Qbrexza (glycopyrronium tosylate) for excessive underarm sweating

At a glance

Mechanism of action

Glycopyrronium tosylate is a quaternary-ammonium sweat-reducing medicine that blocks acetylcholine signaling at sweat-gland muscarinic receptors. Quaternary structure limits whole-body absorption compared with tertiary-amine alternatives, concentrating the effect at the application site.

FDA indication and population

Qbrexza (glycopyrronium tosylate 2.4% cloth) is FDA-approved for the topical treatment of primary excessive underarm sweating in adults and pediatric patients 9 years and older. It is labeled for underarm use only. The pivotal trials (ATMOS-1 and ATMOS-2) enrolled adults and adolescents with primary underarm disease and the label reflects that scope.

Trial evidence

ATMOS-1 and ATMOS-2 were Phase 3 randomized, vehicle-controlled, multicenter trials. Primary endpoints used the Underarm Sweating Daily Diary (ASDD), a patient-reported instrument scored 0-10. Co-primary endpoints assessed ASDD severity-item improvement and gravimetric sweat production. The label and published results report week-4 response rates and gravimetric reductions vs vehicle.

How to apply

Each pre-moistened cloth is used once daily for both axillae. Wipe one underarm with one side of the cloth, flip the cloth, wipe the other underarm. Discard after a single use. Wash hands thoroughly after application to avoid inadvertent eye contact (mydriasis can occur). Application should be to clean, dry skin.

Common adverse reactions

The product label reports application-site reactions (dryness, irritation, erythema) and whole-body sweat-reducing medicine effects (dry mouth, mydriasis, urinary hesitation, blurred vision) as the most common adverse events. Most application-site reactions are mild-to-moderate and reversible. Whole-body effects are less common than with pills that reduce sweating due to limited absorption.

Reasons a treatment may not be safe

Conditions that may be exacerbated by sweat-reducing medicine effects: medical conditions causing dry mouth (Sjögren syndrome), urinary retention (benign prostatic hyperplasia, bladder outlet obstruction), constipation, glaucoma. Inadvertent eye contact can produce temporary mydriasis. Specific reason a treatment may not be safe detail is in the prescribing information; clinicians screen for these conditions before prescribing.

Practical considerations

• • Next step: topical, single-use pre-moistened cloth
• • Frequency: once daily for both axillae
• • Prescription required
• • FDA indication: primary excessive underarm sweating, age 9+
• • Region: underarm ONLY (off-label elsewhere)

Side effects and reasons this may not be safe for you

• • Application-site dryness, irritation, erythema
• • Dry mouth (sweat-reducing medicine)
• • Mydriasis (pupil dilation) if eye contact occurs
• • Urinary hesitation
• • Blurred vision
• • Constipation (less common)

Compare this option

• Compare: qbrexza vs sofdra →

Governed citations

Numbers and approved uses on this page link back to their sources governed in anna-pipeline. Each entry below is a packet bound to this treatment.

Frequently asked

Can I use Qbrexza on my hands or feet?

Qbrexza is FDA-approved for underarm use only. Off-label use on hands, feet, or face is not supported by the ATMOS-1 and ATMOS-2 trial evidence base, and skin in those regions has different absorption and irritation profiles. Hand and foot disease have their own ladders that include iontophoresis as an early-escalation option.

How does Qbrexza compare to Sofdra?

Both are once-daily prescription skin treatments that reduce sweating approved for primary excessive underarm sweating in patients 9 years and older. They differ in molecule (glycopyrronium tosylate vs sofpironium), dosage form (cloth vs gel), main result measured in the clinical trials (ASDD vs HDSM-Ax-7), and the specific side effects in their labels. The /compare/qbrexza-vs-sofdra page lays out the side-by-side comparison.

Will my pupils stay dilated if I get the product in my eye?

Inadvertent eye contact can produce mydriasis (pupil dilation) and can affect near-vision focus temporarily. The effect is typically reversible. Wash hands thoroughly after applying Qbrexza and avoid touching the eyes until hands are clean; the label includes specific instructions on hand hygiene.

Reading paths

• Check your severity with the HDSS calculator →
• Body regions →
• How claims are governed →

When this treatment is usually considered