• Home
  • Store
    • Newsletter Subscriptions
    • Multimedia Subscriptions
    • Books
    • eBooks
    • ABPN SA Courses
  • CME Center
  • Multimedia
    • Podcast
    • Webinars
    • Blog
  • Newsletters
    • General Psychiatry
    • Child Psychiatry
    • Addiction Treatment
    • Hospital Psychiatry
    • Geriatric Psychiatry
  • Log In
  • Register
  • Welcome
  • Sign Out
  • Subscribe
Home » Sublingual Atropine Drops and Clozapine-Induced Drooling

Sublingual Atropine Drops and Clozapine-Induced Drooling

March 23, 2022
Sébastien Hardy, PharmD, BCPS.
From The Carlat Hospital Psychiatry Report
Issue Links: Learning Objectives | Editorial Information | PDF of Issue
Sébastien Hardy, PharmD, BCPS. Dr. Hardy has disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
REVIEW OF: Mubaslat O and Lambert T, Psychopharmacology (Berl) 2020;237(10):2905–2915

STUDY TYPE: Randomized placebo-controlled trial

Excessive salivation or drooling is one of the more troublesome side effects of clozapine, occurring in up to 80% of patients. It is embarrassing for patients and is a factor in drug discontinuation. Aspiration pneumonia is a rare but serious complication.

Non-drug treatment is a first step, such as chewing sugar-free gum and elevating/covering pillows with a towel. Anticholinergics, such as glycopyrrolate, trihexyphenidyl, and benztropine, are usually helpful but significantly exacerbate clozapine’s powerful anticholinergic effects, placing patients at risk for constipation, impaction, and paralytic ileus. This has provoked interest in more localized treatments, such as the sublingual administration of atropine 1% ophthalmic solution. The clinical use of sublingual atropine has been guided by case reports and case series. Recently, Australian researchers investigated its efficacy for clozapine-induced drooling in a randomized controlled trial.

The researchers recruited inpatients (n = 23) from two major psychiatry centers in Sydney. Participants were randomized to receive two drops of sublingual atropine 1% (n = 11) or chloramphenicol 0.5% (n = 12); researchers used chloramphenicol as the placebo because it has a bitter taste similar to atropine. Medications were given at bedtime. The main outcome variable was saliva secretion, which was measured both at baseline and after medication by weighing dental cotton rolls and pads. Saliva secretion was reduced by 34% with sublingual atropine, while it was increased by 23% with placebo (p = 0.02). More atropine-treated participants had an improvement in pillow saliva wetness and sleep, though only 10 of the 21 participants were questioned about these issues.

CHPR’s Take: Sublingual atropine drops appear to be effective for clozapine-induced hypersalivation. A larger study would be helpful to better establish the safety and efficacy of this treatment compared to systemic drugs.
Hospital Psychiatry
KEYWORDS atropine clozapine drooling hypersalivation side-effects
Sébastien Hardy, PharmD, BCPS.

More from this author
www.thecarlatreport.com
Issue Date: March 23, 2022
SUBSCRIBE NOW
Table Of Contents
Note From the Editor-in-Chief
Sublingual Atropine Drops and Clozapine-Induced Drooling
Clozapine for Conduct Disorder in Schizophrenia
Responding to Sexual Activity on the Inpatient Psychiatric Unit
Management of Psychogenic Polydipsia
Electroconvulsive Therapy: A Primer
Assessing and Treating Catatonia
CME Post-Test - Catatonia, CHPR, April/May/June 2022
DOWNLOAD NOW
Featured Book
  • AUDFB1e_CoilBound_Graphic2_transparent_sm.png

    (PRE-ORDER) Treating Alcohol Use Disorder—A Fact Book (2023)

    All the tools and information needed to assess and treat your patients who are struggling with...
    READ MORE
Featured Video
  • therapist_canstockphoto9201097.jpg
    General Psychiatry

    Using SAMe In Clinical Practice with Garrett Rossi, MD

    Read More
Featured Podcast
  • canstockphoto104192710.jpg
    Hospital Psychiatry

    Management of Depression and Neurocognitive Impairment in Patients With HIV

    Strategies for the evaluation and management of HIV-associated mood and cognitive changes and potential drug interactions between psychiatric and antiretroviral medications. 

    Listen now
Recommended
  • Approaches to Autism Intervention

    January 31, 2022
    canstockphoto2240982_child-bubbles_thumb.jpg
  • Currently Available Cannabis Products

    September 1, 2022
  • Interpreting Assessment Discrepancies from Multiple Sources

    October 17, 2022
    ChildAssessment.png
  • Approaches to Autism Intervention

    January 31, 2022
    canstockphoto2240982_child-bubbles_thumb.jpg
  • Currently Available Cannabis Products

    September 1, 2022
  • Interpreting Assessment Discrepancies from Multiple Sources

    October 17, 2022
    ChildAssessment.png
  • Approaches to Autism Intervention

    January 31, 2022
    canstockphoto2240982_child-bubbles_thumb.jpg
  • Currently Available Cannabis Products

    September 1, 2022
  • Interpreting Assessment Discrepancies from Multiple Sources

    October 17, 2022
    ChildAssessment.png

About

  • About Us
  • CME Center
  • FAQ
  • Contact Us

Shop Online

  • Newsletters
  • Multimedia Subscriptions
  • Books
  • eBooks
  • ABPN Self-Assessment Courses

Newsletters

  • The Carlat Psychiatry Report
  • The Carlat Child Psychiatry Report
  • The Carlat Addiction Treatment Report
  • The Carlat Hospital Psychiatry Report
  • The Carlat Geriatric Psychiatry Report

Contact

info@thecarlatreport.com

866-348-9279

PO Box 626, Newburyport MA 01950

Follow Us

Please see our Terms and Conditions, Privacy Policy, Subscription Agreement, Use of Cookies, and Hardware/Software Requirements to view our website.

© 2023 Carlat Publishing, LLC and Affiliates, All Rights Reserved.