Sialorrhea caused by clozapine

What is Sialorrhea Caused by Clozapine?

Sialorrhea, commonly referred to as "drooling," is the excessive secretion of saliva from the mouth. Clozapine is an antipsychotic medication often used to treat schizophrenia and related mental health conditions. Some people on clozapine may experience sialorrhea, which may be bothersome and even potentially dangerous if the person is unable to swallow their saliva.

The mechanisms underlying sialorrhea as a result of clozapine are still not fully understood. Some evidence suggests that clozapine increases parasympathetic activity in the salivary glands, leading to an increase in saliva production. Clozapine has also been noted to have muscarinic receptor agonist properties, which can lead to decreased oral clearance of saliva. Other potential factors contributing to sialorrhea are cognitive deficits and impaired coordination of swallowing due to clozapine-induced parkinsonism. In addition, side effects such as drowsiness and cognitive deficits from clozapine treatment may cause reduced awareness of saliva production, leading to difficulty or inability to swallow.

Potential Treatments

Lifestyle changes such as drinking plenty of fluids and avoiding spicy, salty, and sour foods may help reduce sialorrhea. Chewing gum or sucking on candy can also stimulate reflexes that minimize saliva production. For severe cases of sialorrhea, medications may be prescribed. Some drugs may be used to decrease saliva production, such as antimuscarinics or neuroleptics. Other medications used to treat sialorrhea may include benzodiazepines, tricyclic antidepressants, and botulinum toxin injections.

Risks and Complications

If left untreated, sialorrhea can lead to a variety of complications such as swallowing difficulties, fluid loss, electrolyte imbalance, difficulty speaking, dental cavities due to prolonged contact with saliva, skin rashes, and infections.

Treating Sialorrhea Caused by Clozapine

Sialorrhea caused by clozapine can often be managed with lifestyle modifications and medications. It is important for individuals on clozapine to seek medical attention for any bothersome signs of sialorrhea, as this could potentially lead to other serious complications. It is also important to work closely with a healthcare provider to determine the most appropriate treatment for sialorrhea and to monitor for any signs of improvement or side effects.

Other Considerations

  • Ensure adequate hydration and adequate oral hygiene
  • Take medications as prescribed by your doctor
  • Avoid foods and drinks that increase saliva production
  • Practice mindfulness techniques such as relaxation exercises, yoga, and deep breathing
  • Seek physical and speech therapy to help improve swallowing issues
  • Consider using non-medication interventions such as frequent swallowing, chin tucking, head elevation, lip closure, tongue retraction, and directed mouthwash