Sublingual Atropine Drops for the Treatment of Pediatric Sialorrhea

Abstract

Excess oral secretions or sialorrhea is a common problem affecting children and adults with neurological disorders, as well as those approaching the end of life because of a variety of underlying illnesses. Systemic anticholinergic medications are often prescribed in an attempt to improve quality of life and reduce complications; yet, response rates are variable, and a sizable proportion of patients discontinue these drugs as a result of intolerable side effects. This report describes the successful use of a local treatment, sublingually delivered ophthalmic atropine drops, to reduce sialorrhea in a child receiving palliative care. In addition, medical evidence for the safety and efficacy of traditionally prescribed systemic medications for the treatment of pediatric sialorrhea is reviewed.

Treatment of drooling with sublingual atropine sulfate in children and adolescents with cerebral palsy

“…Glycopyrrolate, benztropine, scopolamine and trihexyphenidyl are the most-used systemic anticholinergic drugs. They induce a significant reduction in saliva flow and their effectiveness has been confirmed in several studies 14,15,16,17,18,19 .…”

“…The prescribed dose consisted of one sublingual drop administered three times a day at six-hour intervals for patients weighing between 10 kg and 19 kg and two sublingual drops administered three times a day at six-hour intervals for patients with a weight equal to or greater than 20 kg. These doses were determined from the single article on the use of atropine sulfate to treat drooling in an adolescent, in which there was a good tolerability level 17 .…”

“…Its mechanism of action is by blocking the muscarinic receptors (M3) in the salivary glands, leading to reduced saliva production 17 . Some articles have reported its use in the treatment of drug-induced drooling 20,21,22 and in Parkinson's disease patients 23 .…”

“…Some articles have reported its use in the treatment of drug-induced drooling 20,21,22 and in Parkinson's disease patients 23 . The only article referring to its use in treating drooling in children or adolescents reported the case of a successfully-treated 14-year-old boy with metachromatic leukodystrophy 17 . There is only one prospective, randomized, placebo-controlled double-blind study that has investigated the use of sublingual atropine sulfate to treat drooling.…”

Effective use of transdermal drug delivery in children

“…Transdermal scopolamine has also been assessed for the management of sialorrhea in children with developmental delays [110][111]. The labelling of scopolamine patches for the treatment of motion sickness in children is inconsistent: Scopoderm TTS is approved for children over 10 years whereas the label information of Transderm Scop and Transderm-V* (essentially the same patch) precludes their use in children.…”