Sofpironium: treating underarm sweating, how to use it, side effects
Last updated September 7, 2026.
Sofpironium is a prescription anticholinergic gel, sold as Sofdra, that you apply to your underarms to reduce heavy underarm sweating. Sweat glands are switched on by a nerve signal that uses a chemical called acetylcholine, and sofpironium blocks that signal in the skin where you apply it, so the glands release less sweat. Because some of the drug is absorbed, it can cause the same effects anywhere in the body that other anticholinergic medicines cause, including dry mouth, blurred vision, and trouble urinating. The single most important habit is washing your hands with soap and water right after every application, since gel carried to your eye on a fingertip can cause a widened pupil and blurred vision on that side.
What does it treat?
Sofpironium is approved for primary axillary hyperhidrosis, which means excessive underarm sweating that is not caused by another illness or by a medication. The pattern clinicians look for is sweating far beyond what the temperature or your activity level calls for, on both sides, lasting six months or longer, often starting in the teens or twenties, soaking through shirts and pausing while you sleep. It treats the underarms only, so it is not used for sweaty palms, soles, face, or scalp, and it does nothing for night sweats or sweating driven by thyroid disease, infection, menopause, low blood sugar, or another drug. There are no combination products that contain sofpironium. Other options a clinician may compare it with include prescription-strength aluminum chloride antiperspirants, glycopyrronium cloths, oral glycopyrrolate or oxybutynin, botulinum toxin injections, and microwave or energy-based treatments.
How do you take it?
Sofpironium comes as a 12.45 percent topical gel in a metered pump bottle with instructions for use in the carton. For adults and children 9 years and older, the usual dose is one application to each underarm once a day at bedtime, using the pump exactly as the instructions describe and priming the pump before the first use. Spread the gel over the whole underarm, then wash your hands with soap and water right away, and keep your fingers away from your eyes, nose, and mouth until you have done so. The ceiling is one application per underarm in 24 hours, so using extra gel or applying it twice a day does not reduce sweating further and does raise the risk of dry mouth, blurred vision, and urinary problems. Apply it to clean, dry, unbroken skin, avoid freshly shaved or irritated skin, and let it dry before dressing. There are no food rules, since the medicine goes on the skin and not in your mouth. If you miss a night, skip it and apply the next dose at your usual bedtime, and never apply two doses to make up for one. Stop using it and call a doctor if you cannot urinate or feel your bladder is not emptying, if your vision blurs or one pupil looks larger than the other, or if the skin under your arms becomes raw, blistered, or painful.
Side effects to know
- Common: The most common effects are dryness in the mouth, nose, throat, or eyes, and application site changes such as redness, itching, stinging, or dryness in the underarm.
- Serious: Stop the gel and get medical care the same day if you cannot pass urine or are straining and emptying poorly, if vision blurs or a pupil widens and stays that way, or if you develop severe eye pain with redness and halos around lights, which can signal acute angle-closure glaucoma. Get emergency help for signs of a serious allergic reaction, including swelling of the lips, tongue, or throat, widespread hives, or trouble breathing.
Who should not take it?
Sofpironium is not for people with conditions that anticholinergic drugs make worse, including narrow-angle glaucoma, myasthenia gravis, Sjogren syndrome, paralytic ileus, severe ulcerative colitis or toxic megacolon, and unstable cardiovascular status during acute bleeding. Talk to a doctor first if you have an enlarged prostate, a history of urinary retention or a slow stream, chronic constipation or slowed gut motility, dementia, or dry eye that already needs treatment. Tell your clinician about every other anticholinergic you take, since oral glycopyrrolate, oxybutynin or tolterodine for bladder symptoms, benztropine or trihexyphenidyl, scopolamine patches, tricyclic antidepressants such as amitriptyline, and sedating antihistamines such as diphenhydramine or hydroxyzine all stack with it and multiply dry mouth, blurred vision, constipation, and urinary retention. There are no adequate human data on sofpironium in pregnancy or breastfeeding, so the current FDA labeling gives no established safe use in either situation and the decision is one to make with your clinician. If you are nursing and using it, wash your hands after each application and keep your baby's face and hands off treated skin. Alcohol does not interact with the gel directly, but it adds to dry mouth and lightheadedness, so go easy on the nights you drink and do not drive or use machinery while your vision is blurred. Do not use it in children under 9 years old.
When is it an emergency?
Call 911 if you collapse, have trouble breathing, or have swelling of the face, lips, tongue, or throat with hives after applying the gel. If anyone swallows the gel, especially a child, call Poison Control at 1-800-222-1222 right away, and call 911 if the person is confused, hallucinating, very agitated, has a racing heartbeat, or has hot dry skin with a rising temperature and no sweating, which are signs of anticholinergic poisoning. Go to an emergency room for sudden severe eye pain with a red eye, halos around lights, nausea, and lost or blurred vision, and for a completely blocked bladder with lower belly pain and no urine output despite the urge to go. If gel gets in your eye, rinse it with water and call a doctor if blurred vision or a widened pupil is still there the next day.
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Common questions
What is the maximum amount of sofpironium I can use?
One application to each underarm, once a day at bedtime, is the maximum. Use the metered pump exactly as the instructions for use in your carton describe, and do not add a second application in the morning. Extra gel does not dry you out faster because the sweat glands in the treated skin are already blocked, and it does push more drug into your bloodstream, which is what causes dry mouth, blurred vision, and urinary retention. If one nightly application is not controlling your sweating after about six weeks, ask about a different treatment rather than using more.
Can I drink alcohol while using sofpironium?
There is no direct interaction between alcohol and sofpironium, and you do not have to give up drinking. Both cause dryness, so you will notice more dry mouth and thirst on nights you drink. Alcohol also adds to lightheadedness, and this gel can blur your vision, so do not drive if either effect is present. Skip driving and machinery entirely on any day your vision is not sharp.
Is sofpironium safe in pregnancy or while breastfeeding?
There are no adequate human studies of sofpironium in pregnancy, so the FDA label does not establish that it is safe, and no risk level has been assigned. Heavy underarm sweating is uncomfortable but not dangerous, so many clinicians pause the gel during pregnancy and use a strong antiperspirant instead. It is not known whether sofpironium passes into breast milk. If you use it while nursing, wash your hands with soap and water immediately after applying and keep your baby's face and hands away from your underarms. Bring this up with your obstetrician or midwife before you continue.
Do I need to take it with food, and when should I shave or shower?
Food rules do not apply, since this is a gel you put on your skin and not a pill. Apply it at bedtime to clean, dry underarm skin, and let it dry before you put on a shirt. Do not apply it to skin you just shaved or to skin that is broken, cut, raw, or already irritated, and shave earlier in the day or on a night you skip if your skin is sensitive. Showering in the morning is fine, and washing the treated area right after applying at night is not, because the gel needs to stay in contact with the skin.
What are the signs of too much sofpironium or of swallowing it?
Too much absorbed drug shows up as strong dry mouth, blurred vision, widened pupils, constipation, difficulty urinating, a fast heartbeat, and reduced sweating in the rest of your body, which can make you overheat in hot weather. Swallowing the gel can cause the same effects much more intensely, along with confusion, hallucinations, agitation, hot dry skin, and fever. Call Poison Control at 1-800-222-1222 immediately if anyone swallows it, and call 911 for confusion, a racing heart, a rising temperature, or trouble breathing. Store the bottle where children cannot reach it.
What medicines interact with sofpironium?
The interactions that matter are other drugs with anticholinergic activity, because their effects add together. That list includes oral glycopyrrolate, oxybutynin, tolterodine and similar bladder medicines, benztropine and trihexyphenidyl, scopolamine patches, tricyclic antidepressants such as amitriptyline and nortriptyline, and sedating antihistamines such as diphenhydramine, hydroxyzine, and the older cold and sleep products that contain them. Taken together with the gel, they raise your risk of urinary retention, constipation, blurred vision, and confusion, especially if you are older. Give your clinician or pharmacist a full list of your prescriptions and over-the-counter products, including sleep aids, before you start.