Antimuscarinic toxicity secondary to moist towelettes containing glycopyrronium tosylate: a case report

Glycopyrronium is an antimuscarinic drug that is available in a moist towelette preparation for the treatment of primary axillary hyperhidrosis, which is characterized by excessive sweating on the palms, soles of feet, and axillary region. Antimuscarinic toxicity is uncommon with therapeutic use. A 25-year-old female presented to the emergency department with urinary retention and visual changes after initiating topical glycopyrronium tosylate therapeutically. She was tachycardic with a heart rate of 115 beats/min and required a Foley catheter for urinary retention of over 1200 mL. She received 1.5 mg physostigmine for antimuscarinic symptoms and her heart rate improved. Despite treatment, she required a Foley catheter for four days with eventual improvement. This case demonstrates side effects of an unusual preparation of glycopyrronium and the need to take a detailed topical medication history in patients with antimuscarinic symptoms.