What to Know About Qbrexza (Glycopyrronium)

First Drug Approved to Treat Abnormal Sweating

In This Article

Qbrexza is a disposable towelette used to treat hyperhidrosis, a condition in which sweating occurs beyond what is needed to regulate body temperature. Each cloth is premoistened with a drug known as glycopyrronium tosylate that inhibits the activity of sweat glands.

Licensed for use by the U.S. Food and Drug Administration (FDA) in 2018, Qbrexza is approved for the treatment of primary axillary hyperhidrosis. This is a form of hyperhidrosis in which unprovoked sweating occurs in the axillary sweat glands of the underarms.

Qbrexza can be used in adults as well as children 9 years of age and older. While considered safe for ongoing use, Qbrexza may cause side effects such as dry mouth and stinging.

Qbrexza is the first drug specifically approved for the treatment of hyperhidrosis.

Uses

Primary hyperhidrosis most typically involves the armpits but can also affect the feet, scalp, face, and groin.

The body's sweat glands are regulated by a chemical known as acetylcholine that transmits signals from the brain to "turn on" perspiration whenever the body is overheated. With hyperhidrosis, these signals are transmitted abnormally, causing perspiration when the body temperature is normal.

Gycopyrronium, an anticholinergic drug, can block acetylcholine from binding to receptors on sweat glands, thereby preventing sweat.

Qbrexza is not the first form of glycopyrronium used to treat hyperhidrosis. An oral form of the drug, called glycopyrronium bromide, is sometimes used off-label when conservative treatments fail to provide relief. With that said, oral glycopyrronium is used with caution due to the risk of vision and urinary dysfunction.

There are currently no clinical guidelines governing the treatment of primary hyperhidrosis. Qbrexza is generally prescribed when high-strength topical antiperspirants fail to prevent excessive underarm sweat.

Qbrexza is considered the first-line pharmaceutical option for primary axillary hyperhidrosis and is used before oral medications (such as propantheline bromide) or injectable drugs (such as Botox) are even considered.

Off-Label Uses

Although doctors have been known to use Qbrexza on other parts of the body, off-label use is not recommended. This is due, in part, to the fact that the sweat glands of the armpit (called eccrine glands) differ from those on other parts of the body (called apocrine glands).

Apocrine glands are primarily activated by adrenaline, also known as epinephrine, which the body produces in response to stress. Eccrine glands are activated by both acetylcholine and epinephrine.

Although oral glycopyrronium is known to improve hyperhidrosis involving the head and face (craniofacial hyperhidrosis) and hands and feet (palmoplantar hyperhidrosis), it appears to do so by reducing anxiety—a primary trigger for adrenaline release—rather than by any anticholinergic effect.

Although safe, studies are mixed as to whether topical glycopyrronium can effectively treat hyperhidrosis of the head, face, feet, or hands.

Before Taking

Even if primary axillary hyperhidrosis is diagnosed, Qbrexza may not be the appropriate choice for everyone. Some people may be vulnerable to side effects, while others may have conditions in which Qbrexza may cause harm.

Precautions

Qbrexza may cause more harm than good if not used appropriately. The FDA warns against the use of Qbrexza under the following circumstances:

  • Hot temperatures: The use of Qbrexza in extremely hot weather can interfere with the body's ability to perspire and lower the body's core temperature, increasing the risk of heatstroke.
  • Operating heavy machinery: Qbrexza may cause a transient blurring of vision. If you need to drive, operate heavy machinery, or do hazardous work, Qbrexza may not be the best option for you.
  • Urinary retention: People with urinary retention (difficulty urinating) may need to avoid Qbrexza as it can worsen symptoms. This is especially true in people with bladder obstruction or an enlarged prostate.

Contraindications

As a neurotransmitter, acetylcholine regulates more than just underarm perspiration. It is involved in many physiological functions, including muscle contraction, blood pressure, heart rhythm, gut motility, pupil dilation, hormone secretion, and rapid eye movement (REM) sleep.

It serves to reason, therefore, that any drug that blocks acetylcholine can potentially interfere with these functions. Even though the anticholinergic action of Qbrexza is relatively mild, it can still complicate certain medical conditions or make them worse.

These include autoimmune diseases in which acetylcholine receptors are often damaged or smooth muscle disorders that rely on acetylcholine to keep organs functioning. For people with these sorts of illnesses, the use of Qbrexza may not only be limited but contraindicated.

Qbrexa is contraindicated for use in people with medical conditions that may be worsened by the drug's anticholinergic effects. These include:

Dosage

Qbrexza is a single-use, pre-moistened cloth packaged in individual pouches. There are 30 pouches per box. Each moist towelette is infused with 2.4% glycopyrronium tosylate, purified water, dehydrated alcohol, and sodium citrate (used to reduce drug acidity). When unfolded, the cloth opens into a 3.75-inch (9.5-centimeter) square.

Qbrexza wipes can be used in adults and children 9 years of age and over. Qbrexza is applied once daily to dry, clean skin on the underarm only. It should not be used on any other part of the body or more than once every 24 hours.

How to Use and Store

Qbrexza is used like any other moist towelettes. There are, however, a few precautions you need to take. To apply Qbrexza correctly:

  1. Tear open the pouch and pull out the cloth.
  2. Unfold the cloth and wipe it across one underarm once.
  3. Using the same cloth, wipe the other underarm once.
  4. Wash your hands immediately with soap and water. Avoid touching the eyes or surrounding skin as this can cause pupil dilation and blurring.
  5. Carefully dispose of the cloth and pouch, well away from the reach of children or pets.

Do not apply Qbrexza to broken skin as it can cause stinging and increase the risk of side effects.

Qbrexza is flammable. Avoid use near heat or an open flame.

Side Effects

As with any drug, Qbrexza may cause side effects. While most are relatively mild, they can on rare occasions be problematic enough to warrant the discontinuation of treatment.

Common side effects (affecting more than 5% of users). They include:

  • Itching
  • Skin redness
  • Burning or stinging

Less common side effects (affecting more than 2% of users) include:

  • Pupil dilation
  • Blurred vision
  • Cold symptoms
  • Nasal pain
  • Headache
  • Urinary retention
  • Rash
  • Nasal dryness
  • Dry throat
  • Dry eye
  • Sore throat
  • Dry skin
  • Constipation

Many of the more severe side effects of oral glycopyrronium (difficulty swallowing, rapid heartbeat, palpations, arrhythmia, and glaucoma) are rare with Qbrexza. Serious allergies are also considered rare.

Because Qbrexa is applied topically, it poses little risk of overdose.

Warnings and Interactions

Qbrexza should be used with caution in people with kidney failure. Since 80% of glycopyronnium is excreted in the urine as unchanged drug, any impairment of kidney function can lead to a rapid accumulation of the drug in the bloodstream and the increased risk of side effects.

Drug Interactions

Qbrexza should also be avoided if taking any other anticholinergic drug. Doing so may have an additive effect, increasing the risk of side effects.

Among them are drugs used to treat diarrhea, asthma, overactive bladder, COPD, insomnia, motion sickness, Parkinson's disease, and psychiatric illnesses. Examples include:

  • Anti-arrhythmia drugs like Norpace (disopyramide)
  • Antidepressants like Tofranil (imipramine), Anafranil (clomipramine), and amitriptyline
  • Antinauseal drugs like Compazine (prochlorperazine) and Phenergan (promethazine)
  • Anti-Parkinsonian agents like Cogentin (benztropine) and trihexyphenidyl
  • Antipsychotics like Clozaril (clozapine), Zyprexa (olanzapine), and Loxitane (loxapine)
  • Antispasmodics like Librax (clidinium-chlordiazepoxide) and Bentyl (dicyclomine)
  • First-generation antihistamines like Benadryl (diphenhydramine), Tavist (clemastine), and Dramamine (dimenhydrinate)
  • Muscle relaxants like Robaxin (methocarbamol) and Norflex (orphenadrine)
  • Urinary incontinence drugs like Enablex (darifenacin) and Toviaz (fesoterodine)

To avoid interactions, always advise your doctor about any drugs you are taking, whether they are prescription, over-the-counter, herbal, or recreational.

Pregnancy

Though the safety of Qbrexza in pregnancy or breastfeeding has not been established, no birth defects were noted in animal studies involving pregnant rabbits.

Due to the lack of safety research, Qbrexza should only be used during pregnancy or nursing if the benefits of treatment outweigh the possible risks.

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