How do you treat clozapine hypersalivation?

Data synthesis: Sialorrhea is a common and disabling adverse effect of clozapine use. Current treatment options include topical and oral antimuscarinic medications and α-adrenergic agents. New areas of investigation include glycopyrrolate, botulinum toxin, and substitute benzamide derivatives.

How is Sialorrhea treated?

Surgical intervention, including salivary gland excision, salivary duct ligation, and duct rerouting, provides the most effective and permanent treatment of significant sialorrhea and can greatly improve the quality of life of patients and their families or caregivers.

What is the most serious risk related to clozapine treatment?

The most severe and potentially life-threatening clozapine-related blood dyscrasias is neutropenia, which may eventually develop into clozapine-induced agranulocytosis or granulocytopenia.

When should clozapine be discontinued?

Permanent discontinuation of clozapine treatment is recommended for patients showing evidence of agranulocytosis, myocarditis, cardiomyopathy, or QT prolongation greater than 500 ms if no alternative causes can be found.

What are the current treatment options for clozapine-induced sialorrhea?

Data synthesis: Sialorrhea is a common and disabling adverse effect of clozapine use. Current treatment options include topical and oral antimuscarinic medications and α-adrenergic agents. New areas of investigation include glycopyrrolate, botulinum toxin, and substitute benzamide derivatives.

What are the side effects of clozapine for schizophrenia?

Clozapine is the most effective antipsychotic drug for treating resistant schizophrenia. It is associated with severe adverse effects, such as agranulocytosis and myocarditis, and a lot of less severe but distressing adverse effects such as sialorrhoea and sedation.

How to reduce the severity of clozapine induced hypersalivation?

Chewing sugarless gums may reduce hypersalivation as it promotes swallowing. Elevating the head and sleeping on the side reduces sleep disruption and risk of aspiration. Clozapine-induced hypersalivation occurs in the early stage of treatment and can reduce in severity over time.

Are there any antimuscarinic agents for sialorrhea?

Overall, there are weak data on use of antimuscarinic agents, consisting mostly of small open-label or retrospective studies. Glycopyrrolate, however, demonstrated significant reduction of hypersalivation in a randomized controlled trial.