Anticholinergic drugs used in hyperhidrosis: a comprehensive overview

Hyperhidrosis is characterised by excessive sweating beyond normal thermoregulatory needs and environmental conditions. It significantly impacts quality of life, necessitating effective medical intervention. Anticholinergic drugs represent a key therapeutic option, particularly for focal and generalised hyperhidrosis. Systemic anticholinergic drugs, oxybutynin, glycopyrrolate, methantheline bromide, propantheline bromide, and bornaprine, demonstrate significant efficacy in treating various forms of hyperhidrosis. Oxybutynin (2.5–7.5 mg/day) outlines improved symptoms in 60–97% of patients, with best results in plantar hyperhidrosis. Glycopyrrolate (1–10 mg/day), which does not cross the blood–brain barrier, delineates effectiveness in 75.5–90% of patients while minimising central nervous system side effects. Methantheline bromide (50 mg every 8–12 h) reduces sweat production by 40% compared to 19% with placebo. Topical anticholinergics (glycopyrrolate, oxybutynin, sofpironium bromide, and umeclidinium) provide localised effects with minimal systemic absorption. The most common adverse effects across all anticholinergics included xerostomia, constipation, and visual disturbances, with quaternary ammonium compounds showing fewer central nervous system effects than tertiary amines. Anticholinergic drugs are valuable therapeutic options for hyperhidrosis management, with systemic formulations effective for both focal and generalised presentations. The emergence of topical formulations offers reduced systemic side effects while maintaining efficacy. Selection of specific anticholinergic agents should be tailored to the patient’s clinical presentation, comorbidities, and risk factors, with careful monitoring, to minimise adverse effects.