From the Guidelines
Treatment for excessive salivation should start with a trial of anticholinergic agents, which are relatively inexpensive and readily available, as recommended by the American College of Chest Physicians clinical practice guideline and expert panel report 1.
Introduction to Treatment Options
The goal of treatment is to reduce saliva production, improve quality of life, and prevent complications such as aspiration and pneumonia.
- Anticholinergic medications, such as glycopyrrolate, scopolamine patches, or atropine drops, can be effective in reducing saliva production by blocking acetylcholine receptors 1.
- Botulinum toxin injections into the salivary glands can provide relief for 3-6 months by blocking nerve signals to the glands, but the certainty of the evidence is low to very low 1.
- Radiation therapy to the salivary glands or surgical interventions like duct ligation or gland removal may be considered in refractory cases, but the balance of benefits and risks is unclear 1.
Considerations for Treatment
When considering treatment options, it is essential to weigh the potential benefits and risks, including treatment-specific adverse events.
- Anticholinergic medications can have side effects such as dry mouth, blurred vision, constipation, and urinary retention, so starting with the lowest effective dose is recommended 1.
- Botulinum toxin injections can have variable effects, and the optimal dose is unclear 1.
- Radiation therapy and surgical interventions can have significant risks and should be reserved for patients with severe debility resulting from sialorrhea 1.
Conclusion and Recommendation
In summary, anticholinergic agents should be the first line of treatment for excessive salivation, due to their relatively low cost and availability, as well as their potential to improve symptoms and quality of life 1. It is crucial to identify and treat underlying conditions, such as GERD, oral infections, medication side effects, or neurological disorders, to ensure long-term management of excessive salivation.
- A comprehensive treatment plan should include a combination of medical and non-medical interventions, tailored to the individual patient's needs and circumstances.
- Further research is needed to determine the optimal treatment strategies for excessive salivation, particularly in patients with neuromuscular weakness.
From the FDA Drug Label
Glycopyrrolate is a competitive inhibitor of acetylcholine receptors that are located on certain peripheral tissues, including salivary glands. Glycopyrrolate indirectly reduces the rate of salivation by preventing the stimulation of these receptors. Glycopyrrolate inhibits the action of acetylcholine on salivary glands thereby reducing the extent of salivation. Glycopyrrolate oral solution was evaluated for chronic severe drooling in patients aged 3-16 years with neurologic conditions associated with problem drooling.
Treatment for excessive salivation: Glycopyrrolate oral solution can be used to treat excessive salivation, as it reduces the rate of salivation by inhibiting the action of acetylcholine on salivary glands.
- Key points:
- Glycopyrrolate is a competitive inhibitor of acetylcholine receptors.
- It indirectly reduces the rate of salivation.
- It has been evaluated for chronic severe drooling in patients aged 3-16 years with neurologic conditions. 2
From the Research
Treatment Options for Excessive Salivation
- Excessive salivation, also known as sialorrhea or drooling, can be caused by poor oral and facial muscle control, hypersecretion of saliva, dental malocclusion, postural problems, and an inability to recognize salivary spill 3.
- Treatment options for excessive salivation range from conservative measures such as observation, postural changes, and biofeedback to more aggressive measures like medication, radiation, and surgical therapy 3, 4.
- Anticholinergic medications, such as glycopyrrolate and scopolamine, are effective in reducing drooling but may have side effects that limit their use 3, 5.
- The injection of botulinum toxin type A into the parotid and submandibular glands is a safe and effective treatment for controlling drooling, but its effects fade over time and require repeat injections 3, 5, 4.
Management of Drug-Induced Sialorrhea
- Drug-induced hypersalivation is a frequent adverse event of psychotropic drugs, and its optimal management is crucial to improve patient care 5.
- Treatment of drug-induced sialorrhea may involve patient education, non-drug related management, and symptomatic treatment with anticholinergic agents, dopamine antagonists, alpha-2-adrenergic agonists, or botulinic toxin 5.
- The choice of treatment depends on the type of sialorrhea, patient preference, tolerance, and availability of drugs 5.
Surgical Intervention
- Surgical intervention, including salivary gland excision, salivary duct ligation, and duct rerouting, provides a permanent treatment for significant sialorrhea and can improve the quality of life of patients and their families or caregivers 3.
- A multidisciplinary team approach is recommended for the management of drooling, starting with conservative measures and progressing to more invasive procedures as needed 3, 4.