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Is Ditropan (oxybutynin chloride) safe for excessive sweating?

Answered by: Dr. Shirish Kumar
Consultant Haematologist,
Sir Ganga Ram Hospital,
New Delhi

Q. I am suffering from hyperhidrosis of the palms and feet. Somebody advised me to use Ditropan (oxybutynin chloride) in consultation with my doctor. Is it a safe drug? Can you help, if not then please give me an alternative drug for this?

A.  Hyperhidrosis is sweating in excess of that required for normal regulation of body temperature. Though any site on the body can be affected, it most commonly affects the palms, soles, and axillae. It may occur without a known cause (idiopathic) or may be secondary to other diseases like metabolic disorders, fevers, or drugs. Three forms of the disease are described: a) emotionally induced (affecting the palms, soles, and axillae), b) localized, or c) generalized. Unlike sweating on the remainder of the body, sweating on the palms and soles is controlled solely by the brain (cerebral cortex) and is responsive to emotional stimuli rather than to temperature stimuli. Both emotional and thermoregulatory stimuli control sweating in the axillae; therefore, palmoplantar hyperhidrosis, unlike generalized hyperhidrosis, does not occur during sleep or sedation. Treatment may include the use of topical &/or systemic medications, iontophoresis (passing a direct current across the skin) and botulinum toxin injections. Systemic agents include anticholinergic medications such as propantheline bromide, glycopyrrolate, oxybutynin, and benztropine. Oxybutynin inhibits action of acetylcholine on smooth muscle and has direct antispasmodic effect on smooth muscles. It is given at a dose of 5 mg orally twice or thrice a day. The drug should not be given to patients with documented hypersensitivity to it, ulcerative colitis, narrow-angle glaucoma or obstructive disease of GI tract or urinary tract. Its effects decrease with concurrent intake of antacids while concurrent disopyramide, tricyclic antidepressants, phenothiazides, corticosteroids, atenolol, digoxin, or other drugs with anticholinergic activity increase toxicity.

A.  Hyperhidrosis is sweating in excess of that required for normal regulation of body temperature. Though any site on the body can be affected, it most commonly affects the palms, soles, and axillae. It may occur without a known cause (idiopathic) or may be secondary to other diseases like metabolic disorders, fevers, or drugs. Three forms of the disease are described: a) emotionally induced (affecting the palms, soles, and axillae), b) localized, or c) generalized. Unlike sweating on the remainder of the body, sweating on the palms and soles is controlled solely by the brain (cerebral cortex) and is responsive to emotional stimuli rather than to temperature stimuli. Both emotional and thermoregulatory stimuli control sweating in the axillae; therefore, palmoplantar hyperhidrosis, unlike generalized hyperhidrosis, does not occur during sleep or sedation. Treatment may include the use of topical &/or systemic medications, iontophoresis (passing a direct current across the skin) and botulinum toxin injections. Systemic agents include anticholinergic medications such as propantheline bromide, glycopyrrolate, oxybutynin, and benztropine. Oxybutynin inhibits action of acetylcholine on smooth muscle and has direct antispasmodic effect on smooth muscles. It is given at a dose of 5 mg orally twice or thrice a day. The drug should not be given to patients with documented hypersensitivity to it, ulcerative colitis, narrow-angle glaucoma or obstructive disease of GI tract or urinary tract. Its effects decrease with concurrent intake of antacids while concurrent disopyramide, tricyclic antidepressants, phenothiazides, corticosteroids, atenolol, digoxin, or other drugs with anticholinergic activity increase toxicity.

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