Estimated impact for the NHS | Hyperhidrosis: oxybutynin | Advice

Other treatments

A number of antimuscarinics can be used to treat hyperhidrosis, although propantheline bromide is the only antimuscarinic licensed for this indication. Oral glycopyrronium bromide is sometimes used for this indication and is discussed in the NICE evidence summary on hyperhidrosis: oral glycopyrronium bromide. Other systemic treatments mentioned in the clinical knowledge summary on hyperhidrosis are clonidine, diltiazem and benzodiazepines.

Costs of other treatments

See table 3 for the cost of other systemic treatments used for hyperhidrosis.

Table 3 Costs of other antimuscarinics

Medicine	Usual dose ^a	30 day cost excluding VAT
Oxybutynin tablets^b	2.5 mg to 10 mg daily^c	£0.62 to £1.60^d
Oxybutynin modified release tablets^b	5 mg to 10 mg daily	£13.77 to £27.54^d
Oxybutynin oral solution sugar-free^b	2.5 mg to 10 mg daily^c	£144.50 to £398.40^d
Oxybutynin transdermal patch^b	3.9 mg/24 hour patch applied twice weekly (every 3 to 4 days)	£29.14^d,e
Propantheline bromide tablets (Pro-Banthine)^f	15 mg to 90 mg daily^g in divided doses	£5.56 to £33.33^d
Glycopyrronium bromide oral solution (Sialanar)^b	1 mg to 8 mg daily in divided doses^h	£96.00 to £768.00ⁱ
^a Doses shown do not represent the full range that can be used and do not imply therapeutic equivalence. ^b Not licensed for the treatment of hyperhidrosis. ^c Based on the doses used in the studies included in this evidence summary. ^d Costs based on Drug Tariff, February 2017; excluding VAT. ^e Based on a person applying 2 patches a week for 30 days. ^f Licensed for the treatment of hyperhidrosis. ^g Dose range suggested by specialists involved in the development of this evidence summary. ^h Dose range based on the studies discussed in the NICE evidence summary on hyperhidrosis: oral glycopyrronium bromide. ⁱ Costs based on MIMS, February 2017; excluding VAT.

Current or estimated usage

No information on oxybutynin for hyperhidrosis was available at the time this evidence summary was prepared. It is not possible to provide estimated usage based on the available data.

Likely place in therapy

Local decision makers need to take safety, efficacy, cost and patient factors into account when considering the likely place in therapy of oxybutynin for hyperhidrosis.

The studies found that oxybutynin (at a dosage of 2.5 mg to 10 mg daily) improved symptoms of hyperhidrosis and quality of life significantly more than placebo. The medicine appeared to be well tolerated, although dry mouth was frequently reported. The standard release formulation of oxybutynin, which was used in the studies, is inexpensive. Many people may prefer a topical treatment to risking the adverse effects of an oral treatment. However, an oral treatment may be preferable to some other options, such as surgery.

The clinical knowledge summary on hyperhidrosis suggests systemic therapies, including oral antimuscarinics, as treatment options for people whose hyperhidrosis is not adequately managed through lifestyle modifications and antiperspirants. Other treatments that may be considered include topical therapies (including topical glycopyrronium), iontophoresis, botulinum toxin injections, other systemic therapies (including clonidine, diltiazem, benzodiazepines) and surgery.

Adverse events are common with oxybutynin, with dry mouth the most frequently reported, occurring in up to 100% of participants taking oxybutynin in the studies discussed in this evidence summary. Other common adverse events include dizziness, nausea, constipation and urinary retention. Treatment with oxybutynin may be limited by a person's ability to tolerate these side effects, although anticholinergic effects are often dose-dependent and may be minimised by using the lowest effective dose.

Many of the participants involved in the studies discussed in this evidence summary had localised hyperhidrosis, which may be more appropriately managed using local treatments including antiperspirants and iontophoresis.