Clozapine-induced hypersalivation: A review of treatment strategies

Canadian Journal of Psychiatry

Volumn 52, Issue 6, 2007, Pages 377-384

  Sockalingam, Sanjeev ^a,b   Shammi, Chekkera ^a,b   Remington, Gary ^b,c  

^a UNIVERSITY OF TORONTO   (Canada)

^b CENTRE FOR ADDICTION AND MENTAL HEALTH   (Canada)

^c UNIVERSITY OF TORONTO   (Canada)

Author keywords

Adverse effects; Clozapine; Salivation; Sialorrhea

Indexed keywords

ALPHA 2 ADRENERGIC RECEPTOR BLOCKING AGENT; AMISULPRIDE; AMITRIPTYLINE; ATROPINE; BENZATROPINE; BIPERIDEN; BOTULINUM TOXIN A; CHOLINERGIC RECEPTOR BLOCKING AGENT; CLONIDINE; CLOZAPINE; EYE DROPS; GUANFACINE; IPRATROPIUM BROMIDE; MIANSERIN; NORCLOZAPINE; OLANZAPINE; PIRENZEPINE; PLACEBO; SCOPOLAMINE; SULPIRIDE; TERAZOSIN; TOLTERODINE; TRIHEXYPHENIDYL; VALPROIC ACID;

ASTHMA; CLINICAL TRIAL; COLON PERFORATION; COMBINATION CHEMOTHERAPY; CONSTIPATION; DISABILITY; DISEASE EXACERBATION; DRUG BLOOD LEVEL; DRUG EFFICACY; DRUG RECEPTOR BINDING; DRUG SAFETY; DRUG SELECTIVITY; ESSENTIAL HYPERTENSION; EXTRAPYRAMIDAL SYMPTOM; HAY FEVER; HUMAN; HYPERHIDROSIS; HYPERSALIVATION; MEDICAL LITERATURE; MEDLINE; MONOTHERAPY; OPEN STUDY; PARKINSON DISEASE; PARKINSONISM; PATHOPHYSIOLOGY; PSYCHOSIS; REVIEW; RHINORRHEA; SCHIZOAFFECTIVE PSYCHOSIS; SCHIZOPHRENIA; TREATMENT DURATION; XEROSTOMIA;

EID: 34347231321     PISSN: 07067437     EISSN: 14970015     Source Type: Journal    
DOI: 10.1177/070674370705200607     Document Type: Review

References (58)

1. Kane J, Honigfeld G, Singer J, et al. Clozapine for the treatment-resistant schizophrenic: a double-blind comparison with chlorpromazine. Arch Gen Psychiatry. 1988;45(9):789-796.
2. McEvoy JP, Lieberman JA, Stroup TS, et al. Effectiveness of clozapine versus olanzapine, quetiapine, and risperidone in patients with chronic schizophrenia who did not respond to prior atypical antipsychotic treatment. Am J Psychiatry. 2006;163(4):563-565.
3. Lieberman JA, Saltz BL, Johns CA, et al. The effects of clozapine on tardive dyskinesia. Br J Psychiatry. 1991;158:503-510.
4. Spivak B, Mester R, Abesgaus J, et al. Clozapine treatment for neuroleptic-induced tardive dyskinesia, parkinsonism, and chronic akathisia in schizophrenic patients. J Clin Psychiatry. 1997;58(7):318-322.
5. Honigfeld G. Effects of the clozapine national registry system on incidence of deaths related to agranulocytosis. Psychiatr Serv. 1996;47(1):52-56.
6. Safferman A, Lieberman JA, Kane JM, et al. Update on the clinical efficacy and side-effects of clozapine. Schizophr Bull. 1991;17(2):247-261.
7. Hinkes R, Quesada T, Currier MB, et al. Aspiration pneumonia possibly secondary to clozapine-induced sialorrhea. J Clin Psychopharmacol. 1996;16(6):462-463.
8. Robinson D, Fenn H, Yesavage J. Possible association of parotitis with clozapine. Am J Psychiatry. 1995;152(2):297-298.
9. Baum B. Principles of saliva secretion. Ann N Y Acad Sci. 1993;694:17-23.
10. Sanchez C, Lembol HL. The involvement of muscarinic receptor subtypes in the mediation of hypothermia, tremor and salivation in male mice. Pharmacol Toxicol. 1994;74(1):35-39.
11. Zorn S, Jones S, Ward K, et al. Clozapine is a potent and selective muscarinic M4 receptor agonist. Eur J Pharmacol. 1994;269(3):R1-R2.
12. Perkins DO, McClure RK. Hypersalivation coincident with olanzapine treatment. Am J Psychiatry. 1998;155(7):993-994.
13. Schneider B, Weigmann H, Hiemke C, et al. Reduction of clozapine-induced hypersalivation by pirenzepine is safe. Pharmacopsychiatry. 2004;37(2):43-45.
14. Ben-Aryeh H, Jungerman T, Szargel R, et al. Salivary flow-rate and composition in schizophrenic patients on clozapine: subjective reports and laboratory data. Biol Psychiatry. 1996;39(11):946-949.
15. Rabinowitz T, Frankenburg FR, Centorrino F, et al. The effect of clozapine on saliva flow rate: a pilot study. Biol Psychiatry. 1996;40(11):1132-1134.
16. Berlan M, Montastruc JL, Lafontan M. Pharmacological prospects for alpha 2 adrenoceptor antagonist therapy. Trends Pharmacol Sci. 1992;13(7):277-282.
17. Ogura C, Kishimoto A, Mizukawa R, et al. Comparative study of the effects of 9 antidepressants on several physiological parameters in healthy volunteers. Neuropsychobiology. 1987;17(3):139-144.
18. Baldessarini RJ, Frankenburg FR. Clozapine - a novel antipsychotic. N Engl J Med. 1991 Mar 14;324(11):746-754.
19. McCarthy RH, Terkelsen KG. Esophageal dysfunction in two patients after clozapine treatment. J Clin Psychopharmacol. 1994;14(4):281-283.
20. Pearlman C. Clozapine, nocturnal sialorrhea, and choking. J Clin Psychopharmacol. 1994;14(4):283.
21. Praharaj SK, Arora M, Gandotra S. Clozapine-induced sialorrhea: pathophysiology and management strategies. Psychopharmacology. (Berl) 2006;185(3):265-273.
22. Reinstein MJ, Sirotovskaya LA, Chasanov MA, et al. Comparative efficacy and tolerability of benztropine and terazosin in the treatment of hypersalivation secondary to clozapine. Clin Drug Invest. 1999;17(2):97-102.
23. Spivak B, Adlersberg S, Rosen L, et al. Trihexyphenidyl treatment of clozapine induced hypersalivation. Int Clin Psychopharmacol. 1997;12(4):213-215.
24. Mier RJ, Bachrach SJ, Lakin RC, et al. Treatment of sialorrhea with glycopyrrolate. Arch Pediatr Adolesc Med. 2000;154(12):1214-1218.
25. Bai YM, Lin CC, Chen JY, et al. Therapeutic effect of pirenzepine for clozapine-induced hypersalivation: a randomized, double-blind, placebo-controlled, cross-over study. J Clin Psychopharmacol. 2001;21(6):608-611.
26. Praharaj SK, Verma P, Roy D, et al. Is clonidine useful for treatment of clozapine-induced sialorrhea. J Psychopharmacol. 2005;19(4):426-428.
27. Freudenreich O, Goff DC. Colon perforation and peritonitis associated with clozapine. J Clin Psychiatry. 2000;61(12):950-951.
28. Brodkin ES, Pelton GH, Price LH. Treatment of clozapine-induced parotid gland swelling. Am J Psychiatry. 1996;153(3):445.
29. Camp-Bruno JA, Winsberg BG, Green-Parsons AR et al. Efficacy of benztropine therapy for drooling. Dev Med Child Neurol. 1989;31(3):309-319.
30. Laurikainen E, Koulu M, Kaila T, et al. Evaluation of the systemic anticholinergic activity of nasally administered ipratropium bromide. Rhinology. 1988;26(2):133-138.
31. Tessier P, Antonello C. Clozapine and sialorrhea: update. J Psychiatry Neurosci. 2001;26(3):253.
32. Freudenreich O, Beebe M, Goff DC. Clozapine-induced sialorrhea treated with sublingual ipratropium spray: a case series. J Clin Psychopharmacol. 2004;24(1):98-100.
33. Calderon J, Rubin E, Sobota WL. Potential use of ipratropium bromide for the treatment of clozapine-induced hypersalivation: a preliminary report. Int Clin Psychopharmacol. 2000;15(1):49-52.
34. Fritze J, Elliger T. Pirenzepine for clozapine-induced hypersalivation. Lancet. 1995;346(8981):1034.
35. Antonello C, Tessier P. Clozapine and sialorrhea: a new intervention for this bothersome and potentially dangerous side effect. J Psychiatry Neurosci. 1999;24(3):250.
36. Sharma A, Ramaswamy S, Dahl E, et al. Intraoral application of atropine sulfate ophthalmic solution for clozapine-induced sialorrhea. Ann Pharmacother. 2004;38(9):1538.
37. Comley C, Galletly C, Ash D. Use of atropine eye drops for clozapine induced hypersalivation. Aust N Z J Psychiatry. 2000;34(6):1033-1034.
38. Gaftanyuk O, Trestman RL. Scopolamine patch for clozapine-induced sialorrhea. Psychiatr Serv. 2004;55(3):318.
39. McKane JP, Hall C, Akram G. Hyoscine patches in clozapine-induced hypersalivation. Psychiatr Bull. 2001;25(7):277.
40. Copp PJ, Lament R, Tennent TG. Amitriptyline in clozapine-induced sialorrhea. Br J Psychiatry. 1991 Jul;59:166.
41. Richardson C, Kelly DL, Conley RR. Biperiden for excessive sweating from clozapine. Am J Psychiatry. 2001;158(8):1329-1330.
42. Grabowski J. Clonidine treatment of clozapine-induced hypersalivation. J Clin Psychopharmacol. 1992;12(1):60-61.
43. Webber MA, Szwast SJ, Steadman TM, et al. Guanfacine treatment of clozapine-induced sialorrhea. J Clin Psychopharmacol. 2004;24(6):675-676.
44. Corrigan FM, MacDonald S, Reynolds GP. Clozapine-induced hypersalivation and the alpha 2 adrenoreceptor. Br J Psychiatry. 1995;167(3):412.
45. Caldara R, Masci E, Cambielli M, et al. Effect of sulpiride isomers on gastric acid and gastrin secretion in healthy man. Eur J Clin Pharmacol. 1983;25(3):319-322.
46. Croissant B, Hermann D, Olbrich R. Reduction of side effects by combining clozapine with amisulpride: case report and short review of clozapine-induced hypersalivation-a case report. Pharmacopsychiatry. 2005;38(1):38-39.
47. George S, Cowan C. Effectiveness of amisulpride augmentation of clozapine in a non-responder to either drug alone: a case report. Acta Psychiatr Scand. 2005;111(2):163.
48. Kampf P, Agelink MW, Mass R, et al. Amisulpride in addition to clozapine: a retrospective study indicates improved efficacy and good tolerability. Germ J Psychiatry. 2003;6(3):64-68.
49. Zink M, Knopf U, Henn FA, et al. Combination of clozapine and amisulpride in treatment-resistant schizophrenia - case reports and review of the literature. Pharmacopsychiatry. 2004;37(1):26-31.
50. Kreinin A, Epshtein S, Sheinkman A, et al. Sulpride addition for the treatment of clozapine-induced hypersalivation: preliminary study. Isr J Psychiatry Relat Sci. 2005;42(1):61-63.
51. Kreinin A, Novitski D, Weizman A. Amisulpride treatment of clozapine-induced hypersalivation in schizophrenia patients: a randomized, double-blind, placebo-controlled cross-over study. Int Clin Psychopharmacol. 2006;21(2):99-103.
52. Lipp A, Trottenberg T, Schink T, et al. A randomized trial of botulinum toxin A for treatment of drooling. Neurology. 2003;61(9):1279-1281.
53. Ondo WG, Hunter C, Moore W. A double-blind placebo-controlled trial of botulinum toxin B for sialorrhea in Parkinson's disease. Neurology. 2004;62(1):37-40.
54. Pal PK, Calne DB, Calne S, et al. Botulinum toxin A as treatment for drooling saliva in PD. Neurology. 2000;54(1):244-247.
55. Kahl KG, Hagenah J, Zapf S, et al. Botulinum toxin as an effective treatment of clozapine-induced hypersalivation. Psychopharmacology (Berl). 2004;173(1-2):229-230.
56. Tan EK, Lo YL, Seah A, et al. Recurrent jaw dislocation after botulinum toxin treatment for sialorrhea in amyotrophic lateral sclerosis. J Neurol Sci. 2001;190(1-2):95-97.
57. Bourgeois JA, Drexler KG, Hall MJ. Hypersalivation and clozapine. Hosp Community Psychiatry. 1991;42(11):1174.
58. Conry A, Siris SG, Bermanzohn PC. Improvement of clozapine-induced sialorrhea after septoplasty. Am J Psychiatry. 1996;153(3):444.