From the Guidelines
Medications for managing excessive oral secretions include anticholinergics like glycopyrrolate, scopolamine, and atropine, which work by blocking acetylcholine receptors to reduce saliva production. These medications are effective in reducing oral secretions, but their use should be balanced with the potential risks and side effects, such as dry mouth, blurred vision, urinary retention, and constipation 1.
Key Considerations
- Anticholinergics, such as glycopyrrolate (0.1-0.2 mg orally 2-3 times daily) and scopolamine (1.5 mg transdermal patch every 72 hours), are commonly used to manage excessive oral secretions 1.
- Atropine drops (1-2 drops of 1% solution sublingually every 4-6 hours as needed) can also be used to reduce oral secretions 1.
- In palliative care settings, hyoscine butylbromide (10-20 mg orally or subcutaneously every 4-6 hours) is another effective option for managing terminal secretions.
Non-Pharmacologic Interventions
- Suction devices can be used to remove excess secretions for immediate relief.
- Proper positioning with the head elevated can help prevent pooling of secretions.
- Good oral hygiene is essential to prevent complications from reduced saliva production.
Important Considerations
- Anticholinergics should be used cautiously in patients with narrow-angle glaucoma, prostatic hypertrophy, or certain cardiac conditions.
- Adequate hydration should be maintained while using these medications to minimize the risk of side effects 1.
From the FDA Drug Label
Glycopyrrolate injection is compatible for mixing and injection with the following injectable dosage forms: atropine sulfate, USP; The FDA drug label does not answer the question.
From the Research
Medications for Oral Secretions
- Anticholinergic medications such as trihexyphenidyl 2, scopolamine 2, 3, and glycopyrrolate 3 are used to treat oral secretions.
- Botulinum toxin injections are also effective in reducing drooling in patients with neurological disorders 2, 4, 3, 5.
- Benztropine is associated with a significant reduction in the frequency and severity of drooling in patients with neurological disorders 5.
Treatment Options
- Oral trihexyphenidyl is recommended as a first-line treatment for drooling in children with neurological disorders 2.
- Scopolamine patch and botulinum toxin injections are alternative treatment options 2, 3.
- Surgical options may be considered for treatment of sialorrhea in patients with amyotrophic lateral sclerosis 3.
Side Effects
- Anticholinergic medications can cause dry mouth, leading to dental caries, intraoral infection, and diminished oral health-related quality of life 6.
- Botulinum toxin injections can cause mild dysphagia 2.
- Scopolamine patch can cause side effects such as lack of efficacy and withdrawal due to side effects 2.