Treatment of primary hyperhidrosis with oral anticholinergic medications: a systematic review

Abstract

Primary hyperhidrosis is a condition characterized by excessive sweating. Patients are treated off-license with oral anticholinergic medications and report adverse events associated with systemic anticholinergic interactions. This review assesses clinical evidence of efficacy, impact on quality of life and adverse events associated with oral anticholinergic therapy for primary hyperhidrosis. PRISMA guidelines were implemented to complete a systematic review (PROSPERO:CRD42016036326). MEDLINE, EMBASE and PubMed were searched from 1946 to 2015. Inclusion criteria included observational and experimental studies, anticholinergic medication use in primary hyperhidrosis, oral therapy and clear diagnostic and outcome measures. Twenty-three articles relevant to the inclusion criteria were analysed. Oxybutynin therapy improved symptoms in an average of 76.2% (range 60-97%) patients and improved QOL in 75.6% (range 57.6-100%) of patients. Methantheline bromide therapy was associated with a 41% reduction in axillary sweating, 16.4% reduction in palmar sweating, 25% decrease in HDSS score and 40.9% increase in DLQI score. Outcome measures of glycopyrrolate therapy were too variable to collate. Dry mouth was reported in 73.4% (range 43.3-100%) of participants taking oxybutynin 10 mg/day, 38.6% (range 27.8-63.2%) of patients taking glycopyrrolate and 68.8% of patients taking methantheline bromide. Nine studies reported that patients stopped therapy due to adverse events. In eight of these studies, a mean of 10.9% of total participants ceased treatment due to dry mouth. Evidence of oral anticholinergic therapy for hyperhidrosis is limited. However, its use is associated with improvement in quality of life and clinical symptoms but at the cost of considerable adverse events.

<p>Management Strategies Of Palmar Hyperhidrosis: Challenges And Solutions</p>

“…Although not yet FDA approved, systemic oral therapies are best suited for resistant cases unresponsive to topical nonsurgical approaches. 11,50 They operate in a variety of ways to systemically prevent stimulation of the eccrine sweat glands, limiting overall sweating. Anticholinergics are the most commonly prescribed oral agents, although antihypertensive and psychotropic drugs have also been utilized.…”

Survival study of treatment adherence by patients given oral oxibutynin for hyperhidrosis

“…Various forms of treatment have been approved for HH, according to the part of the body affected, but in many cases good control of the condition is not achieved, either due to its intensity or because it affects various locations and cannot be addressed in a comprehensive way. In recent years, studies have demonstrated the effectiveness and safety of oral anticholinergics and especially of oral oxybutynin (OOx), which has been corroborated by clinical trials . Most studies in this respect, however, do not conduct follow‐up for more than 1 year and only evaluate effectiveness and adverse effects.…”

A phase 2a randomized controlled study to evaluate the pharmacokinetic, safety, tolerability and clinical effect of topically applied Umeclidinium in subjects with primary axillary hyperhidrosis

“…11,12 A review of oral anticholinergic therapy for hyperhidrosis indicated that 40% of subjects in clinical studies withdraw from the treatment due to AEs. 9 Consequently, developing topical anticholinergic drugs is an ideal approach to treat hyperhidrosis as sweat glands are surrounded with cholinergic sympathetic nerves. Moreover, systemic effects may be mitigated by the reduced plasma drug levels seen with topical application.…”

“…It was hypothesized that topical administration of UMEC could block stimulation of muscarinic receptors by acetylcholine and thereby reduce the overproduction of sweat. Precedents for this approach exist with systemic anticholinergic compounds 8,9 and with topical glycopyrrolate, 10 a pan-active muscarinic receptor antagonist with similar potency to UMEC, supporting both the validity of the mechanism and the route of administration. To date, no topical anticholinergic compound has received regulatory approval for the treatment of hyperhidrosis; UMEC has the potential to provide a safe, well-tolerated and efficacious topical treatment alternative to current modalities in patients who suffer from hyperhidrosis.…”