Glycopyrrolate has become a popular treatment option for people diagnosed with hyperhidrosis, or excessive sweating. While glycopyrrolate was originally developed to treat peptic ulcers, its anticholinergic effects make it effective at managing excessive sweating too. Today, topical and oral forms of glycopyrrolate offer relief to many of the estimated 16 million Americans living with hyperhidrosis when other treatments aren't enough.
Glycopyrrolate for Hyperhidrosis: What You Should Know
Learn about glycopyrrolate for hyperhidrosis treatment, from dose and efficacy to side effects, plus what to expect when starting treatment.
Nov 15, 2024
Written by
Linnea Zielinski
What Is Hyperhidrosis?
Hyperhidrosis is a medical condition causing excessive sweating that affects roughly 4.8% of people, with higher rates among young adults. While sweating typically helps regulate body temperature, people with hyperhidrosis experience sweating unrelated to heat or exercise due to central nervous system dysfunction. The condition can affect specific areas like the underarms, hands, feet, or face, and symptoms must occur on both sides of the body for at least six months to be diagnosed.
The impact of hyperhidrosis extends far beyond physical discomfort, affecting many aspects of daily life. About 75% of people with the condition report negative effects on their quality of life, including their mental health, social relationships, and emotional well-being. Many also face financial burdens from managing symptoms. Despite estimates that over 15 million Americans suffer from hyperhidrosis, only about half of those with the condition discuss their symptoms with healthcare providers, often because they don't realize a range of effective treatments exist.
Treatment typically starts with aluminum chloride antiperspirants and lifestyle modifications. If this doesn't provide the necessary relief, doctors may prescribe anticholinergic medications like glycopyrrolate or oxybutynin. For those who still aren't getting the necessary relief, options like Botox injections, iontophoresis (which uses mild electrical currents), or in severe cases, surgery, may be considered.
What Is Glycopyrrolate?
Glycopyrrolate, also called glycopyrronium, is an anticholinergic drug that now has a wide range of uses related to reducing secretions in the body. Surgeons use it to lower saliva production during procedures, and it’s commonly prescribed for patients with COPD, cerebral palsy, peptic ulcers as lowering bodily secretions helps with all of these conditions. Now, it’s become a favored off-label treatment to manage excessive sweating in those with hyperhidrosis.
How Is Glycopyrrolate Used for Treating Hyperhidrosis?
Glycopyrrolate can be used in two ways to treat hyperhidrosis: topically and orally. Topical glycopyrrolate can be used effectively on hyperhidrosis concentrated in specific parts of the body, while the oral form is a good option for managing hyperhidrosis that affects multiple parts of the body.
Topical Glycopyrrolate
Topical glycopyrrolate is generally prescribed as a spray, gel, or as medicated wipes. For example, Qbrexza is an FDA-approved single-use wipe for primary axillary hyperhidrosis, which uses a 2.4% glycopyrronium solution to quell excessive sweating in the underarms.
Oral Glycopyrrolate
Oral forms of glycopyrrolate are also available, and can be more effective than topical forms, especially for generalized hyperhidrosis that occurs across the body.
How Effective Is Glycopyrrolate for Hyperhidrosis?
The research so far has shown glycopyrrolate to be an effective solution for many who want relief for excessive sweating or hyperhidrosis. Oral glycopyrrolate eased hyperhidrosis for 75% of patients in one study.
Another study on compensatory sweating found that 89% of participants felt an improvement within one month of starting the drug. This was based on the participants rating the discomfort they felt from their sweating in everyday life. This study was done specifically on compensatory sweating, which is sweating in certain parts of the body to make up for reduced sweating after an endoscopic thoracic sympathectomy (ETS) or other procedures to target localized sweating.
In a more recent study, another popular solution, aluminum chloride, was tried for patients before adding oral glycopyrrolate. The aluminum chloride helped 15.3% of study participants, but that increased to 45.8% when a low dose of glycopyrrolate was added, 55.9% when the dose was increased. Increasing the dose further increased efficacy.
What Glycopyrrolate Dosage is Most Effective?
Glycopyrrolate dosing can be highly individual, but most healthcare professionals follow a system of slowly increasing dosage until the right one is found. This means it may take some time to find the most effective dose, but patients shouldn't lose hope if their starting dose isn't perfect.
Patients typically start on a dose of 1mg oral glycopyrrolate twice a day, and increase their dose by 2mg per day until reaching a dose of 8mg per day. If the side effects of the dose become too uncomfortable, patients are usually lowered back to their previous dose. Although oral glycopyrrolate is used off-label for hyperhidrosis, so dosing recommendations can be more variable, glycopyrrolate dosage for other conditions is also increased slowly over time based on the patient’s response to the medication.
How to Take Glycopyrrolate for Best Results
If you’re prescribed oral glycopyrrolate, it can be recommended to take it on an empty stomach. That means taking it at least one hour before eating or at least two hours after a meal. You can continue to follow your normal diet unless your healthcare provider tells you otherwise.
It’s important to tell your healthcare provider about any other medications and supplements you’re taking so they can anticipate any potential reactions, and to always take your medicine as prescribed. If you miss your dose—it happens to everyone once in a while—take it as soon as you remember unless it’s close to the time for your next dose. In that case, just take your next dose as usual.
Is Glycopyrrolate FDA-approved?
Glycopyrrolate is FDA-approved for axillary hyperhidrosis in topical forms, and for treating other conditions in oral forms. This means it’s been thoroughly tested for safety, so using it “off-label” orally for hyperhidrosis or topically in other areas besides the underarms for hyperhidrosis is common and often recommended by dermatologists and other physicians.
What Can I Expect On Glycopyrrolate?
Glycopyrrolate can have an effect on sweating within hours of taking it, although it depends on the individual. In some people, it may take days or weeks to see results. Regardless of how long it takes to first see results, most people are able to find their correct dosage and experience an improvement in symptoms by the one month mark.
Topical glycopyrrolate wipes work more quickly than oral tablets but may not reach their peak efficacy for several weeks. Studies on different topical products using glycopyrrolate suggest that wipes can work as quickly as 90 minutes after application but may need up to four weeks of regular use to best control hyperhidrosis.
Both oral and topical glycopyrrolate can be taken daily or as needed for best results.
Side Effects of Glycopyrrolate
Luckily, glycopyrrolate side effects tend to be mild. One study on oral glycopyrrolate saw 36.1% of participants experience side effects, but they weren’t serious enough for anyone to stop taking the medication. The most common side effect was dry mouth, but other side effects like headache and heart palpitations were noted. More possible side effects include:
Dry eyes
Bloated feeling
Blurred vision
Confusion
Constipation
Difficulty sleeping
Dizziness
Drowsiness
Loss of taste
Nasal congestion
Nausea
Nervousness
Upset stomach
Vision problems
Vomiting
Weakness
Topical glycopyrrolate wipes may have additional side effects including skin reactions where they’re used, redness, burning or stinging, or itching.
Some side effects can be serious. If you experience any of the adverse effects below, you should call your healthcare provider immediately as they may be a sign of an allergic reaction:
Diarrhea
Difficulty breathing or swallowing
Difficulty urinating or urinary retention
Hives
Rash
You should tell your healthcare provider before starting treatment with glycopyrrolate if you have or have had certain medical conditions, including glaucoma, a stomach blockage, megacolon (widening of the intestine), paralytic ileus (a condition that affects how food can move through the intestines), or myasthenia gravis (a nervous system disorder that causes muscle weakness). They may decide glycopyrrolate isn’t the right treatment for you and work to find an alternative.
You should also notify your healthcare provider if you have or have ever had overactive thyroid, prostate enlargement, high blood pressure, irregular or rapid heartbeats, any nervous system disorder, coronary artery disease, hiatal hernia with reflux, kidney or liver disease, ulcerative colitis (a condition that causes inflammation and sores in the large intestine and rectum), or heart failure.
Finally, you should also tell your healthcare provider if you’re pregnant or breastfeeding or plan to become pregnant. If you get pregnant while taking glycopyrrolate, call your healthcare provider but wait for their instruction before making any changes to your medication.
Oral vs Topical Glycopyrrolate Side Effects
Topical glycopyrrolate tends to have fewer side effects than the oral medications, which is why topical treatments are usually tried first. Oral medications often affect your entire body–with topical forms, less of the drug being used accumulates in your body–so topical medications typically have fewer side effects than their oral counterparts.
Glycopyrrolate vs Other Anticholinergics
All anticholinergic drugs work similarly: by muffling or blocking messages coming from the brain to inhibit your body’s acetylcholine activity. In the treatment of hyperhidrosis, this helps to manage sweat production.
Glycopyrrolate isn’t the only anticholinergic drug used to treat hyperhidrosis symptoms. Oxybutynin is also widely prescribed. These medications work very similarly in the body, but glycopyrrolate doesn’t cross the blood-brain barrier, while oxybutynin does. Drugs that cross the blood-brain barrier can cause more side effects related to the nervous system like drowsiness or confusion.
Even though glycopyrrolate and oxybutynin are similar medications, one not working for you doesn’t mean the other won’t. Glycopyrrolate is often tried first as its side effects can be more mild, but oxybutynin is a good option for those who understand the side effects and want an alternative.
Managing Glycopyrrolate Side Effects
Dry mouth and dry eyes are the most common side effects of glycopyrrolate, but they’re often easily managed. Dry mouth can be managed with sugar-free gum or sugar-free lozenges, and staying hydrated–drinking electrolytes and sipping water frequently throughout the day. Artificial saliva products are available, but their effect is limited and they may not be cost-effective for you.
Artificial tears and other eye drops can be used to manage dry eyes. If you live in a dry climate, you may want to also consider using a humidifier to keep your environment from getting too dry and further aggravating your eyes.
Final Thoughts
Living with hyperhidrosis can feel isolating, but you're part of a community of millions who understand the daily challenges of excessive sweating. While glycopyrrolate wasn't originally designed to treat hyperhidrosis, it has become a valuable treatment option that helps many people manage their symptoms effectively—whether used topically or orally.
Understanding your treatment options and working with healthcare professionals who understand hyperhidrosis is crucial for finding relief. That's where SweatRx comes in. Our personalized treatment plans take into account your specific symptoms, lifestyle, and needs to help you find the most effective way to manage your hyperhidrosis.
Ready to take control of your excessive sweating? Connect with SweatRx today to start your journey toward better symptom management.
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