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Many treatments available for clozapine-related drooling

Adult Psychiatry
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 The Problem
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 The Question
to reducing drooling were switched to in- a patient with severe drooling because of tients “reported improvement” and two The Analysis
the patient’s clothes quickly ceased” (Br.
bining “clozapine” and “sialorrhea or flow. We were not able to locate any cas- The Evidence
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 (Psychopharmacology 2006;185:265-73).
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 The Conclusion
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

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