Current Treatment Strategies for Clozapine-Induced Sialorrhea

Bird, Angela M; Smith, Tawny; Walton, Amy E

doi:10.1345/aph.1p761

Cited by 51 publications

(50 citation statements)

References 33 publications

(2 reference statements)

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“…Data from these trials and our retrospective evaluation suggests that more rigorous investigation of FGAs as potential clozapine augmentation agents is needed. The incidence of sialorrhea and urinary incontinence is similar to what has been reported in past literature with clozapine as monotherapy [32]. This accounts in part for the observed concomitant use of anticholinergic agents in nearly 70 % of patients.…”

supporting

confidence: 85%

Antipsychotic Agents used to Augment Clozapine during Long-Term Inpatient Hospitalizations

et al. 2014

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supporting

confidence: 85%

Antipsychotic Agents used to Augment Clozapine during Long-Term Inpatient Hospitalizations

et al. 2014

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“…As with many antipsychotic side effects, using the lowest necessary dose and observing a gradual titration schedule are thought to minimize development of sialorrhea. A number of treatments have been explored, principally antimuscarinic and alpha‐adrenergic agents.…”

Section: Specific Adverse Effectsmentioning

confidence: 99%

Management of common adverse effects of antipsychotic medications

2018

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The benefits of antipsychotic medications are sometimes obscured by their adverse effects. These effects range from relatively minor tolerability issues (e.g., mild sedation or dry mouth) to very unpleasant (e.g., constipation, akathisia, sexual dysfunction) to painful (e.g., acute dystonias) to disfiguring (e.g., weight gain, tardive dyskinesia) to life-threatening (e.g., myocarditis, agranulocytosis). Importantly, adverse effect profiles are specific to each antipsychotic medication and do not neatly fit into first- and second-generation classifications. This paper reviews management strategies for the most frequent side effects and identifies common principles intended to optimize net antipsychotic benefits. Only use antipsychotics if the indication is clear; only continue antipsychotics if a benefit is discernible. If an antipsychotic is providing substantial benefit, and the adverse effect is not life-threatening, then the first management choice is to lower the dose or adjust the dosing schedule. The next option is to change the antipsychotic; this is often reasonable unless the risk of relapse is high. In some instances, behavioral interventions can be tried. Finally, concomitant medications, though generally not desirable, are necessary in many instances and can provide considerable relief. Among concomitant medication strategies, anticholinergic medications for dystonias and parkinsonism are often effective; beta-blockers and anticholinergic medications are useful for akathisia; and metformin may lead to slight to moderate weight loss. Anticholinergic drops applied sublingually reduce sialorrhea. Usual medications are effective for constipation or dyslipidemias. The clinical utility of recently approved treatments for tardive dyskinesia, valbenazine and deutetrabenazine, is unclear.

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“…There is a scarcity of information in the medical literature on established strategies to deal with this issue, and the studies available have methodological problems, such as small sample sizes, a short follow-up period, and the lack of a control group. Syed et al (2008) argue these points as do other researchers (Sockalingam et al, 2007;Bird et al, 2011). We may thus conclude that there are no unequivocal guidelines at this time for the proper treatment of hypersalivation associated with clozapine treatment and neither is there a drug of choice.…”

Section: Hypersalivation (Sialorrhea/drooling)mentioning

confidence: 67%

Pharmacological and behavioral management of some often-overlooked clozapine-induced side effects

Sagy

Weizman

Katz

2014

International Clinical Psychopharmacology

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This article reviews four of the milder but still bothersome side effects of clozapine that are fairly frequent and may have a negative impact on patients' compliance with the treatment regime. We reviewed the available literature on the rate and management of four non-life-threatening side effects of clozapine, including hypersalivation, constipation, tachycardia, and nocturnal enuresis. We found a variety of pharmacological and behavioral strategies to manage these four side effects. There is, however, no consensus on a preferred strategy to control these distressing side effects and there are no guidelines. Psychiatrists should be aware of the relatively high rate of hypersalivation, constipation, tachycardia, and nocturnal enuresis in clozapine-treated patients, of the impact that these side effects may have on patients' quality of life, and should be able to suggest management strategies to the patients.

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Current Treatment Strategies for Clozapine-Induced Sialorrhea

Abstract: Current pharmacologic treatment options for clozapine-induced sialorrhea are limited in number and efficacy. Although few randomized controlled trials have been conducted, this review identifies potential treatment alternatives for this common and sometimes severe adverse effect.

Cited by 51 publications

References 33 publications

Antipsychotic Agents used to Augment Clozapine during Long-Term Inpatient Hospitalizations

Antipsychotic Agents used to Augment Clozapine during Long-Term Inpatient Hospitalizations

Management of common adverse effects of antipsychotic medications

Pharmacological and behavioral management of some often-overlooked clozapine-induced side effects

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