Sublingual atropine for the treatment of severe and hyoscine-resistant clozapine-induced sialorrhea

Mustafa, Ali; Khan, Atiya; Burke, John; Cox, Merrilee; Sherif, Sara Abou

doi:10.4314/ajpsy.v16i4.32

Cited by 9 publications

(14 citation statements)

References 6 publications

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“…Finally, Mustapha published a report on one patient who, despite hyoscine, continued to suffer from severe CID, which had ceased with 1‐3 drops of sublingual atropine 1%, allowing the clozapine levels to be adjusted. However, the CIS did not return after discontinuation of atropine, meaning it could have been a temporary side effect, besides the fact that the treatment was in combination with hyoscine.…”

Section: Resultsmentioning

confidence: 99%

The sublingual use of atropine in the treatment of clozapine‐induced sialorrhea: A systematic review

Poorten

Hert

2019

Clinical Case Reports

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Section: Resultsmentioning

confidence: 99%

The sublingual use of atropine in the treatment of clozapine‐induced sialorrhea: A systematic review

Poorten

Hert

2019

Clinical Case Reports

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“…There are also recent findings on the use of atropine drops three times a day for a week, combined with hyoscine (antimuscarinic agent). This treatment led to significant relief in the symptoms of a patient with a disabling clozapine-induced hypersalivation (Mustafa et al, 2013). Additional possible treatments are injection of the botulinum toxin into the parotid gland, leading to short-term (12 weeks) significant reduction in saliva production and improvement in social withdrawal (Kahl et al, 2004).…”

Section: Hypersalivation (Sialorrhea/drooling)mentioning

confidence: 98%

Pharmacological and behavioral management of some often-overlooked clozapine-induced side effects

Sagy

Weizman

Katz

2014

International Clinical Psychopharmacology

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This article reviews four of the milder but still bothersome side effects of clozapine that are fairly frequent and may have a negative impact on patients' compliance with the treatment regime. We reviewed the available literature on the rate and management of four non-life-threatening side effects of clozapine, including hypersalivation, constipation, tachycardia, and nocturnal enuresis. We found a variety of pharmacological and behavioral strategies to manage these four side effects. There is, however, no consensus on a preferred strategy to control these distressing side effects and there are no guidelines. Psychiatrists should be aware of the relatively high rate of hypersalivation, constipation, tachycardia, and nocturnal enuresis in clozapine-treated patients, of the impact that these side effects may have on patients' quality of life, and should be able to suggest management strategies to the patients.

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“…[4] As a parasympatholytic, it is a competitive antagonist for multiple muscarinic receptors. [4,5] As an anti-secretagogue, atropine has a high affinity for muscarinic-3 (M3) receptors, on sali-vary glands resulting in decreased saliva production. [6] Atropine is available in both intravenous and ophthalmic dosage forms.…”

Section: Introductionmentioning

confidence: 99%

“…[7] However, sublingual administration of the opthalmic solution may be advantageous by minimizing adverse systemic exposure. [2][3][4][5] The off-label use of atropine for secretion control has been well studied in palliative care and has been reportedly used in patients with neurodevelopmental disorders and antipsychotic induced sialorrhea. [2,5,6] Outside of these indications, there is limited evidence to support its use in more general patient populations.…”

Section: Introductionmentioning

confidence: 99%

Ophthalmic atropine for sublingual use: A novel treatment for excessive respiratory secretions

Staffieri

Owusu

Cardinale

et al. 2016

CRIM

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We describe a novel case of utilizing ophthalmic atropine suspension via sublingual route to control excessive secretions in a critically ill patient. In addition, a medication event related to a labeling and administration event is described where the patient received the drug via ophthalmic route. A 32-year-old Hispanic female presenting with NMDA-receptor antibody mediated encephalitis experienced a prolonged intensive care unit (ICU) stay secondary to hypercarbic respiratory failure complicated by excessive respiratory secretions. After one week on mechanical ventilation, the patient was set to undergo a percutaneous endoscopic gastrostomy (PEG) tube placement and tracheotomy. The patient’s respiratory status was compromised by copious secretion production, preventing the patient from being transitioned to the general care floor. For secretion control, pharmacological interventions such as scopolamine transdermal patches and glycopyrrolate oral tablets were trialed, however systemic exposure to these agents resulted in urinary retention requiring catherization with a mild and persistent tachycardia. Ophthalmic atropine was administered sublingually at a dose of 1 mg every six hours to provide local relief of the patient's secretion production. Secretion production improved within 72 hours and the patient’s urinary retention resolved at the time of scopolamine and glycopyrrolate discontinuation. Previously in the literature the use of sublingual atropine was only described for secretion control in patients receiving end of life care, drug induced sialorrhea and neuro-developmental disorders. As observed in this case report, sublingual atropine may be an effective treatment to control respiratory secretions in critically ill patients who are unable to tolerate other therapies.

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Sublingual atropine for the treatment of severe and hyoscine-resistant clozapine-induced sialorrhea

Cited by 9 publications

References 6 publications

The sublingual use of atropine in the treatment of clozapine‐induced sialorrhea: A systematic review

The sublingual use of atropine in the treatment of clozapine‐induced sialorrhea: A systematic review

Pharmacological and behavioral management of some often-overlooked clozapine-induced side effects

Ophthalmic atropine for sublingual use: A novel treatment for excessive respiratory secretions

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