Examining the Role of Sublingual Atropine for the Treatment of Sialorrhea in Patients with Neurodevelopmental Disabilities: A Retrospective Review

Abstract

Sialorrhea is common in children with neurodevelopmental disabilities (NDD) and is reported in >40% of children with cerebral palsy (CP). It causes a range of complications, including significant respiratory morbidity. This single-center retrospective chart review aims to document sublingual atropine (SLA) utilization to guide further study in establishing its role in secretion management for children with NDD. A chart review was completed for patients with NDD ≤ 22 years of age treated with SLA at a free-standing children’s hospital between 1 January 2016 and 1 June 2021. Descriptive statistics were generated to summarize findings. In total, 190 patients were identified, of which 178 met inclusion criteria. The average starting dose for SLA was 1.5 mg/day, or 0.09 mg/kg/day when adjusted for patient weight. Eighty-nine (50%) patients were prescribed SLA first line for secretion management while 85 (48%) patients tried glycopyrrolate prior to SLA. SLA was used after salivary Botox, ablation, and/or surgery in 16 (9%) patients. This study investigates SLA as a potential pharmacologic agent to treat sialorrhea in children with NDD. We identify a range of prescribing patterns regarding dosing, schedule, and place in therapy, highlighting the need for further evidence to support and guide its safe and efficacious use.

Clinical pharmacokinetics of atropine oral gel formulation in healthy volunteers

“…Sublingual use of atropine eye drops has been proven to be effective 15–22,39 . However, their off‐label use is limited by medication errors 24 and low residence time.…”

“…Sublingual use of atropine eye drops has been proven to be effective. 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 39 However, their off‐label use is limited by medication errors 24 and low residence time. Reformulated atropine gel for oral use can further improve the safety and efficacy of treatment.…”

“…In addition to available anticholinergic agents, off‐label use of atropine eye drops to treat sialorrhea is mainstay therapy in institutions across the world 15–22 . However, this off‐label treatment is limited by the need for frequent administration due to lack of retention on oral mucosa, 18 incidence of dosing and medication errors, 23 and systemic side effects, such as tachycardia, fever, tremors, and restlessness 24 .…”

“…In addition to available anticholinergic agents, off‐label use of atropine eye drops to treat sialorrhea is mainstay therapy in institutions across the world. 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 However, this off‐label treatment is limited by the need for frequent administration due to lack of retention on oral mucosa, 18 incidence of dosing and medication errors, 23 and systemic side effects, such as tachycardia, fever, tremors, and restlessness. 24 Several case reports described that the dosing and medication errors with atropine eye drops were due to accidental ingestion of the entire contents of the atropine eye drop bottle by the patients.…”