Oxybuntina para hiperhidrosis en poblacion pediatrica...
Individualized Dosing of Oral Oxybutynin for the Treatment of Primary Focal Hyperhidrosis in Children and Teenagers
Pediatr Dermatol 2016 Apr 28;[EPub Ahead of Print], J Del Boz, JF Millán-Cayetano, N Blázquez-Sánchez, M de TroyaDose Individualization of Oral Oxybutynin for Primary Focal Hyperhidrosis in Children and Teenagers
TAKE-HOME MESSAGE
This prospective study assessed the effectiveness of oxybutynin treatment for primary focal hyperhidrosis in children and teenagers. Patients received progressively increasing doses starting at 2.5 mg/day with a maximum of 12.5 mg/day until control was achieved. At the 3-month follow-up, 15/16 patients responded to treatment, 62.5% with an excellent response. The 11 patients who remained on the medication at 1 year continued responding. The most common adverse effect was oropharyngeal xerosis, with less common adverse effects including epistaxis, headaches, and drowsiness.
Individualized regimens of oxybutynin were found to be useful for the treatment of hyperhidrosis in children and adolescents.
– Sarah Churton, MD
- Written by
Pediatric hyperhidrosis commonly presents itself in the first 2 decades of life. There are limited therapies for this condition, ranging from antiperspirants to neurosurgery, with few choices in between. The FDA approval of botulinum toxin for this difficult condition has been the best new treatment option in years. This treatment can be painful and costly for any patient, let alone children. While antiperspirants are often the first line of therapy, they are frequently ineffective. Therefore, oral anticholinergics have been suggested to be a second-line treatment option in both children and adults with primary hyperhidrosis.
In the US, glycopyrrolate is traditionally the oral anticholinergic of choice for hyperhidrosis. Several recent studies have shown oral oxybutynin (more commonly used for bladder instability) to be a safe and effective alternative. This article highlights that oral oxybutynin can be initiated at a lower dosage in pediatric patients then titrated up to an effective dose, whereas prior studies have used a fixed-dose regimen. Oxybutynin was started at a dose of 2.5 mg/day to a maximum of 12.5 mg/day. The most common side effect was dry mouth, which is similar to the finding in studies with oral glycopyrrolate.
To date there have been no studies comparing oxybutynin and glycopyrrolate. With both medications readily available in the US, this could be valuable knowledge.
Abstract
BACKGROUND/OBJECTIVES
Oral anticholinergic drugs, such as oxybutynin, are often used in the treatment of hyperhidrosis, but few studies have focused on dosing strategies for children. The objective was to assess the effectiveness and safety of individualized dosing regimens of oral oxybutynin for treating primary focal hyperhidrosis (PFH) in children and teenagers.
METHODS
A prospective study was performed including patients who initiated treatment for hyperhidrosis between November 2011 and November 2014. Response to treatment and adverse effects were evaluated using the Hyperhidrosis Disease Severity Scale at baseline and at 3 and 12 months.
RESULTS
Of 16 patients included in the study, 15 (93.8%) had responded to treatment at the 3-month follow-up (62.5% with excellent response). At the 12-month follow-up, the 11 patients who continued the treatment were still responding (63.6% with excellent response). Adverse effects were reported for 68.8% of the patients at 3 months and 54.5% at 12 months, with a predominance of oropharyngeal xerosis. No serious adverse effects were observed.
CONCLUSION
Dose individualization of oral oxybutynin according to clinical response and tolerance observed in each patient is a useful management strategy in children and teenagers
posted by dermatica at
May 16, 2016
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