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The sublingual use of atropine in the treatment of clozapine‐induced sialorrhea

Published online by Cambridge University Press:  13 August 2021

H. Becerra Darriba
H. Becerra Darriba*
Affiliation:
Centro Salud Mental De Tudela - Hospital Reina Sofía, Servicio Navarro de Salud - Osasunbidea., Tudela (Navarra), Spain

Abstract

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Introduction

Clozapine is a second-generation antipsychotic indicated in treatment-resistant schizophrenia. Patients taking clozapine are likely to experience an increase in salivation or sialorrhea. Clozapine‐induced sialorrhea (CIS) may lead to sleep disturbances or aspiration pneumonia. Treatment options include locally administered anticholinergic medication with atropine ophthalmic drops applied sublingually.

Objectives

To review the current evidence for the effectiveness, safety, side effects and dosage of sublingual application of atropine in reducing or resolving of CIS.

Methods

Systematic review. Data were obtained from PubMed/Medline, EMBASE, PsycINFO, Cochrane Plus, Trip Database, Science Direct and Scopus searches of English-language articles, without restriction for date of publication and study design, reporting the sublingual use of atropine in the treatment of CIS. Large clinical studies with appropriate statistical methods and recruited adults were preferred.

Results

12 selected articles (of 458 references) consisted entirely of case reports and case series. A total of 29 patients with CIS were reported, of whom 24 responded favorably to sublingually administered atropine drops 1% (1-2 drops a day). One limitation of its utilization is the dose-related dry mouth, which can be addressed by lowering the number of drops administered. CIS can occur at different clozapine doses, in various stages of treatment.

Conclusions

The reviewed articles suggest that the use of sublingual atropine is a promising local treatment for CIS. Oral anticholinergic and alpha-2 agonist medications have been used to treat CIS with variable efficacy, but can cause systemic anticholinergic side effects. Further experimental research is needed.

Disclosure

No significant relationships.

Keywords

CISsublingual atropineclozapine‐induced sialorrhea
Type
Abstract
Information
European Psychiatry , Volume 64 , Special Issue S1: Abstracts of the 29th European Congress of Psychiatry , April 2021 , pp. S779
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of the European Psychiatric Association
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