Sweating part II
MailCA
When topical antiperspirants aren´t enough, medications in the anticholinergic
category are tried. Oral medications such as Pro-Banthine 1.5 mg/kg every 24
hours may be used. As with all anticholinergic agents, potential side effects
include dry mouth, and possibly blurred vision may occur.
DERMAdoctor.com
Excessivesweating.org reports the medical treatments, and the physiology of
sweating. Some physicians recommend using a small dose of a drug known as a
beta blocker, such as propranolol (Inderal®) for sweating from stagefright.
Beta-blockers are often used for high blood pressure, angina, heart disease,
and migraines, but must be used very carefully, especially by people with
asthma, diabetes or lung diseases, and are only available by prescription.
Physicians have often found the combination of Robinul® and propranolol to be
very effective. Medication may be taken internally that works to block the
neurotransmitter, acetylcholine, from stimulating the sweat glands. Some of the
more useful medications include the anticholinergics (such as glycopyrrolate or
atropine), some antihistamines, some antidepressants, and some of the
tranquilizers. However, these medications will also affect other parts of the
body, and may lead to possible side effects, including dry mouth, drying of
other secretions, constipation, or other side effects. For hyperhidrosis,
the most commonly used drugs are the anticholinergics and the antidepressants
glycopyrrolate (Robinul® and Robinul® Forte), atropine, propantheline bromide
(ProBanthine®) and oxybutynin (Ditropan®). All require prescription in the
United States. None of these drugs are formally indicated for use in
hyperhidrosis, but many physicians have found them to be extremely helpfulBy
blocking the acetylcholine neurotransmitter, they cut down on the nerve
impulses to the sweat glands, thus lowering the amount of perspiration
produced.
Glycopyrrolate (Robinul® and Robinul® Forte) tablets come in two different
strengths (Robinul® 1mg and Robinul® Forte 2 mg), so the dose can be easily
adjusted. The tablets can also be crushed up and given mixed with soft foods
such as applesauce, pudding, ice cream, etc., or made into a liquid form by a
pharmacist, if swallowing tablets are a problem. Glycopyrrolate is usually
taken 1 to 3 times a day, in doses of 1 or 2 mg at a time, depending on the
severity of the sweating. Side effects are few and usually very mild and not
that bothersome. Some patients may develop a dry mouth. Patients who tend to
get diarrhea frequently may find that the glycopyrrolate tends to help control
that, as it is used for diarrhea in other countries. Glycopyrrolate does not
cross the blood-brain barrier, therefore Central Nervous System (CNS)
side-effects are virtually non-existent.
Atropine tends to have more side effects than the others do; because it gets
into the brain very easily, it is more likely to produce drowsiness,
restlessness, irritability, or even mental confusion. It is the shortest acting
of the four anticholinergics, and needs to be taken every 4-6 hours. Oxybutynin
is often used to help calm down bladder spasms and an overactive bladder, while
propantheline bromide is used for stomach ulcers as well as for bladder spasms.
However, they need to be taken 2-5 times a day, and the propantheline tablets
cannot be split. Usually, the best way to adjust these medications is by trial
and error. Multiple medications and schedules may be tried before finding a
treatment that works best for that individual patient. The anticholinergics are
much less likely to cause rashes and skin irritation than the antiperspirants,
and the dose can be adjusted fairly easily. Some people may need only a
fraction of one tablet a day to control their hyperhidrosis, while others may
need higher doses. Some physicians have used these anticholinergics by
iontophoresing them into the skin, in a manner similar to the tap-water
electrophoresis described before, but scientific studies have shown that they
also work well when formed into topical skin preparations. Topical gels,
lotions and creams containing anticholinergics such as Robinul®
(glycopyrrolate) can be compounded up fairly easily by many pharmacists, and so
they may be applied onto the skin at particularly bothersome sites, as was
reported in the papers on gustatory sweating in diabetes or Frey's syndrome Of
course, for people who suffer from hyperhidrosis throughout their entire body,
topical cream treatment is probably not as desirable as oral tablet therapy.
The ability to control excessive sweating by taking a simple tablet may make
the other treatments seem less desirable.
Ask Dr. Weil - Q&A: Soaking in Sweat? I would definitely avoid coffee, tea and
other stimulants. They increase the activity of apocrine sweat glands --
special glands in hairy parts of the body that produce strong-smelling, musky
secretions. These drugs arouse your body's fight-or-flight response, increasing
any anxiety you may already have. Do drink lots of water, because you're going
to need to replenish the fluid you've lost. Avoid environmental stimuli that
can trigger your sympathetic nervous system into an alarm response -- such as
loud music, lots of interruptions at work (try closing the door) or even
annoying people who get on your nerves (we all know some of those!). Practice
my breathing exercise, especially when you feel yourself getting tense. You may
also want to try meditation. And be sure to keep up your exercise. You're lucky
-- sweat is sort of a badge of honor among the fitness crowd because people in
good shape tend to sweat more. Their bodies have been trained to cool
themselves efficiently. If you think stress may be part of the problem,
biofeedback is an excellent way to learn how to relax your sympathetic nervous
system and lower tension in your body. I also would try hypnosis or go to a
Chinese medical practitioner to see if they can help. You also may be losing
quite a bit of zinc with your sweat -- as much as 3 mg a day. Zinc is important
for protein and DNA synthesis, blood stability and brain and immune function.
You may want to take 30 milligrams of zinc a day to compensate.
Muscle cramps may sometimes be due to excessive sweating, which causes a loss
of salt from the body. So you may need to supplement with electolytes to
maintain balance when you're sweating a lot.
Reports from Medline (just the pertinent sentences) about unusual sweating.
-No previous studies have detailed a treatment regimen for specific excessive
localized sweating of the face and scalp. In this report, a patient was treated
for this condition with a combination of clonidine hydrochloride (0.3 mg to 0.4
mg, with 0.25 mg to be taken at bedtime, to prevent daytime sedation)
[corrected] and a topical solution of 20% aluminum chloride in anhydrous ethyl
alcohol (Drysol). Over a period of 2 or 3 weeks, the patient achieved a
complete remission of symptoms, while having only mild side effects. The
treatment regimen also had the added advantage of lowering generalized anxiety.
-Exagerating sweating in a paraplegic was diminished by methantheline bromide
treatment though not abolished.
-There is some indication in the literature that ascorbic acid (vitamin C) may
reduce the physiological responses to heat stress. The study listed
improvements at only 250mg a day.
-"While increased sweating is a prominent symptom in patients with active
acromegaly, reduced sweating is gaining status as part of the growth hormone
deficiency (GHD) syndrome" is a quote from a study about Horner's Syndrome,
regarding unusual sweating patterns. Any link to Growth Hormones is
interesting, since most patients with FMS have disturbed sleeping patterns that
affect growth hormone production. So maybe for some, after Xyrem gets approved
by the FDA, GHB may end up being a help by regulating sleep and growth hormone
production.
-In GHD (growth hormone deficiency) patients, SSR (sweat secretion rate) was
reduced in males but not in females (by control of the growth hormone), which
together with the established gender difference in normal controls emphasises
the role of androgen deficiency as a cofactor for reduced sweating in
hypopituitary patients. Sweat gland development seems to be more susceptible to
lack of hormones in childhood and adolescence than in adulthood, whereas growth
hormone excess can modify sweat function later in life.
My thought- might androgen oversensitivity be a cofactor for increase
sweating? PCOS is characterized in part by an androgen sensitivity (thus the
increased facial hair and other hormone problems) and has a vast number of
similarities with FMS, and many of us have been diagnosed with both. Perhaps
finding a way to decrease androgen levels or simply decreasing androgen
sensitivity would help. Eg, maybe spironolactone which is recommended by the
FDA for treatment of hormone related acne due to its desensitizing effect,
might help. It's also a diuretic (that's its normal function) so perhaps
decreasing hydration levels in the body via urine instead of sweat might help.
Gustatory sweating is another localized sweating phenomenon in which people
start sweating when they eat.
A diabetes type I patient was given the antimuscarine agent oxybutynine, which
provided a striking relief from gustatory sweating.
topical application of glycopyrrolate cured gustatory sweating
Thread from a physician message board about combatting SSRI sweats:
-I had a patient with a virtually identical presentation (as far as can be
conveyed in a paragraph) who achieved complete relief on a very low dose of
imipramine added at bedtime. She got the upside of the TCA side effect and it
dried her out like a sheet on the clothesline in the Texas heat. I think she
was taking 25 or 50 mg at hs.
-R. Feder suggested in a letter, J Clin Psychiatr 1995, 15:35, that clonidine
can be useful for control of medication induced diaphoresis. I have tried this
with two patients: one on trancylpromine, the other on clomipramine, and found
it useful.
I used low level dosage, 0.1 mg bid or tid, without problem.
-Terazosin (Hytrin) is a useful agent for the control of excessive sweating
whether idiopathic or secondary to TCAs or SSRIs. Start with a 1 mg dose at
bedtime (to prevent a hypotensive reaction) and slowly increase the dose. Once
or twice a day dosing is all that is needed. I sometimes go up to about a total
daily dose of 10 mg.
-I have a 38 yo patient who responded well to nortriptyline except for
hyperhidrosis. She taught me about Drysol, a solution of aluminum chloride in
anhydrous ethyl alcohol, which she has used with excellent success. I believe
it is by prescription only and may be irritating to some.
-Severe sweating is regularly social phobia and responds to MAOI. However
patients on TCA have severe facial neck sweating in distribution of superior
cervical ganglion. This responds to Hytrin and similar agents.
-I have a small experience with Cardura (doxazosin) which seems helpful.
-I have found Ditropan in doses of 5mg BID to be helpful in limiting the
sweating associated with the SSRIs. However there are some anticholinergic
effects.
-I discourage using Hytrin. Why? ... It [causes] a good deal of orthostatic
hypotension -- especially after hot showers! Be careful!
-I had a patient with a virtually identical presentation (as far as can be
conveyed in a paragraph) who achieved complete relief on a very low dose of
imipramine added at bedtime. She got the upside of the TCA side effect and it
dried her out like a sheet on the clothesLevsinex (hyoscyamine), an
anticholinergic that used to be used for peptic ulcer, has been helpful in some
of my patients.
http://www.rxmed.com/illnesses/hyperhidrosis.html
Tranquilizers or anti-cholinergics to reduce activity of the central nervous
system. Don't use these if you have glaucoma or prostate disease.
Special solutions to reduce sweating, such as topical applications of aluminum
chloride.
Beta-adrenergic blockers may occasionally help.
http://www.skinsite.com/info_hyperhidrosis.htm
Usually, local applications of aluminum chloride hexahydrate provide
satisfactory sweat control; when they fail, we can try internal medicines or
electrophoresis
NePhiFoFum
thank you for such a great article - i've been doing a lot of research into
other people's experiences with HH (i.e. support groups) but i have not delved
as deeply as i should into the more scientific side of this condition
while the support groups/bulletin boards may be more comforting to read,
knowing that i am not alone, the scientific articles may be just as valuable,
since the condtion is so incredibly individual
thanks again!
dave :-)