Oral glycopyrrolate as second-line treatment for primary pediatric hyperhidrosis

Special Considerations for Children with Hyperhidrosis

“…Annual treatment with generic oral glycopyrrolate at a dosage of 2 mg/day has been estimated to cost $756 per year, which is a fraction of the cost for treatment with botulinum toxin injections. 5 Side effects of anticholinergic medications can be limiting at the doses required for efficacy and include xerostomia most frequently, and blurred vision, tachycardia, urinary hesitancy, and constipation. 16,25 To help determine the efficacy of oral glycopyrrolate in the treatment of hyperhidrosis, Bajaj and Langtry 21 conducted a retrospective analysis of 24 adult subjects ages 19 to 62 that were treated with oral glycopyrrolate.…”

“…The authors concluded that oral glycopyrrolate is an inexpensive, well-tolerated, and painless second-line treatment of pediatric subjects with primary focal hyperhidrosis. 5 Another institutional review by Kumar and coworkers 26 looked at 12 children with severe, refractory hyperhidrosis treated with oral glycopyrrolate from July 2009 to January 2012. The average length of therapy was 18 months and the most common dosing regimen was 1 mg/day.…”

“…10 A lack of FDA approval for the treatment of hyperhidrosis in children often forces affected individuals to pay out-of-pocket for treatment estimated to cost a minimum of $2400 annually. 5,6,9,33 Injection Site Pain Injection site pain is a major limiting factor for intradermal injections of botulinum toxin, although options exist to help minimize this pain. Application of topical anesthetics and cryotreatment before injection with botulinum toxin are only partially effective but may provide mild shortterm relief.…”

“…2 The primary locations of involvement in pediatric subjects include the palmoplantar and axillary areas. 4,5 Psychological and social development and wellbeing are often affected, impacting patient quality of life, which may in turn lead to profound emotional and social distress. 2,5,6 Pediatric subjects with hyperhidrosis can have difficulties handing a writing utensil, keeping papers dry, gripping the handlebar of a bicycle, manipulating a computer mouse, and using a video game controller.…”

“…4,5 Psychological and social development and wellbeing are often affected, impacting patient quality of life, which may in turn lead to profound emotional and social distress. 2,5,6 Pediatric subjects with hyperhidrosis can have difficulties handing a writing utensil, keeping papers dry, gripping the handlebar of a bicycle, manipulating a computer mouse, and using a video game controller. 6 Quality of life can be significantly improved by early diagnosis and therapy; however, underdiagnosis and lack of knowledge regarding therapeutic options has hindered maximization of therapy in the pediatric population.…”