may not be familiar with them and might refer you to a Dermatologist for this.

Glycopyrromium Bromide is licensed for use in iontophoresis. Adding a 0.05% solution can prove more successful for iontophoresis than using ordinary tap water, so do discuss this with your dermatologist if tap water iontophoresis hasn't worked for you.

Side effects and contraindications of Robinul

For further information on Robinul see www.nhs.uk

Oxybutynin (Ditropan)

The starting dose is 2.5mg twice a day, increasing if necessary (take it at least one hour before meals).

Oxybutynin modified release 10mg - 30mg is very helpful for people who suffer from Hyperhidrosis all over their body or for those who suffer from compensatory sweating following ETS surgery. It has fewer side effects than normal oral Oxybutynin.

Ditropan XL is used in the most severe cases.

Side effects and contraindications of Oxybutynin

For futher information on Oxybutynin see www.nhs.uk

Pro-Banthine (Propantheline Bromide)

An antimuscarine and antispasmodic, this medication also works to block the signals which stimulate sweat glands and has similar side-effects to the anti-cholinergic drugs above. It is commonly prescribed to relieve cramps and stomach pains. This medication is not often prescribed now as it is generally less effective than Robinul or Oxybutynin.

Side effects and contraindications of Pro-Banthine

For futher information on Pro-Banthine see www.nhs.uk

BETA BLOCKERS (such as Propranalol)

Patients with anxiety conditions may also find beta-blockers useful for stress-induced hyperhidrosis, as long as they are correctly prescribed. Beta-blockers work differently to anxiolytics in that they focus on the sympathetic nervous system instead of the brain. Beta- blockers block adrenaline and nor-adrenaline, the chemicals which make us anxious, thus making us less likely to sweat. They are unsuitable for those with asthma and other respiratory difficulties. They do not need to be taken regularly like anti-depressant anxiolytics, just used when needed.

For further information on Propranalol see www.nhs.uk

ANTIHYPERTENSIVES (Clonidine hydrochloride)

An antihypertensive, this drug was originally used to treat high blood pressure; however it has now been used to combat hyperhidrosis. Clonidine reduces stimulation of the nerves which enable sweating, and therefore reducing the volume of sweat. As with anti-cholinergics, this medication can cause dry mouth, blurred vision, tiredness and dizziness. In our experience, Clonidine doesn't work for many people, and is rarely prescribed.

For further information on Clonidine see www.nhs.uk

ANXIOLYTICS

Anxiolytics are medications used to treat anxiety conditions. These include many SSRIs, SNRIs, tricyclic anti-depressants, benzodiazepines, barbiturates and certain anticonvulsants. These may be of use to those with secondary hyperhidrosis linked to depression and anxiety. Dermatologists are often limited in what anxiolytics they can prescribe, due to the properties of the medications and side effects, many of these are usually prescribed by mental health professionals for emotional conditions. Anxiolytics are well known for side effects such as tiredness, nausea, constipation and occasional dizziness. Despite this, many anxiety sufferers find these medications useful.

OTHER

There are other medications sometimes useful for relieving hyperhidrosis, such as calcium-channel blockers, carbonic anhydrase inhibitors and NSAIDs such as Indomethacin, but these are not as widely prescribed as those outlined above. This does not mean that these options are not available to you, but may be worth asking your dermatologist about if you feel the common options are becoming exhausted.