Sir: Quetiapine fumarate is a dibenzothiazepinederivative antipsychotic with combined antagonism at dopamine (D 1 , D 2) and serotonin type 1 and type 2 (5-HT 1A , 5-HT 2A , 5-HT 2C) receptors. Additionally, quetiapine antagonizes α 1-and α 2-adrenergic and histamine H 1 receptors. Protean binding at the above receptors explains the common side effects, which include hypersomnolence, hypotension, headache, weight gain, and gastrointestinal disturbance. However, to our knowledge, there have been no case reports of quetiapine-induced hypersalivation. We report the case of a patient with schizoaffective disorder taking low-dose quetiapine who developed hypersalivation, which remitted after discontinuation of the drug. We suggest that quetiapine antagonism at the α 2 receptor contributes to the phenomenon of hypersalivation. Case report. Ms. A, a 36-year-old woman of Korean descent with a 16-year history of schizoaffective disorder, was admitted to the adult psychiatric medical care unit with a relapse of mania with psychosis. The patient's symptoms included elated mood, grandiose delusions of being a Power Ranger, disorganized behavior, and decreased need for sleep. The patient had been previously stabilized on clozapine with the only noted side effect being increased sedation. During this hospitalization, the patient refused administration of clozapine and instead was started on risperidone. Within a few days of commencement, the patient developed extrapyramidal symptoms with rigidity, dystonia, and slurring of speech, which prompted discontinuation of the risperidone. After a drug-free period of 3 days, the patient was started on quetiapine 25 mg b.i.d., and within a day, she developed increased salivation. When the dosage was increased to 50 mg b.i.d., the salivation worsened; the patient was drooling most of the day, and all of her clothing was wet. Benztropine (1 mg p.o. b.i.d.) and atropine eye drops (0.1%) sublingually did not reduce the hypersalivation. The quetiapine was stopped, and 1 day later, the hypersalivation resolved.
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