Research
Oral Anticholinergics for Sweating: Evidence and Side Effects
Oral anticholinergic tablets, most commonly oxybutynin, and sometimes glycopyrrolate, are used off-label for excessive sweating that is widespread or affects several body areas. Randomized placebo-controlled trials show they help: in two key trials, about 60-70% of people improved on a standard severity scale versus roughly a quarter on placebo. The catch is tolerability. Dry mouth is very common: reported in about 43-48% of users in those trials, and higher still at larger doses. This page compiles the verified trial figures. It is educational information, not medical advice.
By the Sweat Explained Editorial Team · Published 2026-07-13 · Last reviewed 2026-07-13 · Educational information, not medical advice.
Key statistics at a glance
60% vs 27%
improved ≥1 point on the HDSS severity scale (oxybutynin vs placebo) in a generalized-hyperhidrosis RCT
Schollhammer 2015, Br J Dermatol
>70%
of oxybutynin patients reported improved palmar/axillary sweating vs 27.3% on placebo
Wolosker 2012, J Vasc Surg
43% vs 11%
dry mouth on oxybutynin vs placebo in the generalized-hyperhidrosis RCT
Schollhammer 2015
RR 1.68
pooled likelihood of HDSS improvement with oxybutynin vs placebo (95% CI 1.21–2.33)
El-Samahy 2023 meta-analysis
off-label
status of oral oxybutynin and glycopyrrolate for hyperhidrosis (not FDA-approved for this use)
Review literature
What oral anticholinergics are and how they're used
Anticholinergics block acetylcholine, the chemical signal that switches sweat glands on. Taken as a tablet, they reduce sweating body-wide, which makes them an option when sweating is generalized or affects multiple sites (hands, feet, underarms, face) rather than a single area. The two used most often are oxybutynin and glycopyrrolate. Neither is FDA-approved specifically for hyperhidrosis, so this is off-label use, a common and accepted practice, but one that means the dosing and evidence come from investigator trials rather than a formal approval package.
Because the drug acts everywhere, its benefits and its side effects both come from the same mechanism: less sweat, but also less saliva, tears, and other secretions.
What the randomized trials found
The strongest evidence is for oral oxybutynin, tested in several randomized placebo-controlled trials. The figures below are from the trials' own reports. They used different populations, doses, and outcome measures, so read each row on its own rather than ranking them against each other.
| Trial | Population (N) | Efficacy (drug vs placebo) | Dry mouth (drug vs placebo) | Source |
|---|---|---|---|---|
| Schollhammer 2015 | Generalized/localized hyperhidrosis (62) | 60% vs 27% improved ≥1 pt on HDSS (P=0.009); DLQI improved 6.9 vs 2.3 | 43% vs 11% | PubMed |
| Wolosker 2012 | Palmar/axillary hyperhidrosis (50; 45 completed) | >70% improved palmar/axillary sweating vs 27.3%; QoL improved in 65.2% | 47.8% reported | PubMed |
| Costa 2014 | Plantar sweating, postmenopausal women (32; 10 mg/day) | Improvement favored oxybutynin over placebo | 100% vs 43.8% | Review (PMC) |
Dosing was typically escalated (e.g., 2.5 mg once daily up to 5–7.5 mg/day). Costa 2014 used a higher fixed 10 mg/day dose, which is reflected in its very high dry-mouth rate. Costa figures are cited via a peer-reviewed review.
Improvement rates in two placebo-controlled trials
Both trials that used a clear responder definition found oxybutynin roughly doubled the share of people who improved compared with placebo. The chart shows those paired rates.
| Group | Value |
|---|---|
| Schollhammer, oxybutynin | 60% |
| Schollhammer, placebo | 27% |
| Wolosker, oxybutynin | 70% (reported as >70%) |
| Wolosker, placebo | 27.3% |
Source: Schollhammer 2015 (HDSS ≥1 pt); Wolosker 2012 (palmar/axillary improvement). Chart is an original rendering of the cited data.
Pooling the trials
A 2023 systematic review and meta-analysis pooled 6 randomized controlled trials covering 293 patients. Combining the trials that measured it, oxybutynin was significantly more likely than placebo to improve the Hyperhidrosis Disease Severity Scale (risk ratio 1.68, 95% CI 1.21–2.33; P=0.002). Interestingly, when the reviewers pooled dry-mouth rates across four trials (275 patients), the difference versus placebo did not reach statistical significance (risk ratio 2.04, 95% CI 0.97–4.30; P=0.06). The estimate points to more dry mouth on the drug, but the pooled confidence interval just crossed 1. Individual trials still consistently report dry mouth as the dominant complaint, so this is best read as pooling and small samples widening the uncertainty, not as evidence that dry mouth is uncommon.
Glycopyrrolate: the other oral option
Glycopyrrolate is the second oral anticholinergic used off-label for sweating. It works by the same mechanism as oxybutynin, and reviews describe similar effectiveness and a similar dryness side-effect profile. Its randomized-trial evidence base for hyperhidrosis is thinner than oxybutynin's, so the numbers on this page focus on oxybutynin, where placebo-controlled data are strongest. Choice between the two is a clinical decision that depends on tolerability and individual response.
What this means in practice
Put simply: oral oxybutynin has real, randomized-trial support for reducing excessive sweating, with most users improving and a minority reaching large improvements, but dry mouth is common and often the reason people stop. The two well-designed trials reported dry mouth in roughly 43–48% of users, and a higher fixed dose pushed that to nearly everyone. Other anticholinergic effects (blurred vision, constipation, urinary hesitation) can occur too.
These drugs are used off-label, are not suitable for everyone (for example, some eye and prostate conditions), and require a prescription and clinical oversight. If widespread or multi-site sweating is affecting daily life, a clinician can weigh an oral anticholinergic against other options and monitor for side effects.
Methodology and limitations
Figures are drawn from primary randomized controlled trials (Schollhammer 2015, Br J Dermatol, PMID 26114588; Wolosker 2012, J Vasc Surg, PMID 22341836), a peer-reviewed meta-analysis (El-Samahy 2023, Arch Dermatol Res, via PMC10462517), and a peer-reviewed review that reports the Costa 2014 trial (PMC4857824). Each figure was traced to its source and confirmed.
Limitations: these trials are small (dozens of patients each), use different populations, doses, and outcome scales, and cannot be ranked head to head. The Wolosker efficacy figure is reported as 'over 70%' rather than a precise value, and the Costa 2014 figures are cited via a review rather than the primary paper. Oral use for hyperhidrosis is off-label. This page is verified evidence for general education only. It is not medical advice and not a basis for starting, stopping, or changing any medication, which should be decided with a prescribing clinician.
Frequently asked questions
- Do oral anticholinergics actually reduce sweating?
- Yes. Randomized placebo-controlled trials of oral oxybutynin show benefit. In one generalized-hyperhidrosis trial, 60% improved on the HDSS scale versus 27% on placebo; in another, over 70% of palmar/axillary patients improved versus about 27% on placebo. A meta-analysis of 6 trials confirmed a significant benefit (risk ratio 1.68).
- How common is dry mouth?
- Very common. The two best-designed trials reported dry mouth in about 43–48% of oxybutynin users (versus 11% on placebo in one). A higher fixed 10 mg/day dose in one study produced dry mouth in essentially all participants. It is the most frequent reason people stop the drug.
- Are these drugs FDA-approved for sweating?
- No. Oral oxybutynin and glycopyrrolate are used off-label for hyperhidrosis. That is a common and accepted practice, but it means dosing and evidence come from investigator-led trials rather than a formal approval for this specific use.
- How is oxybutynin dosed for sweating?
- Trials typically started low and increased gradually (for example 2.5 mg once daily, titrated up to about 5–7.5 mg per day) to improve tolerability. Exact dosing is individualized by a prescriber; the figures here describe what specific trials used, not a recommendation.
- What about glycopyrrolate instead of oxybutynin?
- Glycopyrrolate is the other oral anticholinergic used off-label, working by the same mechanism with a broadly similar effect and dryness profile. Its randomized-trial evidence for hyperhidrosis is less extensive than oxybutynin's, which is why this page's figures center on oxybutynin.
- Is this medical advice?
- No. These are verified figures from randomized trials and reviews for general education. Oral anticholinergics are prescription medicines with meaningful side effects and are not right for everyone; any decision to use them belongs with a clinician.
Sources
Primary peer-reviewed studies and official sources first, then reviews and institutional framing (secondary).
- Schollhammer M, Brenaut E, Menard-Andivot N, et al. Oxybutynin as a treatment for generalized hyperhidrosis: a randomized, placebo-controlled trial. Br J Dermatol. 2015;173(5):1163–1168. PMID 26114588. PubMed
- Wolosker N, de Campos JRM, Kauffman P, Puech-Leão P. A randomized placebo-controlled trial of oxybutynin for the initial treatment of palmar and axillary hyperhidrosis. J Vasc Surg. 2012;55(6):1696–1700. PMID 22341836. PubMed
- El-Samahy M, et al. Safety and efficacy of oxybutynin in patients with hyperhidrosis: systematic review and meta-analysis of randomized controlled trials. Arch Dermatol Res. 2023;315(8):2215–2226. (6 RCTs, 293 patients.) Full text
- Cruddas L, Baker DM (review). Oxybutynin for the Treatment of Primary Hyperhidrosis: Current State of the Art. Reports the Costa 2014 plantar-sweating trial (dry mouth 100% vs 43.8%). Review article, PubMed Central. (secondary) Review (PMC)
How to cite this page
Sweat Explained. Oral Anticholinergics for Sweating: Evidence and Side Effects. Published 2026-07-13; last reviewed 2026-07-13. Available at: https://sweatexplained.com/research/oral-anticholinergics-for-sweating-evidence
Please cite the original studies for the underlying figures. Journalists are welcome to link to this page; the charts are original renderings of the cited data.