Medication Guide App

Aluminum Chloride Hexahydrate topical

Class: Astringents
VA Class: DE450
Chemical Name: Aluminum chloride, hexahydrate
Molecular Formula: AlCl3•6H2O
CAS Number: 7784-13-6, 7446-70-0
Brands: Certain Dri, Drysol, Hypercare, Xerac AC

Introduction

Antiperspirant.2 11 13 14 15

Uses for Aluminum Chloride Hexahydrate

HyperHIDrosis

Topical treatment of hyperHIDrosis.1 2 4 5 6 7 8 9 10 11 13 14 15

HyperHIDrosis (excessive sweating) may be primary (physiologic, idiopathic, essential; possibly hereditary) or secondary (associated with an underlying condition).5 7 8 9 10 14 Secondary hyperHIDrosis is associated with neurologic, endocrinologic, metabolic, or other such disorders; febrile illness; malignancy; or drugs.5 7 8 9 10 14

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HyperHIDrosis is classified as focal or generalized.5 Focal hyperHIDrosis most commonly affects the palms and soles (palmar-plantar hyperHIDrosis) and underarms (axillary hyperHIDrosis), and least commonly affects the face (craniofacial hyperHIDrosis).5 7 8 9 10 14 Generalized hyperHIDrosis involves the entire body and usually is associated with an underlying condition.10

Generally considered first-line therapy for mild or moderate primary focal hyperHIDrosis, including axillary5 7 8 10 11 13 14 and palmar-plantar hyperHIDrosis.7 8 10 11 14 An adequate trial of topical aluminum chloride usually is recommended before other therapeutic options (e.g., botulinum toxin injections, iontophoresis, local excision, liposuction, sympathectomy) considered.7 8 9 10 11 In severe cases of axillary, palmar, or plantar hyperHIDrosis, some clinicians state that aluminum chloride hexahydrate, botulinum toxin injections, or iontophoresis are considered first-line therapy.8

One of several options for treatment of craniofacial hyperHIDrosis.1 7 8

Self-medication (Certain Dri, OTC use) for axillary hyperHIDrosis only.15

Aluminum Chloride Hexahydrate Dosage and Administration

Administration

Topical Administration

Preparations are for external use only.1 2 4 15

Apply topically to the skin as a solution1 2 4 or as an antiperspirant stick.15

Avoid contact with eyes.1 2 4 7 15 If contact occurs, wash affected eye(s) thoroughly with water.1 2

Apply to dry, intact skin only; do not apply to any irritated, broken, or recently shaven areas.1 2 4 5 6 7 8 9 11 15 May use a hairdryer on warm setting to dry the skin.1 2

Do not apply other deodorants or antiperspirants to treatment area.1 2

For optimum effect, apply at bedtime when sweat glands are least active.1 2 4 8 9 10 11 13 15

Apply solution using fingers, moistened cotton ball, or applicator (Dab-O-Matic) supplied by manufacturer.1 2 4 If using the Dab-O-Matic applicator, remove and discard protective cap prior to use.1 2 4 Push applicator into bottle and twist white cap to secure in place.2 4

Consult individual manufacturer’s prescribing or patient information for complete instructions regarding proper drug application and removal.1 2 4 7 15

Dosage

Adults

HyperHIDrosis
Axillary, Palmar, Plantar, or Craniofacial HyperHIDrosis
Topical

Apply solution to completely dry affected area (e.g., underarms, palms, soles, scalp) once daily at bedtime.1 2 4 5 7 8 9 11

To minimize irritation when using the solution, let alcohol evaporate1 2 (may use a hairdryer on cold setting when administered under arms);1 a thin film of drug should remain on skin.1 2

To prevent drug from rubbing off, cover treated area with a T-shirt for axillary application;1 2 4 5 use a plastic shower cap for scalp application1 5 or plastic wrap and overlying gloves or socks for palmar or plantar application, respectively.1 4 5 14 Do not use adhesive tape.1 4 Some clinicians state that occlusion is not necessary and may increase risk of skin irritation.9 11 (See Dermatologic Effects under Cautions.)

After 6–8 hours (usually the following morning), remove garments and/or plastic wrap; to prevent irritation, wash treatment area(s) thoroughly with soap and water or shampoo.1 2 4 5 6 7 9 10 14 Some clinicians also suggest topical application of sodium bicarbonate.6 Dry with towel.1

Repeat applications for ≥2 consecutive nights until desired effect (lack of sweating) achieved.1 4 5 6 7 9 11 Thereafter, may apply additional treatments once or twice weekly as needed.1 4 5 9

Self-medication for Axillary HyperHIDrosis
Topical

Apply sparingly (i.e., a few strokes) to affected areas under each arm.15 Dry skin completely prior to application.15

Allow solution to dry following application.15

May repeat treatment until desired effect achieved.15 Thereafter, apply every other day or as needed.15

Cautions for Aluminum Chloride Hexahydrate

Contraindications

  • Known hypersensitivity to aluminum chloride hexahydrate or any ingredient in the formulation.6

Warnings/Precautions

Warnings

Administration

Self-medication: Apply Certain Dri to underarms only.15 (For further information on warnings and precautions associated with administration of aluminum chloride hexahydrate (Drysol, Xerac AC, and Hypercare) and aluminum chloride [Certain Dri], see Topical Administration under Dosage and Administration.)

Flammability

Aluminum chloride solutions are flammable; do not use near an open flame.1 2 4

Sensitivity Reactions

Dermatologic Effects

Possible local irritation (e.g., burning, stinging, itching, tingling);1 2 4 7 8 10 13 14 usually resolves with temporary discontinuance of drug.1 2 4 Because risk of skin sensitivity increases with higher concentrations, some patients may benefit from an initial trial with reduced concentrations (10–12%) of aluminum chloride hexahydrate.7 8

To minimize skin irritation, follow specific instructions provided by each manufacturer on proper drug application and removal.1 2 4 7 10 Ensure that skin is completely dry prior to and following drug application.1 2 4 5 7 9 11 15 (See Topical Administration under Dosage and Administration.)

If rash or skin reaction develops during therapy, discontinue use and consult a clinician.1 2 4 15 Topical sodium bicarbonate or a low-dose corticosteroid cream (e.g., 1% hydrocortisone) may be used to limit or treat irritation.6 7 9 11 14 Other measures include decreasing concentration or frequency of applications.7 If persistent skin irritation occurs, refer patient to a dermatologist.7

General Precautions

Fabric or Metal Stains

May be harmful to certain fabrics (e.g., cotton) or metals.1 2 4 11 13 15 Allow skin to dry completely following application and thoroughly wash off any residual drug after 6–8 hours of treatment to avoid damage to clothing.1 15

Specific Populations

Pregnancy

The manufacturer of Drysol and Xerac AC states that there is no pregnancy category for these drugs; however, they recommend that the drug not be used in pregnant women.3

Pediatric Use

Keep preparations out of reach of children.1 2 4 15 16

Infants (especially preterm infants) and children may be at greater risk of aluminum exposure because of immature renal function.16

Renal Impairment

Possible increased exposure to any systemically absorbed aluminum in patients with renal impairment; patients with renal impairment should consult a clinician before use.16 (See Bioavailability and Special Populations under Pharmacokinetics.)

Common Adverse Effects

Local skin irritation (burning, stinging, itching, tingling).1 7 8 10 11 13 14

Aluminum Chloride Hexahydrate Pharmacokinetics

Absorption

Bioavailability

One manufacturer states that drug is not absorbed; however, some clinicians state that minimal systemic absorption may occur when applied topically.16 17

Onset

Following topical application of aluminum chloride hexahydrate 20% solution to the palms, reduced sweating occurs within 48 hours.10 14

Duration

Following topical application of aluminum chloride hexahydrate 20% to the palms, effects of reduced sweating diminish or disappear within 48 hours after discontinuance of therapy.10 14

Elimination

Elimination Route

Absorbed aluminum is eliminated principally by the kidneys.17

Special Populations

Renal impairment: Possible decreased clearance and increased exposure to any absorbed aluminum.16 17

Stability

Storage

Topical

Solution

15–30°C,4 in tightly closed container when not in use (to prevent evaporation).1 2 4

Keep away from open flames.1 2 4

Actions

  • Pathophysiology of focal hyperHIDrosis is poorly understood.8 10

  • Eccrine (sweat) glands are distributed over nearly the entire body surface with high concentrations in palms, soles, and forehead.8 These glands are innervated by cholinergic fibers of the sympathetic nervous system.8 9 10

  • Since patients with focal hyperHIDrosis do not have any histopathologic changes in sweat glands or in their numbers, it has been suggested that a complex dysfunction of the sympathetic nervous system is likely to contribute to hyperHIDrosis.8 10

  • Mechanically blocks eccrine sweat gland ducts,5 6 7 9 10 12 13 14 possibly by forming aluminum ion precipitate complexes within the acrosyringium (most superficial) portion of eccrine glands.12

  • Long-term (≥6 months) use appears to cause dilation and atrophy of secretory cells within eccrine sweat glands.5 12 13 14

  • Does not appear to affect apocrine glands.12

Advice to Patients

  • Importance of avoiding contact with eyes.1 2 4 15 If ocular contact occurs, rinse eye(s) thoroughly with water.1 2

  • Importance of instructing patients on proper technique for application and removal of drug.1 2 4 7 15

  • Importance of discontinuing therapy and informing clinician if a rash or skin reaction occurs.1 2 4 15

  • Importance of patients with renal impairment consulting a clinician before starting or continuing to use antiperspirants containing aluminum because of possible increased exposure to any absorbed aluminum.16

  • Importance of informing clinician if accidental ingestion occurs in a pediatric patient.16

  • Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.1 2 4 15

  • Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs.1 2 4 15

  • Importance of informing patients of other important precautionary information.1 2 4 15 (See Cautions.)

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Aluminum Chloride

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Topical

Stick

12%

Certain Dri

DSE Healthcare Solutions

Aluminum Chloride Hexahydrate

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Topical

Solution

6.25%

Xerac AC (with anhydrous ethyl alcohol 96%)

Person and Covey

20%

Drysol (with anhydrous ethyl alcohol 93%)

Person and Covey

Hypercare

Stratus

AHFS DI Essentials. © Copyright, 2004-2014, Selected Revisions March 1, 2009. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.

References

1. Person and Covey, Inc. Drysol (aluminum chloride hexahydrate) solution prescribing information. Glendale, CA; 2001 Sep 27.

2. Person and Covey, Inc. Xerac AC (aluminum chloride hexahydrate) solution prescribing information. Glendale, CA; 2001 Sep 24.

3. Person and Covey, Glendale,CA: Personal communication.

4. Stratus Pharmaceuticals, Inc. Hypercare (aluminum chloride hexahydrate) solution prescribing information. Miami, FL; undated.

5. Eisenach JH, Atkinson JLD, Fealey RD. HyperHIDrosis: evolving therapies for a well-established phenomenon. Mayo Clin Proc. 2005; 80:657-66. [PubMed 15887434]

6. Thomas I, Brown J, Vafaie J et al. Palmoplantar hyperHIDrosis: a therapeutic challenge. Am Fam Physician. 2004; 69:1117-20. [PubMed 15023010]

7. Hornberger J, Grimes K, Naumann M et al. Recognition, diagnosis, and treatment of primary focal hyperHIDrosis. J Am Acad Dermatol. 2004; 51:274-86. [PubMed 15280848]

8. Solish N, Bertucci V, Dansereau A et al. A comprehensive approach to the recognition, diagnosis, and severity-based treatment of focal hyperHIDrosis: recommendations of the Canadian hyperHIDrosis advisory committee. Dermatol Surg. 2007; 33:908-23. [PubMed 17661933]

9. Stolman LP. Treatment of hyperHIDrosis. Dermatol Clin. 1998; 16:863-9. [PubMed 9891696]

10. Haider A, Solish N. Focal hyperHIDrosis: diagnosis and management. CMAJ. 2005; 172:69-75. [PubMed 15632408]

11. International HyperHIDrosis Society. HyperHIDrosis treatments, antiperspirants. From the IHS Website (www.sweathelp.org/English/PFF_Treatment_Antiperspirants.asp). Accessed January 14, 2008.

12. Hölzle E, Braun-Falco O. Structural changes in axillary eccrine glands following long-term treatment with aluminum chloride hexahydrate solution. Br J Dermatol. 1984; 110:399-403.

13. Tögel B, Greve B, Raulin C. Current therapeutic strategies for hyperHIDrosis: a review. Eur J Dermatol. 2002; 12:219-23.

14. Connolly M, de Berker D. Management of primary hyperHIDrosis, a summary of the different treatment modalities. Am J Clin Dermatol. 2003; 4:681-97. [PubMed 14507230]

15. DSE Healthcare Solutions, LLC. Certain Dri (aluminum chloride) anti-perspirant patient information. Edison, NJ; 2006 Mar.

16. Food and Drug Administration. Antiperspirant drug products for over-the-counter human use; final monograph. 21 CFR Parts 310, 350 and 369. Final Rule. [Docket No. 78N-0064] Fed Regist. 2003; 68:34273-93.

17. Guillard O, Fauconneau B, Olichon D et al. Hyperaluminemia in a woman using an aluminum-containing antiperspirant for 4 years. Am J Med. 2004; 117:956-9. [PubMed 15629736]

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