Sofpironium (Sofdra) for Hyperhidrosis

In this episode, TRC Healthcare editor, Gina Corley, PharmD, discusses how to treat hyperhidrosis, or excessive sweating, including the use of a drug called sofpironium or Sofdra, which is a new topical agent approved for primary axillary hyperhidrosis. 

This is an excerpt from our November 2024 Pharmacy Essential Updates continuing education webinar series.

The clinical resources mentioned during the podcast are part of a subscription to Pharmacist’s Letter, Pharmacy Technician’s Letter, and Prescriber Insights: 

• Article: Clarify the Role of Sofpironium for Hyperhidrosis
• Resource: Topically Applied Dosage Forms 

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Transcript

This transcript is automatically generated. 

00:00:04 Narrator

Welcome to Clinical Capsules, your go-to podcast and trusted source for quick, evidence-based insights from TRC Healthcare. 

00:00:12 Narrator

For four decades, we've been keeping healthcare professionals at the forefront of drug information and medical knowledge, and now we're bringing these vital clinical updates right to your ears every 2nd and 4th Tuesday - delivering practical, actionable takeaways in bite-sized episodes.

00:00:29 Narrator

Today, Assistant Editor and Clinical Pharmacist Gina Corley discusses how to treat hyperhidrosis, or excessive sweating in an excerpt from our popular Pharmacy Essential Updates webinar series.  

With that, Let's get started…

00:00:48 Gina Corley

Now let's jump into how to treat hyperhidrosis or excessive sweating.

00:00:54 Gina Corley

There are different types of hyperhidrosis, and it can occur in different parts of the body, but the main type we're going to be focusing on is primary axillary hyperhidrosis, which is excessive sweating underneath the armpits.

00:01:10 Gina Corley

Our article highlights a drug called Sofpironium or Sofdra, which is a new topical agent approved for primary axillary hyperhidrosis.

00:01:22 Gina Corley

So today we're going to talk about all the options patients have to treat this condition and then figure out where Sofpironium is going to fit in. But first, let's take a step back and talk about what hyperhidrosis is.

00:01:38 Gina Corley

So like I said, patients with hyperhidrosis have excessive sweating, usually in the armpits, palms, soles of the feet or face. And this isn't just regular sweating. It's profuse sweat.

00:01:53 Gina Corley

Hyperhidrosis can have a significant impact on people's quality of life. It can lead to anxiety or depression and can even affect work and social life.

00:02:06 Gina Corley

So first we want to consider any possible medications that could be causing excessive sweating. These can include anti-depressants such as venlafaxine or fluoxetine, NSAIDs such as ibuprofen, aces and Arbs like enalapril, or even opioids like morphine.

00:02:28 Gina Corley

Usually if it's due to medications, the sweating can occur all over, but most often people have sweating limited to certain areas.

00:02:39 Gina Corley

So, after ruling out meds, most patients will follow a stepwise approach. And the first step in that stepwise approach is antiperspirants.

00:02:51 Gina Corley

Antiperspirants have various aluminum salts and come in a variety of strengths, and they seem to work by plugging sweat glands to block sweat.

00:03:00 Gina Corley

Reassure patients that aluminum antiperspirants are safe and there's not good evidence of any link with breast cancer or Alzheimer's.

00:03:11 Gina Corley

Any of these products can also be used with deodorants to help decrease or mask odor due to sweating, but make sure to apply the antiperspirant first and then deodorant after.

00:03:24 Gina Corley

Overall, antiperspirants are well tolerated, low cost, and can be applied to any affected area. They are usually effective for mild to moderate symptoms.

00:03:39 Gina Corley

So, with antiperspirants, we want to try OTC's first, and if this doesn't work, we'll go to prescription products.

00:03:48 Gina Corley

And intuitively, prescriptions might seem like they're more effective but explain there's not good evidence that prescriptions work better than OTC's or that one aluminum salt or strength is more effective than the other.

00:04:04 Gina Corley

These products vary in their strengths and prescription strengths are not necessarily higher than Otcs.

00:04:11 Gina Corley

So, for example, OTC products can come in clinical strength, which may have up to 20% aluminum.

00:04:18 Gina Corley

And the prescription products have more varying strengths. For example, dry salt has 20%, but prescription xer ac AC has 6.25%, which is less than many OTC.

00:04:32 Gina Corley

And Otcs cost around $15 per bottle and prescriptions cost around roughly $30 per bottle.

00:04:42 Gina Corley

So if you want you can suggest trying a high strength OTC 1st and then moving on to a prescription product.

00:04:51 Gina Corley

So we also want to help patients focus on proper antiperspirant application, emphasize applying to dry skin once a day before bed. This is because people often sweat less at night, so it's easier for aluminum to get in and plug those sweat glands.

00:05:11 Gina Corley

Also make sure patients know to wash the product off in the morning. 

00:05:16 Gina Corley

Aluminum chloride can mix with water in sweat and form small amounts of hydrochloric acid, which can irritate skin. If this happens, we can suggest patients get an OTC hydrocortisone cream.

00:05:30 Gina Corley

So if antiperspirants aren't enough, there are a plethora of other options that patients can try. We have topical meds, we have injections, and we have orals that we can try and the order that we choose these and will depend on patient preference, cost, side effects, etcetera.

00:05:50 Gina Corley

There's really no best option.

00:05:53 Gina Corley

So now let's take a look at each one of these things individually.

00:05:58 Gina Corley

First, we're going to talk about a new prescription drug called Sofpironium or Sofdra.

00:06:05 Gina Corley 

This is used for excessive underarm sweating. Sofpironium is an anticholinergic which is why it helps reduce sweating. It comes as a 50ML bottle containing 12.45% Sofpironium gel.

00:06:20 Gina Corley

The bottle has a pump and applicator that patients use to apply the product.

00:06:26 Gina Corley

Patient should be instructed to apply one pump to each armpit once daily at bedtime, so that's two pumps of gel total.

00:06:37 Gina Corley

But there are things that patients need to keep in mind before applying. First, patients should avoid shaving their armpits at least 8 hours before applying Sofpironium. This helps to lessen skin irritation.

00:06:53 Gina Corley

Patients should also avoid bathing at least 30 minutes before and eight hours after applying Sofpironium, so the product has enough time to penetrate the skin, make sure the skin is completely dry when applying, and wait 5 minutes for the gel to dry completely before getting dressed.

00:07:14 Gina Corley

So patients will probably wonder how well Sofpironium works and how much it costs.

00:07:19 Gina Corley

Sofpironium has been shown to benefit one in six patients over six weeks, but it costs about $1000 per month and insurance companies are not likely to pay.

00:07:32 Gina Corley

So expect prior auths, if you get a prescription for this product.

00:07:39 Gina Corley

Now we're going to talk about Qbrexza or topical glycopyrronium.

00:07:45 Gina Corley

Like Sofpironium, glycopyrronium is also an anticholinergic. It comes as a box of 30 clothes containing glycopyrronium 2.4%.

00:07:57 Gina Corley

Patients should use one cloth for both underarms. They should wipe one time across each underarm once per day.

00:08:05 Gina Corley

About one in three patients see improvement after four weeks.

00:08:11 Gina Corley

So, it appears to have better efficacy than Sofpironium, but it still costs about $650 per month.

00:08:21 Gina Corley

And now we're going to talk about practice pearls that apply to both Sofpironium and glycopyrronium. These can both cause systemic or whole-body anticholinergic side effects such as dry mouth, blurred vision and possible urinary retention.

00:08:36 Gina Corley

And for that same reason, recommend avoiding these two drugs if patients are taking oral anticholinergics because of concerns about additive side effects.

00:08:46 Gina Corley

We want to avoid these drugs with set 2D6 inhibitors such as bupropion, for the same reason. These can also increase anticholinergic side effects and we want to also remind patients to wash their hands after they use these products because we don't want patients to use them and then rub their eyes because this could increase the risk of blurred vision.

00:09:09 Gina Corley

Text want to make sure to enter day's supply correctly when entering prescriptions for Sofpironium and glycopyrronium SO1 box of 30 glycopyrronium cloth will last 30 days. Since patients use one cloth to wipe both underarms once per day.

00:09:27 Gina Corley

And 150ML bottle of Sofpironium gel will also last 30 days since each bottle contains roughly 60 pumps of gel and patients will use one separate pump for each underarm.

00:09:42 Gina Corley

These drugs are both approved for patients 9 and up, so older children and adults can use them.

00:09:49 Gina Corley

But we are currently not recommending  Sofpironium or glycopyrronium in pregnant patients since there's not enough data to assess fetal risk.

00:10:00 Gina Corley

Lastly, these products are flammable, so advise patients to keep away from heat and flame. For example, don't store near candles.

00:10:12 Gina Corley

So moving on, another option that we could possibly try would be Botox or Onabotulinumtoxin A.

00:10:20 Gina Corley

This is given as 50 units injected into each armpit, so 100 units total. It can have long lasting effects up to several months, and most people respond well.

00:10:34 Gina Corley

But it’s costly, for example, 1, 100 unit vile can cost around $650. Plus injection site pain is common, and a lot of patients don't like needles.

00:10:51 Gina Corley

Another option that can be used is oral anticholinergics such as oxybutynin or glycopyrrolate.

00:10:58 Gina Corley

Both of these drugs are used off label to treat hyperhidrosis. They are some of the most affordable options since they have been around for a long time and to be covered by most insurance plans. These tend to work pretty well in terms of efficacy, but have the biggest risks were systemic side effects, so they are often discontinued because of this.

00:11:21 Gina Corley

Another downside with these is they may need to be dosed multiple times per day. For example, with immediate release oxybutynin and glycopyrrolate patients may need to take these meds up to two to three times per day.

00:11:34 Gina Corley

But if they report that they keep forgetting to take a dose, they can try oxybutynin ER, which is only dosed once per day.

00:11:44 Gina Corley

So that sums up our overview of the meds for hyperhidrosis. To wrap this topic up, I want to show you our tech tutorial resource called topically applied dosage forms. It has more tips on dispensing topical meds such as topical Sofpironium or glycopyrronium correctly.

00:12:06 Narrator

We hope you enjoyed and gained practical insights from listening to this presentation. Be sure to follow or subscribe, rate, and review this show in your favorite podcast app. Or find the show on YouTube by searching for ‘TRC Healthcare’ or clicking the link in the show notes. While you’re there, check out our other TRC podcasts like Medication Talk and Rumor vs Truth.

00:12:29 Narrator

Also in the show notes, we’ve linked directly to a few of the excellent resources mentioned today available to subscribers of Pharmacist’s Letter, Pharmacy Technician’s Letter, or Prescriber Insights. On those websites you’ll also find a lot more evidence-based, concise, yet comprehensive resources on this and other medication therapy topics. 

00:12:52 Narrator

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00:13:06 Narrator

And if you're a student, good news—students can access a free version of Pharmacist’s Letter, we’ve linked to that directly in the show notes as well… Check it out!

00:13:17 Narrator

Find out more about our product offerings at trchealthcare.com. You can also reach out to provide feedback or make suggestions by emailing us at ContactUs@trchealthcare.com. 

00:13:30 Narrator

Thanks for listening to Clinical Capsules!