Effect of Scopolamine Butylbromide on Clozapine-induced Hypersalivation in Schizophrenic Patients: A Case Series

Abstract

Clozapine has been demonstrated to be useful for treating refractory schizophrenia. However, hypersalivation occurs in 31.0–97.4% of the patients treated with clozapine. Accordingly, some patients who are disturbed by their hypersalivation refuse to continue with clozapine treatment. This study investigated the efficacy of the anticholinergic agent scopolamine butylbromide against clozapine-induced hypersalivation. Five schizophrenia patients were coadministered scopolamine butylbromide (30–60 mg/day) for 4 weeks. At the baseline and after 4 weeks’ treatment, we subjectively evaluated hypersalivation using a visual analog scale and objectively assessed it using the Drooling Severity Scale and Drooling Frequency Scale. As a result, improvements in the patients’ Drooling Severity Scale and Drooling Frequency Scale scores, but no improvements in their visual analog scale scores, were observed after scopolamine butylbromide treatment. These results indicate that at least some schizophrenic patients with clozapine-induced hypersalivation would benefit from scopolamine butylbromide treatment. We conclude that clozapine-induced hypersalivation is one factor of stress to patients. Subjective hypersalivation was not improved, but objective hypersalivation was, by scopolamine butylbromide treatment. However, scopolamine butylbromide and clozapine possess anticholinergic effects so clinicians should closely monitor patients who take scopolamine butylbromide.

A Questionnaire-based Study of the Views of Schizophrenia Patients and Psychiatric Healthcare Professionals in Japan about the Side Effects of Clozapine

“… 17 , 18) It usually develops early in the course of treatment. Previous reports have indicated that scopolamine 19) and scopolamine butylbromide 20) (anticholinergic agents) are effective against hypersalivation. However, the treatment of hypersalivation remains incompletely understood.…”

Association BetweenN-Desmethylclozapine and Clozapine-Induced Sialorrhea: Involvement of Increased Nocturnal Salivary Secretion via Muscarinic Receptors byN-Desmethylclozapine

“…However, we observed no significant difference in DSFS scores between anti-cholinergic users and non-users in our clinical study. Anti-cholinergic drug users were taking biperiden or scopolamine butylbromide, which are reportedly effective against CIS (Liang et al, 2010;Takeuchi et al, 2015). This result may be attributed to the fact that most anti-cholinergic drug users took the drug during the day, which might have been less effective against nocturnal sialorrhea.…”

Evaluation of acrylic acid grafting on the loading and release of scopolamine butylbromide from polymeric matrices for future sialorrhea treatment

“…However, future development of a patch should use SBB rather than scopolamine due to the reduced side effects of SBB. 7…”

“…However, different from scopolamine, SBB cannot cross the blood-brain barrier, and therefore does not cause undesired effects in central nervous system. 7 The administration of scopolamine or SBB can be orally, intravenous or transdermal. According to Brown and Laiken, 8 scopolamine can be absorbed effectively when applied transdermal in the retroauricular region, where the major salivary gland is located.…”