Qbrexza 2.4% External Pads 30s
It is used to lower underarm sweating.
Drug Class
Antiperspirant
Pharmacologic Class
Anticholinergic; Antimuscarinic
Pregnancy Category
Not available
FDA Approved
Sep 2018
DEA Schedule
Not Controlled
Overview
What is this medicine?
Qbrexza is a medicated cloth used to reduce excessive underarm sweating. It contains a medicine called glycopyrronium, which works by blocking the signals that tell your sweat glands to produce sweat.
How to Use This Medicine
Proper Use of This Medication
To use this medication correctly, follow your doctor's instructions and read all provided information carefully. It is essential to use this medication as directed.
Application Instructions
Apply this medication only to your skin, specifically to the underarm area. Avoid getting it in your mouth, nose, or eyes, as it may cause burning.
Wash your hands before and after applying the medication.
Clean the affected area before use and dry it thoroughly.
To apply, wipe the medication across each underarm once, using the same cloth for both underarms.
Do not apply this medication to areas other than the underarm.
If you accidentally get the medication in your eyes, it may cause large pupils and blurred vision. If this occurs, seek medical attention.
Avoid applying this medication to open sores or broken skin.
Unless instructed by your doctor, do not cover the treated area with bandages or dressings.
Storage and Disposal
Store this medication at room temperature in a dry place, avoiding storage in a bathroom.
Protect the medication from heat and open flames.
Keep all medications in a safe location, out of the reach of children and pets.
Missed Dose Instructions
If you miss a dose, apply it as soon as you remember.
If it is close to the time for your next scheduled dose, skip the missed dose and resume your regular application schedule.
Do not use more than one dose of this medication within a 24-hour period.
To use this medication correctly, follow your doctor's instructions and read all provided information carefully. It is essential to use this medication as directed.
Application Instructions
Apply this medication only to your skin, specifically to the underarm area. Avoid getting it in your mouth, nose, or eyes, as it may cause burning.
Wash your hands before and after applying the medication.
Clean the affected area before use and dry it thoroughly.
To apply, wipe the medication across each underarm once, using the same cloth for both underarms.
Do not apply this medication to areas other than the underarm.
If you accidentally get the medication in your eyes, it may cause large pupils and blurred vision. If this occurs, seek medical attention.
Avoid applying this medication to open sores or broken skin.
Unless instructed by your doctor, do not cover the treated area with bandages or dressings.
Storage and Disposal
Store this medication at room temperature in a dry place, avoiding storage in a bathroom.
Protect the medication from heat and open flames.
Keep all medications in a safe location, out of the reach of children and pets.
Missed Dose Instructions
If you miss a dose, apply it as soon as you remember.
If it is close to the time for your next scheduled dose, skip the missed dose and resume your regular application schedule.
Do not use more than one dose of this medication within a 24-hour period.
Lifestyle & Tips
- Apply only to the underarms. Do not apply to other areas of the body.
- Wash hands immediately after handling the cloth.
- Avoid contact with eyes, nose, mouth, and other mucous membranes. If contact occurs, rinse thoroughly with water.
- Do not use on broken, irritated, or recently shaved skin.
- Store at room temperature, away from moisture and heat.
Available Forms & Alternatives
Available Strengths:
Dosing & Administration
Adult Dosing
Standard Dose:
Apply one Qbrexza cloth to each axilla once daily
Pediatric Dosing
Neonatal:
Not established
Infant:
Not established
Child:
Apply one Qbrexza cloth to each axilla once daily (for patients 9 years of age and older)
Adolescent:
Apply one Qbrexza cloth to each axilla once daily
Dose Adjustments
Renal Impairment:
Mild:
No adjustment recommended
Moderate:
No adjustment recommended
Severe:
No adjustment recommended
Dialysis:
No adjustment recommended due to minimal systemic absorption
Hepatic Impairment:
Mild:
No adjustment recommended
Moderate:
No adjustment recommended
Severe:
No adjustment recommended
Pharmacology
Mechanism of Action
Glycopyrronium is an anticholinergic drug that inhibits the action of acetylcholine on muscarinic receptors. When applied topically, it inhibits sweat production by blocking the muscarinic receptors in the sweat glands.
Pharmacokinetics
Absorption:
Bioavailability:
Minimal systemic absorption (mean Cmax 0.06 ng/mL)
Tmax:
Approximately 6-8 hours
FoodEffect:
Not applicable for topical administration
Distribution:
Vd:
Not available (due to minimal systemic absorption)
ProteinBinding:
Not available (due to minimal systemic absorption)
CnssPenetration:
Limited
Elimination:
HalfLife:
Approximately 24 hours (systemic)
Clearance:
Not available (due to minimal systemic absorption)
ExcretionRoute:
Primarily renal (for absorbed drug)
Unchanged:
Not available
Pharmacodynamics
OnsetOfAction:
Within 1 week of daily use
PeakEffect:
Within 2-4 weeks of daily use
DurationOfAction:
Maintained with continued daily use
Safety & Warnings
Side Effects
Serious Side Effects: Seek Medical Attention Immediately
Although rare, this medication can cause severe and potentially life-threatening side effects. If you experience any of the following symptoms, contact your doctor or seek medical help right away:
Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Urination problems, including:
+ Trouble passing urine
+ Frequent urination
+ Weak or dripping urine stream
Eye problems, such as:
+ Larger pupils
+ Blurred vision
Reduced sweating in areas other than the underarm, which can lead to:
+ High body temperature
+ Heat stroke
Call your doctor if you experience:
+ Fast or abnormal heartbeat
+ Fast or shallow breathing
+ Fever
+ Hot, red skin
+ Feeling less alert
+ Passing out
+ Lack of sweating during activities or in warm temperatures
Other Possible Side Effects
Like all medications, this drug can cause side effects. While many people may not experience any side effects or only minor ones, it's essential to contact your doctor or seek medical help if you're bothered by any of the following:
Dryness in the:
+ Mouth
+ Skin
+ Eyes
+ Nose
Sore throat
Headache
Redness
Burning or stinging sensation
Itching
Constipation
This list is not exhaustive, and you may experience other side effects not mentioned here. If you have questions or concerns about side effects, contact your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Although rare, this medication can cause severe and potentially life-threatening side effects. If you experience any of the following symptoms, contact your doctor or seek medical help right away:
Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Urination problems, including:
+ Trouble passing urine
+ Frequent urination
+ Weak or dripping urine stream
Eye problems, such as:
+ Larger pupils
+ Blurred vision
Reduced sweating in areas other than the underarm, which can lead to:
+ High body temperature
+ Heat stroke
Call your doctor if you experience:
+ Fast or abnormal heartbeat
+ Fast or shallow breathing
+ Fever
+ Hot, red skin
+ Feeling less alert
+ Passing out
+ Lack of sweating during activities or in warm temperatures
Other Possible Side Effects
Like all medications, this drug can cause side effects. While many people may not experience any side effects or only minor ones, it's essential to contact your doctor or seek medical help if you're bothered by any of the following:
Dryness in the:
+ Mouth
+ Skin
+ Eyes
+ Nose
Sore throat
Headache
Redness
Burning or stinging sensation
Itching
Constipation
This list is not exhaustive, and you may experience other side effects not mentioned here. If you have questions or concerns about side effects, contact your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Seek Immediate Medical Attention If You Experience:
- Severe dry mouth
- Blurred vision or difficulty focusing
- Difficulty urinating or painful urination
- Severe constipation
- Worsening of glaucoma symptoms
- Severe skin irritation at the application site
Before Using This Medicine
Before Taking This Medication: Important Information to Share with Your Doctor
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances. Be sure to describe the symptoms you experienced.
Certain health conditions, such as:
+ Glaucoma
+ Heart problems caused by bleeding
+ Myasthenia gravis
+ Sjogren's disease
+ Stomach or bowel problems, including bowel block, enlarged colon, or ulcerative colitis
If you are not sweating normally during physical activity or in warm temperatures.
If you are taking other medications called anticholinergics, such as ipratropium or oxybutynin. If you are unsure whether any of your medications fall into this category, consult your doctor.
This list is not exhaustive, and it is crucial to discuss all your medications (prescription, over-the-counter, natural products, and vitamins) and health problems with your doctor and pharmacist. They will help determine whether it is safe to take this medication with your other medications and health conditions. Never start, stop, or change the dose of any medication without first consulting your doctor.
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances. Be sure to describe the symptoms you experienced.
Certain health conditions, such as:
+ Glaucoma
+ Heart problems caused by bleeding
+ Myasthenia gravis
+ Sjogren's disease
+ Stomach or bowel problems, including bowel block, enlarged colon, or ulcerative colitis
If you are not sweating normally during physical activity or in warm temperatures.
If you are taking other medications called anticholinergics, such as ipratropium or oxybutynin. If you are unsure whether any of your medications fall into this category, consult your doctor.
This list is not exhaustive, and it is crucial to discuss all your medications (prescription, over-the-counter, natural products, and vitamins) and health problems with your doctor and pharmacist. They will help determine whether it is safe to take this medication with your other medications and health conditions. Never start, stop, or change the dose of any medication without first consulting your doctor.
Precautions & Cautions
It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication.
When starting this medication, avoid driving and other activities that require alertness and clear vision until you understand how it affects you.
Be cautious in hot weather or during physical activity, as this can lead to fluid loss. To prevent dehydration, drink plenty of fluids.
This medication is flammable, so it's crucial to keep it away from open flames and not to use it while smoking.
If the medication comes into contact with your eyes, you may experience blurred vision, dilated pupils, or uneven pupil size. These effects are usually temporary, resolving within one week. To minimize the risk of eye exposure, wash your hands thoroughly after handling the medication. Dispose of used wipes in a secure trash can, out of reach of children and pets.
If you are pregnant, planning to become pregnant, or are breastfeeding, consult your doctor to discuss the potential benefits and risks of this medication to both you and your baby.
When starting this medication, avoid driving and other activities that require alertness and clear vision until you understand how it affects you.
Be cautious in hot weather or during physical activity, as this can lead to fluid loss. To prevent dehydration, drink plenty of fluids.
This medication is flammable, so it's crucial to keep it away from open flames and not to use it while smoking.
If the medication comes into contact with your eyes, you may experience blurred vision, dilated pupils, or uneven pupil size. These effects are usually temporary, resolving within one week. To minimize the risk of eye exposure, wash your hands thoroughly after handling the medication. Dispose of used wipes in a secure trash can, out of reach of children and pets.
If you are pregnant, planning to become pregnant, or are breastfeeding, consult your doctor to discuss the potential benefits and risks of this medication to both you and your baby.
Overdose Information
Overdose Symptoms:
- Severe dry mouth
- Blurred vision
- Dilated pupils
- Urinary retention
- Constipation
- Flushing
- Increased heart rate
- Fever
- Central nervous system effects (e.g., confusion, agitation, hallucinations)
What to Do:
Seek immediate medical attention or call a poison control center (1-800-222-1222). Treatment is supportive and symptomatic. Physostigmine may be considered in severe cases of central anticholinergic syndrome.
Drug Interactions
Moderate Interactions
- Other anticholinergic medications (e.g., atropine, scopolamine, tricyclic antidepressants, phenothiazines, quinidine, disopyramide, some antihistamines)
Monitoring
Baseline Monitoring
Severity of axillary hyperhidrosis
Rationale: To establish baseline and assess treatment efficacy
Timing: Prior to initiation of therapy
Routine Monitoring
Local skin reactions (e.g., erythema, burning, stinging, pruritus)
Frequency: Daily, with each application
Target: Minimal to none
Action Threshold: Discontinue use if severe or persistent irritation occurs
Signs of systemic anticholinergic effects (e.g., dry mouth, blurred vision, urinary retention, constipation)
Frequency: Periodically, especially during initial treatment
Target: Absence of significant symptoms
Action Threshold: Reduce frequency of application or discontinue if bothersome or severe symptoms occur
Symptom Monitoring
- Dry mouth
- Blurred vision
- Urinary retention
- Constipation
- Local skin irritation (erythema, burning, stinging, pruritus)
- Headache
- Sore throat
Special Patient Groups
Pregnancy
Use during pregnancy should be considered only if the potential benefit justifies the potential risk to the fetus. Minimal systemic absorption is expected.
Trimester-Specific Risks:
First Trimester:
Risk is generally low due to minimal systemic absorption, but data are limited.
Second Trimester:
Risk is generally low due to minimal systemic absorption, but data are limited.
Third Trimester:
Risk is generally low due to minimal systemic absorption, but data are limited.
Lactation
It is not known whether glycopyrronium is excreted in human milk. Due to minimal systemic absorption, infant exposure is expected to be low. Caution should be exercised.
Infant Risk:
Low risk, but monitor for anticholinergic effects in the infant (e.g., dry mouth, constipation).
Pediatric Use
Approved for patients 9 years of age and older. Safety and effectiveness have not been established in pediatric patients under 9 years of age.
Geriatric Use
Use with caution in elderly patients due to increased sensitivity to anticholinergic effects (e.g., urinary retention, constipation, cognitive impairment).
Clinical Information
Clinical Pearls
- Qbrexza pads are for topical use only and should not be ingested.
- Ensure skin is clean and dry before application for optimal efficacy.
- Patients should be advised to wash their hands thoroughly after applying the product to avoid accidental transfer to eyes or other mucous membranes.
- Inform patients about potential systemic anticholinergic side effects, even with topical application, and when to seek medical advice.
- This product is specifically for axillary (underarm) hyperhidrosis and should not be used for sweating in other body areas.
Alternative Therapies
- Aluminum chloride hexahydrate topical (e.g., Drysol)
- Botulinum toxin injections (e.g., Botox)
- Oral anticholinergics (e.g., oxybutynin, glycopyrrolate - systemic)
- Iontophoresis
- Surgical sympathectomy (for severe cases)
Cost & Coverage
Average Cost:
Approximately $600 - $800 per 30 pads
Insurance Coverage:
Tier 3 or Specialty
General Drug Facts
If your symptoms or health issues persist or worsen, it is essential to contact your doctor for further guidance. To ensure your safety, never share your medication with others or take someone else's medication. Some medications may come with an additional patient information leaflet, so it's a good idea to check with your pharmacist for more information. If you have any questions or concerns about this medication, don't hesitate to reach out to your doctor, nurse, pharmacist, or other healthcare provider. In the event of a suspected overdose, immediately call your local poison control center or seek medical attention. When reporting the incident, be prepared to provide details about the medication taken, the amount, and the time it occurred.