Treatment of generalised hyperhidrosis

First-line treatment of generalised hyperhidrosis is systemic therapy. It can also be trialled in patients with primary focal hyperhidrosis who do not respond to initial treatment with topical antiperspirants, or if it is impractical to use topical antiperspirants (eg in primary craniofacial hyperhidrosis)Nawrocki, 2019Schollhammer, 2015.

Patient response to systemic treatment is variable. Treatment is stopped in a third of patients because of troublesome anticholinergic side effects (eg dry eyes, dry mouth, urinary retention, constipation, postural hypotension, drowsiness) Bajaj, 2007. Concurrent use of anticholinergic drugs (eg anti-Parkinson drugs, tricyclic antidepressants) can exacerbate anticholinergic side effects.

For systemic treatment of primary hyperhidrosis, use:

1oxybutynin 2.5 mg to 5 mg orally, once daily initially; depending on tolerance and response, increase to 2.5 to 5 mg orally, two to three times daily (maximum of 5 mg four times daily)Nawrocki, 2019 oxybutynin oxybutynin oxybutynin

OR

1propantheline 15 mg to 30 mg orally, twice daily initially; depending on tolerance and response, increase to 15 to 30 mg orally, four times daily (maximum of 120 mg daily in divided doses). propantheline propantheline propantheline

Elderly patients are more sensitive to anticholinergic side effects—start with the lowest dosage and increase cautiously to the lowest effective dose possible.

If primary hyperhidrosis does not respond, refer for dermatologist advice. Clonidine is also sometimes used for primary hyperhidrosis.