Medication

Qbrexza

A medicated cloth wiped across the underarms once a day for heavy sweating. It blocks the nerve signal that switches sweat glands on, and because it is an anticholinergic it can cause dry mouth and blurred vision if it reaches places it should not.
Dr. Schwarz, MD · Board-certified dermatologistLast reviewed September 8, 2026
16:9 hero for Qbrexza. Never cropped: the tone strip and the corner logo depend on the full frame.

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The instruction I repeat is the boring one: wash your hands with soap and water straight after using the cloth. The drug cannot tell a sweat gland from an eye, and people who rub an eye first end up with a dilated pupil and blurred vision on that side. Qbrexza is approved for the underarms and it is convenient, but a prescription-strength antiperspirant used properly at night is cheaper and worth trying first. Dry mouth is not dangerous, but it is the usual reason the box ends up in a drawer.

— Dr. Schwarz, Board Certified Dermatologist

Key Facts

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Also calledGlycopyrronium tosylate cloth
Drug classTopical anticholinergic
Applied asA single-use 2.4% medicated cloth
Typical courseLong term, once a day, for as long as the sweating is a problem
Time to workWithin the first week, judged at about four weeks
Prescription onlyYes

What It Is

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Qbrexza is a single-use cloth soaked in glycopyrronium tosylate, approved in the United States in 2018 for primary axillary hyperhidrosis — heavy underarm sweating with no underlying cause — in people aged nine and over. One cloth does both underarms, then goes in the bin. Primary hyperhidrosis is sweating well beyond what the body needs to control temperature. It usually starts in childhood or the teens, affects the underarms, palms, soles and face, and often runs in families. It is not caused by anxiety, though living with it makes people anxious. Glycopyrronium is an old drug, used for decades as a tablet and an injection. The cloth keeps most of the effect where it is applied. A related cream is approved in some countries for facial sweating — a different product.

How It Works

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Sweat glands are switched on by acetylcholine landing on muscarinic receptors. Glycopyrronium blocks those receptors, so the message never arrives and the gland makes less sweat. It does not plug the duct or shrink the gland — it silences the signal, which is why the effect fades within days of stopping.

The same receptors sit in the salivary glands, the eye, the bladder and the gut. Applying it to skin keeps most of it local, but enough is absorbed in some people to cause dry mouth, blurred vision, constipation or trouble passing urine.

The commonest route is not absorption through the underarm but transfer on the fingers. Glycopyrronium from a fingertip to an eye dilates that pupil and blurs near vision on that side, sometimes for a day or two. That is the whole reason for the hand-washing rule.

Here is where Qbrexza acts in the skin, and what the others do instead.

About Qbrexza
Compare
Skin basics
BARRIEREPIDERMISDERMISSWEAT GLANDBLOCKS THE SWEAT SIGNALCROSSES EASILYPLUGS THE DUCT

Sweat glands are told to work by a nerve signal. Qbrexza blocks that message where it reaches the gland, so the gland stays quiet. It wears off, and has to be repeated. A wipe, so it treats the underarm it is used on. An aluminum antiperspirant works at the other end of the same gland — a plug in the duct — which is why one can be used when the other is not enough.

Glycopyrronium on a cloth crosses to the sweat glands, which sit just under the skin. Some reaches the body, which is why a dry mouth is the usual side effect.

Aluminum salts react with sweat inside the duct and form a plug near the top, so sweat cannot get out. The gland is untouched and still working, which is why the plug washes away and has to be reapplied.

The outer film of dead cells and oil. It holds water in and keeps irritants out, and it is thinner than a sheet of paper. Almost every dry, itchy, stinging skin problem starts here.

The outer layer, and the only one anything in a jar reaches. It renews itself constantly: a cell made at the bottom takes about a month to reach the surface and flake off. Most of what a skincare product does, it does here.

The living layer underneath, holding the blood vessels, the nerves and the collagen. It is where lasting change happens and it is hard to reach: most of what is sold for the skin never gets this far.

What It Treats

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Hyperhidrosis
Hyperhidrosis
Strong evidence
A prescription glycopyrronium wipe used once a day on the underarms. It blocks the chemical message from the nerve to the gland, which is a different step from an antiperspirant, so it is an option when aluminum has failed or is too irritating. Wash your hands afterwards and keep it well away from the eyes — touching the eyes after using it causes blurred vision and an enlarged pupil.

Not the Best For

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Hands, feet and face
Doesn't work
The cloth has not been approved or studied for palms, soles or the face, and using it there makes getting it into the eyes much more likely.
Sweating all over the body
Doesn't work
A cloth treats one area. Sweating across the whole body is managed with tablets, and is also a reason to look for an underlying cause.

Forms

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Medicated cloth:

Glycopyrronium cream:

Glycopyrrolate tablets:

Strengths

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One strength only.

The only strength
2.4%
Every cloth holds the same amount, and one cloth is the dose. If it is not enough, the next step is a different treatment, not a stronger wipe.

Basics

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When to Apply
Once a day at bedtime, on clean dry underarm skin. Wipe one cloth across one whole underarm, then the same cloth across the other, then throw it away. Let the skin dry and wash your hands with soap and water straight away. Do not shower straight after.
How to Start
Once daily from day one, with no build-up period. If you shave, do it a day or two before rather than the same night — it stings sharply on freshly shaved skin. Give it four weeks before deciding.
If It Irritates
Redness, burning and itching are the commonest problems and often settle over the first few weeks. A plain moisturizer the next morning helps. If the skin becomes sore or raw, take a few days off and ask — breaks are allowed.
If It’s Not Working
One strength, nothing to increase, and two cloths is not the answer. Four weeks is a fair test. After that the options are a prescription-strength antiperspirant, iontophoresis, botulinum toxin injections, tablets, or a procedure that reduces the glands.

Sample Routine

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Here is where Qbrexza sits in a day, and what goes around it. Pick what you are treating and what your skin is like, and the rest of the routine changes to suit.

What to Expect

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First wipe | Using it
One cloth across both underarms at bedtime, then wash your hands. Stinging and redness are common at the start.
Week 1 | Starting
Most people notice less sweating within the first week.
Weeks 1 to 4 | Settling
The local irritation often eases. Dry mouth, if it happens, appears early.
Week 4 | Judge it here
Where the trials measured their main result. The clearest change was how much the sweating interfered with everyday life — more than measured sweat volume.
Ongoing | While you use it
The effect lasts only while you use it; sweating returns within days of stopping.

What to Avoid

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  • Touching your eyes before washing your hands: The commonest avoidable problem. On a fingertip it can dilate a pupil and blur near vision for hours or a couple of days.
  • Handling contact lenses before washing your hands: Same reason, same result.
  • Applying it to broken, raw or freshly shaved skin: Stings sharply; more is absorbed.
  • Using more than one cloth a day, or keeping a used one: One cloth is the dose; a used one is not clean or reliable.
  • Applying it anywhere other than the underarms: Not made for palms, soles, face or groin.
  • Showering or swimming straight after applying: Let it dry first.
  • Applying it for someone else and not washing your hands: Same rule for a parent applying it to a child.

Monitoring

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No blood tests or laboratory monitoring for routine use.

Monitoring is a conversation at about four weeks — is the sweating better, and are the anticholinergic effects tolerable. Dry mouth is commonest, then blurred vision, then constipation and trouble passing urine.

Some people need more care — anyone with glaucoma, particularly the narrow-angle form, because anticholinergics can raise pressure inside the eye; anyone with an enlarged prostate or bladder outflow problems, myasthenia gravis, severe ulcerative colitis or a bowel obstruction; and older people already on several medicines with anticholinergic effects, where total exposure matters, not any one drug.

Sweating is how the body cools; take care in hot weather and hard exercise.

If You Stop

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There is no taper and no rebound. Sweating returns to its previous level within a few days — the nerve signal was blocked, not the gland removed. Dry mouth, blurred vision or constipation settles once you stop, usually within days. People stop for two reasons: underarm irritation and dry mouth. Neither is dangerous, and both are worth raising at a review before concluding the drug failed.

Cost

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Brand only in the United States, no generic cloth, and expensive. Coverage is inconsistent and prior authorization is common — plans often ask that a prescription-strength antiperspirant was tried first. It comes as a box of single-use cloths used daily, so the cost recurs monthly rather than once. Manufacturer savings programs exist and change often. Glycopyrrolate tablets are inexpensive by comparison, which is one reason they are still used off-label for sweating despite the wider side effects.

Ask Your Doctor

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If you are pregnant or breastfeeding
Not studied in pregnancy. Ask the doctor managing your pregnancy before starting or continuing.
If you have glaucoma
Narrow-angle especially. Anticholinergics can raise pressure inside the eye.
If you have an enlarged prostate
Trouble passing urine counts too. Anticholinergics worsen it and can rarely cause retention.
If you have myasthenia gravis
Severe ulcerative colitis or a bowel problem counts too. Anticholinergics affect all of these.
If you take other anticholinergics
Some antihistamines, bladder medicines, older antidepressants and Parkinson's medicines add to the same effect. The total matters.
If your vision blurs
Or one pupil looks larger than the other. Usually transfer from the hands, and it settles, but get it checked.
If you work in heat or exercise hard
Sweating is how the body cools, and anticholinergics reduce that ability.
If the underarm skin becomes raw
Or does not settle. Irritation is the commonest reason for stopping, and it can be managed before giving up.

How It Compares

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Botulinum toxin injections
Better
And the most reliable option for underarm sweating, given as a set of small injections every four to six months in a clinic. Expensive, though coverage for underarm hyperhidrosis is often better than for the cloth.
Glycopyrrolate or oxybutynin tablets
Different job
Useful when several areas sweat, with reasonable if less formal evidence. The same anticholinergic effects as the cloth, felt more strongly because the whole body is exposed.
Iontophoresis
Different job
Good evidence for palms and soles and much less practical for underarms. No drug involved, but it needs a device and repeated sessions at home.
Microwave treatment such as miraDry
The same
Reduces underarm sweat glands lastingly in one or two sessions, with good evidence. It is a procedure, with swelling and soreness afterwards, it is expensive, and it is not reversible.
Qbrexza's case
Different job
It is a once-daily wipe with no needles and no device. Its limits are that it treats one area, has to be used continuously, and brings anticholinergic effects with it.

Myths

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  • "It blocks the sweat glands." It blocks the nerve message that switches them on. The glands are unchanged, so the effect goes within days.
  • "It is just a stronger antiperspirant." Different mechanism. Antiperspirants plug the duct with aluminum salts; this blocks the signal. They can be used together.
  • "Sweating this much is anxiety." It starts in childhood or the teens, runs in families, and happens without a trigger. Anxiety makes it worse but does not cause it.
  • "You can use it on your hands and feet." Approved for the underarms only, and the hands are where it gets into your eyes.
  • "Blurred vision means something is seriously wrong." Usually the drug reached the eye on a fingertip, and it wears off. Report it; prevent it by washing your hands.
  • "Stopping sweat in one place is dangerous." Treating both underarms does not stop the body cooling. Care in extreme heat is sensible with any anticholinergic.

Questions Patients Ask

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Why do I have to wash my hands after using it?

Because the drug works wherever it lands. Rubbing an eye with it on your fingers can dilate that pupil and blur near vision for hours or a couple of days. Wash with soap and water straight after.

Does it stop me sweating everywhere?

No. It works where you apply it, approved for the underarms only. Some is absorbed — hence dry mouth — but it is not a body-wide blocker.

How long does it take to work?

Most people notice less wetness in the first week. Four weeks is the fair point to judge, where the trials measured.

Can I use my antiperspirant as well?

Yes — different mechanisms, often used together, antiperspirant in the morning and the cloth at night.

What happens if I stop?

Sweating returns to its usual level within a few days. No rebound, nothing to taper.

Can I use it on my hands or face?

Not approved or studied for those areas, and on the hands it gets into your eyes far more easily.

References

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