The Effect of Diphemanil Methylsulfate (Prantal) on Hyperhidrosis

Abstract

Many efforts have been made to develop a safe, effective, ambulatory oral treatment to control hyperhidrosis.^1-6 There have been some reports of the therapeutic effectiveness of the quaternary ammonium compounds.^7,8 The sweat glands are controlled by the autonomic sympathetic postganglionic nervous system. They are not adrenergic but, with certain specialized blood vessels, receive postganglionic cholinergic fibers from the paravertebral ganglia. This acetylcholine sweat gland activation explains the pharmacologic effectiveness of cholinergic-blocking agents in reducing hyperhidrosis. The antiacetylcholine activity of quaternary ammonium compounds such as diphemanil methylsulfate (Prantal) and methantheline (Banthine) has been demonstrated in vitro by a modified Magnus Dale technique.⁷ Acetylcholine is itself a quaternary ammonium compound. The formulae of acetylcholine and diphemanil methylsulfate are shown in the Figure; their structural relationship is apparent. This may explain the mechanism of the blocking action of diphemanil methylsulfate in the hypothesized sequence of events by