Many treatments available for clozapine-related drooling
C L I N I C A L P S Y C H I A T R Y N E W S • N o v e m b e r 2 0 0 8
E V I D E N C E - B A S E D
P S Y C H I A T R I C
M E D I C I N E
Many Treatments Available for Clozapine-Related Drooling
on the patients’ pillows. Three patients
who is finally doing well on clozapine.
failed trials of benztropine or clonidine
vestigators gave lofexidine 0.4 mg/day to
to reducing drooling were switched to in-
a patient with severe drooling because of
tients “reported improvement” and two
the patient’s clothes quickly ceased” (Br.
bining “clozapine” and “sialorrhea or
flow. We were not able to locate any cas-
drooling because of clozapine (Clin.
one-third of patients treated with cloza-
pine (Can. J. Psychiatry 2007;52:377-84).
Patients will complain of drooling, a wet
But is the problem really the result of hy-
persalivation, or are patients having trou-
B Y J A N L E A R D -
B Y L A U R E N C E
response,” versus 67% of patients in the
H A N S S O N , M . D .
G U T T M A C H E R , M . D .
had failed prior trials of agents such as
Five case reports of amitriptyline’s al-
vestigator used a different tactic: adding
leviation of clozapine drooling have been
sulpiride) to clozapine and then reducing
tients reported no benefit; five patients
the clozapine dose and thus this side ef-
reported partial benefit, with the effect
fect (Isr. J. Psychiatry Relat. Sci.
2006;63:128-9). In four cases, amitripty-
patients reported full response ( J. Clin.
col. 2006;21:99-103). “Significant reduc-
in the control group. This difference was
duced” or resolved drooling due to cloza-
A patient with “profound sialorrhea,”
not considered statistically significant.
pine (Br. J. Psychiatry 1991;159:166).
parotid gland in a patient suffering with
tr. Serv. 2004;55:318). Drooling resolved
“entirely within hours and has persisted
clozapine, and in matched controls (Biol.
able to locate the original article (Hosp.
experienced “resolution of hypersaliva-
that clozapine-induced drooling is a result
Psychiatry 1996;39:946-9). No significant
saliva, so the reduction of salivary flow by
parkinsonism—was given to a patient ex-
should be of some benefit, as less saliva
ical antipsychotics at a minimum of 1,000
“eliminated,” as was the sweating (Am.
the night” ( J. Psychiatry Neurosci.
chlorpromazine equivalents ( J. Clin. Psy-
many case reports, with at least partial re-
sponse to anticholinergics (amitriptyline,
ly to reduce salivary and respiratory se-
results were negative, except for mild lip
ment was noted (Lancet 1995;346:1034).
because of clozapine, drooling was “im-
proved” in all cases as judged by patients
and staff observation ( J. Child Adolesc.
likely source of the problem lower in the
system, investigators in India gave cloni-
psychiatrist who practices in San Diego.
DR. GUTTMACHER is chief of psychiatry
the upper limits of normal. Intervals be-
zepine titrated up to 100 mg/day. No dif-
at the Rochester (N.Y.) Psychiatric Center.
8). Clonidine is an α2-adrenergic agonist
They have no financial interest in any
product or service discussed in this
case, the patient complained of difficul-
by the diameter of the saliva wet spot left
Notes sur les technologies de la santé en émergence Le tiotropium : un substitut potentiel à l’ipratropium dans le traitement de la BPCO numéro 35 juillet 2002 Boehringer Ingelheim, Burlington (Ontario), le30 avril 2002) et à la Food and Drug Administration auxÉtats-Unis4, en quête de l’approbation de l’utilisation du9 Dans le traitement de la bronchopneumopathie médicam
Jasco Labs Pvt. Ltd. Plot No. 213, Industrial Area, Phase - I, Chandigarh. PRODUCT NAME AND COMPOSITION ACIPLUS MOUTH WASH (100 ML) 98 BOTTLES PER CASE (ANTISEPTIC ANTIPLAQUE MOUTH FRESHNER) AVEBACT - DS (30 ML) 192 BOTTLES PER CASE (CEFIXIME AND LACTIC ACID BACILLUS DRY SYP) AVEBACT -200 TABLETS (ALU - ALU) 3 STRIPS PER BOX (CEFIXIME TRIHYDRATE U.S.P. EQ. TO CEFIX