Clozapine-Induced Hypersalivation

Davydov, Liya; Botts, Sheila

doi:10.1345/aph.19259

Cited by 83 publications

(48 citation statements)

References 25 publications

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“…Avoiding rapid titration when starting clozapine may reduce the chances of inducing sialorrhea (Cree et al 2001) and other adverse effects as orthostatic hypotension. If clinically possible, reducing the dose of clozapine may be tried, but this may result in a loss of efficacy (Davydov and Botts 2000). Measurement of plasma clozapine levels can help guide the decision as to whether the dose of clozapine can be safely reduced.…”

Section: Management Strategiesmentioning

confidence: 99%

“…Despite demonstrated efficacy, its use is limited by its potential for adverse effects like agranulocytosis, seizures, orthostatic hypotension, sedation, weight gain, and sialorrhea. Clozapine-induced sialorrhea (CIS) occurs at a rate of approximately 30% (Rogers and Shramko 2000;Cree et al 2001), though it varies from 10 to 80% in the literature, almost 100 times greater than agranulocytosis (Marinkovic et al 1994;Ben-Areyh et al 1996;Davydov and Botts 2000). Several treatment options exist, but in practice most cases of sialorrhea are not adequately treated because available treatment options have limited efficacy or unwanted side effects (Gaftanyuk and Trestman 2004).…”

Section: Introductionmentioning

confidence: 99%

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Clozapine-induced sialorrhea: pathophysiology and management strategies

2006

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Rationale: Clozapine is an atypical antipsychotic agent with proven efficacy in refractory schizophrenia, but its widespread use is limited by adverse effects such as agranulocytosis, seizures, sedation, weight gain, and sialorrhea. Clozapine-induced sialorrhea (CIS) is bothersome and has socially stigmatizing adverse effects, which result in poor treatment compliance. The pathophysiology of this condition is poorly understood and the treatment options available are based mostly on case reports and open-label studies. Objective: To review the available studies on CIS. Method: All relevant studies available through PUBMED search supplemented with manual search were undertaken. Result: The clinical features, complications, assessment, pathophysiology, and management of CIS are discussed. Conclusion: Although the studies evaluating the therapeutic options has limitations and no drug has been found to be superior, judicious use of pharmacological agents along with behavioral methods will reduce this troublesome side effect and enhance compliance.

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Section: Management Strategiesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Clozapine-induced sialorrhea: pathophysiology and management strategies

2006

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“…Clozapine is a potent anticholinergic (Arnt and Skarsfeldt 1998;Moller 2000) yet it appears to improve PPI more than typical antipsychotics. Given that in animal studies both hyper-and hypocholinergia appear to disrupt PPI (review, Swerdlow et al 1992), it would appear that there is a response range, and clozapine-treated patients remained within this range because clozapine also has procholinergic effects (Davydov and Botts 2000). Another puzzling observation is that treatment with clozapine reduces ad lib cigarette smoking in patients (Procyshyn et al 2001).…”

Section: Atypical Antipsychoticsmentioning

confidence: 99%

Effects of typical and atypical antipsychotics on prepulse inhibition in schizophrenia: a critical evaluation of current evidence and directions for future research

Kumari¹,

Sharma²

2002

Psychopharmacology

154

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Prepulse inhibition (PPI) of the startle response refers to an attenuation in response to a strong stimulus (pulse) if this is preceded shortly by a weak non-startling stimulus (prepulse). PPI provides a simple operational measure of sensorimotor gating, serving to prevent the interruption of ongoing perceptual and early sensory analysis. In accord with postulated deficits in early stages of information processing, there is ample evidence that PPI is disrupted in individuals with schizophrenia. PPI in animals is thought to represent a well-validated model for evaluating potential new treatments for schizophrenia. Currently, available data on the differential effects of typical and atypical antipsychotics suggest that atypical antipsychotics, in particular clozapine and risperidone, may be more effective than typical antipsychotics in improving PPI deficits in schizophrenia. However, studies have so far used small samples and/or between-subjects designs, and not examined the effects of other concomitant medications that may also influence PPI. The directions are identified for further applications of this model using within-subjects longitudinal designs and reasonable sample sizes to establish superiority of particular atypical antipsychotics over typical antipsychotics in improving PPI in schizophrenic populations.

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“…Out of the 44 patients on clozapine 19 complained of sialorrhea, accounting for a prevalence of 43%, while in a similar study by Davydov L et al it was 54%. 18 The difference could be due to the difference in the prescribed dose of clozapine.…”

Section: Discussionmentioning

confidence: 99%