Sublingual administration of atropine eyedrops in children with excessive drooling – a pilot study

Abstract

BackgroundDrooling can be a severe disability and have high impact on daily life. Reversible treatment is preferable.AimTo analyse whether sublingual administration of atropine eyedrops is a useful reversible treatment option for severe drooling in children with disabilities.DesignThe study had a prospective, single‐system research design. The participants served as their own controls. The study period was 3 weeks without treatment, 4 weeks with atropine eyedrop solution 10 mg/mL one drop a day followed by 4 weeks of one drop twice a day. Parents’ rating of their child's drooling was assessed on a 100‐mm VAS, and unstimulated salivary secretion rate measurement was performed together with notations about side effects and practicality.ResultsParents’ VAS assessment of drooling decreased from a median (range) of 74 (40–98) at baseline to 48 (18–88) (P = 0.05) and 32 (12–85) (P = 0.004) after 4 weeks of atropine once a day and another 4 weeks of atropine twice a day, respectively (n = 11). Unstimulated salivary secretion rates decreased from baseline to end of study (P = 0.032). Several parents complained about difficult administration. No irreversible side effects were noted.ConclusionsSublingual atropine eyedrops may be an alternative for treatment of severe drooling in children with disabilities.

The sublingual use of atropine in the treatment of clozapine‐induced sialorrhea: A systematic review

“…Another pilot study about children with sialorrhea (n = 11) with various underlying disorders (including cerebral palsy, epilepsy, and autism) showed a significant reduction in salivation after sublingual administration of atropine eye drops 1‐2× a day, by weighing dental cotton wool rolls and measurement on a visual analogue scale or VAS with the parents). No irreversible adverse reactions were noted, xerostomia occurred in 3 children and some parents reported difficulties with the administration.…”

“…Possible side effects in the reviewed literature are the occurrence of xerostomia at higher dosages: with one patient with CIS this occurred with three drops and in 3 out of 11 children studied by Norderyd taking only 1 to 2 doses per day. The unpleasant taste and at times, the too short duration of action with reoccurrence of salivation in the early morning, which on its turn can be managed by the “top‐up method” .…”

“…Some safety concerns include the fact that more disorganized patients or distracted staff members have been reported to accidentally administer the drops in the eyes of the patient, an accidental overdose (as with any product) is also possible . Some parents of children with sialorrhea treated with atropine sublingually experienced some difficulties in administering it . Accidental overdoses seem to be more easy with eyedrops than with nose sprays…”

Sublingual Atropine Sulfate Use for Sialorrhea in Pediatric Patients

“…1,2 Negatively affecting social relationships, it is a factor that reduces a person's selfrespect. 3 Sialorrhea may be due to neuromuscular, sensorial, or anatomic disorders, while the most common cause is neuromuscular dysfunction. 4 Medical, surgical as well as behavioral treatment methods may be applied to reduce the secretions.…”

“…5 Biofeedback and acupuncture methods are among the experimental treatment methods. 3 According to 2012 Cochrane data, there is insufficient evidence of success of treatments applied for oral secretions in pediatric patients monitored for cerebral palsy. 3 In recent years, some publications have demonstrated that sublingual atropine eye drops are effective in reducing secretions in adults and children.…”