Sweat production is triggered by the sympathetic nerves that supply the sweat glands releasing a chemical called acetylcholine.
Anticholinergic medications can be prescribed to reduce sweating in people with hyperhidrosis. Anticholinergics are also known as antimuscarinics. Because of the unwanted effects experienced with anticholinertgic medications, few people take them long term but many find them useful for short periods of time around important events such as interviews, celebrations, exams and other important life events.
Anticholinergic medications can be prescribed to reduce sweating in people with hyperhidrosis. Anticholinergics are also known as antimuscarinics. Because of the unwanted effects experienced with anticholinertgic medications, few people take them long term but many find them useful for short periods of time around important events such as interviews, celebrations, exams and other important life events.
how do they work?
Pharmacodynamics is the term used to describe what a drug does to the body, i.e. how it works. Anticholinergic drugs work by stopping acetylcholine activating the sweat glands. They block the receptors on the surface of the sweat glands which are like the lock normally being activated by the key being the acetylcholine. In pharmacodynamic terms anticholinergic drugs are known as competitive antagonists. That means they work in a dose-dependent manner; the more drug available, the greater the effect. Said effect is reversable.
Anticholinergic drugs are prescribed for a number of medical indications. A common use is for treating overactive bladder (and hence why one of the unwanted effects when taken for sweating is difficulty urinating). They can be used to control drooling of saliva from the mouth in people with neurological conditions including Parkinson’s disease (again explaining why dry mouth is a common effect when used for treating sweating). Used as antispasmodics to reduce intestinal mobility and spasm in conditions such as irritable bowel syndrome(and why constipation is another unwanted effect when taking the drugs for other reasons).
Anticholinergic drugs are prescribed for a number of medical indications. A common use is for treating overactive bladder (and hence why one of the unwanted effects when taken for sweating is difficulty urinating). They can be used to control drooling of saliva from the mouth in people with neurological conditions including Parkinson’s disease (again explaining why dry mouth is a common effect when used for treating sweating). Used as antispasmodics to reduce intestinal mobility and spasm in conditions such as irritable bowel syndrome(and why constipation is another unwanted effect when taking the drugs for other reasons).
which anticholinergic drugs are licensed for treating hyperhidrosis?
Glycopyrronium bromide, also known as glycopyrrolate, is licensed for adding to tap water for iontophoresis. It is used as a 0.05% solution in the water bath containing the anode or positive electrode since it is positively charged and repelled away from the electrode towards the skin. It tends to achieve good results but can be difficult to obtain and very expensive. Once made into a solution it can be re-used but cannot be kept for more than 14 days. Glycopyrronium bromide cream (Axhidrox) was licensed in the UK in 2025 by Leith Healthcare. This product is currently undergoing an evaluation by NICE.
Glycopyrronium can be prescribed off label as tablets to be taken orally (by mouth). The evidence for how effective oral glycopyrronium is for treating hyperhidrosis is weak.
Porpantheline bromide, also know as Pro-Banthine, is licensed as tablets taken orally for the treatment of hyperhidrosis.
Glycopyrronium can be prescribed off label as tablets to be taken orally (by mouth). The evidence for how effective oral glycopyrronium is for treating hyperhidrosis is weak.
Porpantheline bromide, also know as Pro-Banthine, is licensed as tablets taken orally for the treatment of hyperhidrosis.
what other anticholinergic drugs are used for hyperhidrosis?
Oxybutynin is used primarily for bladder related problems. Useed off label, especially the modified (delayed) release form of the drug, it is better tolerated by many to reduce sweating without so many of the unwanted effects. There is now irrefutable evidence that long term use of anticholinergic drugs that are able to cross the blood-brain barrier, such as ozybutynin, are linked with an increased risk of dementia:
- Richardson et al (2018)
- Bell et al (2021)
- Mur et al (2022)
- Hanlon et al (2020)
- Coupland et al (2019)
- Asiimwe et al (2025)
- Richardson et al (2018)
- Bell et al (2021)
- Mur et al (2022)
- Hanlon et al (2020)
- Coupland et al (2019)
- Asiimwe et al (2025)
unwanted effects of anticholinergic drugs
Many would call them side efects but most of the unwanted effects of taking anticholinergic drugs are expected effects of their antimuscarinic action. Because they block the actrion of acetylcholine it has the effect of blocking activities usually controlled by thge parasympathetic nervous system. The effects that can be expected are:
- Blurred vision
- Dry eyes
- Dry mouth
- Constipation
- Urinary retention
- Increased heart rate and sometimes palpitations
These effects often limit people using anticholinergic drugs for very long. The effects can be minimised by reducing the dose and titrating the effect on reducing sweating with the unwanted effects.
Additionally, those anticholinergics that cross the blood-brain barrier (e.g. oxybutynin) are strongly associated with early onset of dementia.
- Blurred vision
- Dry eyes
- Dry mouth
- Constipation
- Urinary retention
- Increased heart rate and sometimes palpitations
These effects often limit people using anticholinergic drugs for very long. The effects can be minimised by reducing the dose and titrating the effect on reducing sweating with the unwanted effects.
Additionally, those anticholinergics that cross the blood-brain barrier (e.g. oxybutynin) are strongly associated with early onset of dementia.
other medications used for hyperhidrosis
Beta blockers and anxiolytics (such as benzodiazepines) are sometimes used to reduce anxiety and calm the body down. Anxiety plays a lesser or greater role in hyperhidrosis for most people and these drugs can be helpful for some people in certain situations.
Benzodiazepines are addictive and must not be taken regularly or for long periods.
Clonidine acts on adrenaline receptors in the brain to help with hyperhidrosis but there is not the body of clinical evidence to support it as there is for other medical treatments.
Benzodiazepines are addictive and must not be taken regularly or for long periods.
Clonidine acts on adrenaline receptors in the brain to help with hyperhidrosis but there is not the body of clinical evidence to support it as there is for other medical treatments.
