Pharmacological Interventions for Clozapine-induced Hypersalivation

Sheriff, Rebecca Syed; Au, Katie; Cahill, Caroline; Duggan, Lorna; He, Ya‐Ling; Udu, Victor; Xia, Jun

doi:10.1093/schbul/sbn043

Cited by 8 publications

(5 citation statements)

References 1 publication

(1 reference statement)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Some authors even question the hypersalivation and instead relate the phenomenon to the pooling of saliva because of a weakened swallowing reflex (McCarthy and Terkelsen, 1994; Pearlman, 1994). Clinical studies that have actually measured the flow of saliva are few in number, and, moreover, the data are not consistent (Sockalingam et al , 2007; Syed Sheriff et al , 2008). Despite drooling in the groups of schizophrenic patients on clozapine in the studies of Ben‐Aryeh et al (1996) and Rabinowitz et al (1996), the mean salivary flow rate at rest was not different from that of controls.…”

Section: Introductionmentioning

confidence: 99%

Atypical antipsychotics – effects of amisulpride on salivary secretion and on clozapine‐induced sialorrhea

Godoy¹,

Riva²,

Ekström³

2012

Oral Diseases

View full text Add to dashboard Cite

show abstract

Section: Introductionmentioning

confidence: 99%

Atypical antipsychotics – effects of amisulpride on salivary secretion and on clozapine‐induced sialorrhea

Godoy¹,

Riva²,

Ekström³

2012

Oral Diseases

View full text Add to dashboard Cite

show abstract

“…More detailed findings are to be reported in the full version of this review. 1 Of the other interventions, oryzanol (rice bran oil and rice embryo oil extract) showed benefit over the antimuscarinic doxepin in terms of ''no clinically important change'' (n = 104, 1 RCT, RR 0.45, CI 0.27 to 0.75, NNT 4, CI 2 to 7). The Chinese medicine Suo quo wan (comprises spicebush root, Chinese yam, and bitter cardamom) showed benefit over doxepin (n = 70, 1 RCT, RR ''no clinically important change'' 0.31, CI 0.16-0.59, NNT 3, CI 1.5 to 3.7).…”

Section: Resultsmentioning

confidence: 99%

Pharmacological Interventions for Clozapine-induced Hypersalivation

Sheriff¹,

Cahill

et al. 2007

Schizophrenia Bulletin

Self Cite

View full text Add to dashboard Cite

“…Moreover, reduced swallowing secondary to reduced motility of the gastrointestinal system, including the esophagus, may also play a role in the pathogenesis of CAS. 13,34,36 Lastly, clozapine may interact with circadian rhythms of salivary flow, which could result in hypersalivation at night. 37 Therefore, the main pharmacologic mechanism behind the effectiveness of studied medications is their nonselective, competitive, muscarinic receptor antagonist activity.…”

Section: Discussionmentioning

confidence: 99%

“…Third, the blockade of these receptors in the salivary glands may lead to unopposed β-receptors. Moreover, reduced swallowing secondary to reduced motility of the gastrointestinal system, including the esophagus, may also play a role in the pathogenesis of CAS 13,34,36 . Lastly, clozapine may interact with circadian rhythms of salivary flow, which could result in hypersalivation at night 37 .…”

Section: Discussionmentioning

confidence: 99%

Evaluation and Comparison of the Effectiveness of Atropine Eye Drops, Ipratropium Bromide Nasal Spray, and Amitriptyline Tablet in the Management of Clozapine-Associated Sialorrhea in Patients With Refractory Schizophrenia: A Randomized Clinical Trial

Mohammad-Gholizad,

Karimzadeh,

Moghimi-Sarani

et al. 2024

J Clin Psychopharmacol

View full text Add to dashboard Cite

Purpose Clozapine, a second-generation antipsychotic medication, is mainly indicated for managing treatment-resistant schizophrenia. Among all the nonthreatening adverse effects of clozapine, sialorrhea is a stigmatizing complication occurring in approximately 31.0% to 97.4% of patients. In this study, 2 topical agents (atropine eye drop and ipratropium nasal spray) and a systemic medication (amitriptyline) were compared simultaneously for the management of clozapine-associated sialorrhea. Methods We conducted a randomized, single-blinded, non–placebo-controlled clinical trial from June 2022 to January 2023. Eligible patients were randomly allocated into 3 mentioned groups. Patients were monitored for sialorrhea weekly based on scales, including the Toronto Nocturnal Hypersalivation Scale, Clinical Global Impression-Improvement, and Clinical Global Impression-Severity for 1 month. Possible adverse drug reactions and adherence were also recorded. Results Twenty-four patients, including 6, 10, and 8 individuals in ipratropium bromide nasal spray, atropine eye drop, and amitriptyline groups, completed the study, respectively. The cohort's demographic, baseline clinical, and sociocultural characteristics were comparable among the 3 groups. Within-group comparisons, between times baseline and week 4, demonstrated that significant differences were in groups atropine and amitriptyline based on Toronto Nocturnal Hypersalivation Scale, in 3 groups based on Clinical Global Impression-Improvement, and also in only-atropine group based on Clinical Global Impression-Severity. Likewise, between-group comparisons showed that atropine was significantly more effective in clozapine-associated sialorrhea management than amitriptyline and ipratropium, in the first 2 weeks and second 2 weeks of study, respectively. Regarding safety, the interventions were tolerated relatively well. Conclusions Conclusively, atropine is more efficacious than amitriptyline, within the first 2 weeks of study and also relative to ipratropium, overall. As time effect was significant between atropine and amitriptyline, according to analysis of covariance test, further investigation with longer follow-up duration would be prudent. In addition, expanding patient population with larger sample size should be conducted for more precision.

show abstract

Pharmacological Interventions for Clozapine-induced Hypersalivation

Cited by 8 publications

References 1 publication

Atypical antipsychotics – effects of amisulpride on salivary secretion and on clozapine‐induced sialorrhea

Atypical antipsychotics – effects of amisulpride on salivary secretion and on clozapine‐induced sialorrhea

Pharmacological Interventions for Clozapine-induced Hypersalivation

Evaluation and Comparison of the Effectiveness of Atropine Eye Drops, Ipratropium Bromide Nasal Spray, and Amitriptyline Tablet in the Management of Clozapine-Associated Sialorrhea in Patients With Refractory Schizophrenia: A Randomized Clinical Trial

Contact Info

Product

Resources

About