NHS England (NHSE) has published new prescribing guidance for various common conditions for which over the counter (OTC) items should not be routinely prescribed in primary care (quick reference guide). One of these conditions is mild to moderate hyperhidrosis (excessive sweating).

Many of these products are cheap to buy and are readily available OTC along with advice from pharmacies. Some self-care medicines are available from shops and supermarkets. Please click here for further information, exceptions, and a patient leaflet.

Drugs used but not listed here:

• Oxybutynin hydrochloride (off-label) (See 7.4.2 Drugs for urinary frequency, enuresis, and incontinence)
  Propantheline bromide (See 1.2 Antispasmodics and other drugs altering gut motility)
  Botulinum toxin type A (See 4.9.3 Drugs used in essential tremor, chorea, tics, and related disorders)
  

Aluminium chloride hexahydrate

• Roll-on applicator 20% (click here for preferred brand)

Indications and dose

• Hyperhidrosis affecting axillae, hands or feet (see note 1)
  • Apply once daily at night to dry skin, wash off the following morning, reduce frequency as condition improves.
  • Review after 6 weeks. If response is inadequate or treatment is not tolerated, oral treatment with systemic anticholinergics can be considered.
    

Notes

1. This product is available to purchase OTC. In line with guidance from NHS England (see above), it should not be routinely prescribed in primary care for patients with mild to moderate hyperhidrosis.
2. Use alongside advice and self-care management strategies
3. Do not bathe immediately before use
4. Avoid contact with eyes and mucous membranes; avoid use on broken or irritated skin; do not shave axillae or use depilatories within 12 hours of application
5. Avoid contact with clothing
6. Where a preferred brand is recommended for a particular presentation, prescribing by brand helps ensure cost-efficient use of local NHS resources (see preferred brand link above)