Hyperhidrosis medicine
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hyperhidrosis treatment medicines International Hyperhidrosis Society topical oral 2025
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https://www.sweathelp.org/hyperhidrosis-treatments/treatment…
For primary focal hyperhidrosis (underarms, palms, soles, face), medicines commonly used are:
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Aluminum chloride antiperspirant
First choice for many people. Prescription-strength aluminum chloride is applied to completely dry skin at night, then washed off in the morning. It can cause burning or irritation. Andrews' Diseases of the Skin, p. 892. -
Topical anticholinergics for underarms
- Glycopyrronium cloth (Qbrexza)
- Sofpironium gel (Sofdra)
These reduce sweat-gland signaling. They are prescription medicines and can cause dry mouth, blurred vision, constipation, or urinary difficulty if absorbed or transferred to the eyes. A recent systematic review of sofpironium supports its efficacy for primary hyperhidrosis.
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Oral prescription medicines, usually if sweating is widespread or other methods fail
- Glycopyrrolate
- Oxybutynin
Both are anticholinergics used off-label for hyperhidrosis. Dry mouth, constipation, blurred vision, overheating, fast heartbeat, and trouble passing urine can limit use. Avoid or use only with clinician guidance if you have narrow-angle glaucoma, urinary retention, bowel obstruction, or certain heart conditions. The International Hyperhidrosis Society notes these are the most commonly used oral options.
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If sweating is triggered mainly by performance anxiety
A clinician may sometimes prescribe a beta-blocker such as propranolol for occasional event-related sweating, not usually for daily generalized sweating.
Important: New sweating all over the body, sweating during sleep, fever, weight loss, palpitations, tremor, or a recent medication change needs medical assessment first. Hyperthyroidism, low blood sugar, menopause, infections, some cancers, and medicines including antidepressants and opioids can cause secondary hyperhidrosis. Andrews' Diseases of the Skin, p. 892.
For palms/soles, iontophoresis is often more useful than oral medication. For severe focal areas, botulinum toxin injections are another effective option.
Treatment & medicine
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FDA approved treatment primary axillary hyperhidrosis Qbrexza Sofdra official prescribing information
Hyperhidrosis treatment and medicines
Treatment depends on where you sweat most.
| Area / severity | Usual treatment |
|---|---|
| Underarms | Start with a strong aluminum chloride antiperspirant. If insufficient, use prescription glycopyrronium cloth 2.4% (Qbrexza) or sofpironium gel (Sofdra), where available. Botox injections are an effective next option. |
| Palms and soles | Aluminum chloride at night plus iontophoresis is usually preferred. Botox can help severe cases, especially palms. |
| Face/scalp | A dermatologist may prescribe compounded topical glycopyrrolate. Botox is an option for selected areas. |
| Sweating in several body areas or treatment-resistant sweating | Oral oxybutynin or glycopyrrolate, prescribed and monitored by a clinician. |
Medicines
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Aluminum chloride hexahydrate 10% to 35%
Apply at night to completely dry skin, then wash off in the morning. Start with a lower concentration if irritation occurs. Do not apply just after shaving or onto broken/irritated skin. Fitzpatrick's Dermatology, management of hyperhidrosis. -
Glycopyrronium 2.4% cloth
Prescription topical anticholinergic for primary underarm hyperhidrosis, approved in the US for people aged 9 years and above. Use only on the underarms as prescribed. The FDA label describes its indication and safety information. -
Sofpironium topical gel
Another prescription topical anticholinergic for underarm sweating. A 2025 systematic review found evidence of benefit in primary hyperhidrosis. -
Oxybutynin tablets or glycopyrrolate tablets
Oral anticholinergic medicines, generally used off-label when topical treatment and procedures are inadequate or sweating is more generalized. They can work well but are not right for everyone.
Side effects and precautions
Anticholinergic medicines may cause:
- Dry mouth
- Constipation
- Blurred vision or dilated pupils
- Difficulty urinating
- Fast heartbeat
- Overheating, especially in hot weather or during exercise
Do not self-start oral oxybutynin or glycopyrrolate. A clinician should check for conditions such as narrow-angle glaucoma, urinary retention, bowel obstruction, certain prostate problems, and interacting medicines.
Other effective treatments
- Iontophoresis: particularly useful for hands and feet.
- Botulinum toxin (Botox) injections: effective for underarms, palms, soles, face, and gustatory sweating.
- miraDry: an underarm procedure that reduces sweat glands.
- Sympathectomy surgery: reserved for severe resistant palmar sweating because it can cause compensatory sweating elsewhere.
If sweating began suddenly, occurs during sleep, or is associated with weight loss, fever, tremor, palpitations, or a new medication, see a doctor to rule out causes such as thyroid disease, diabetes/hypoglycemia, infection, menopause, or drug side effects.
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