What are the guidelines for managing hypersalivation in patients on clozapine (Clozaril)?

Medical Advisory BoardAll articles are reviewed for accuracy by our Medical Advisory Board
Article Review Status
Submitted
Under Review
Approved

Last updated: June 22, 2025 • View editorial policy

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Management of clozapine-induced hypersalivation should begin with non-pharmacological approaches and first-line pharmacological treatment typically includes anticholinergic medications such as glycopyrrolate or hyoscine. The most recent and highest quality study 1 suggests that sublingual atropine sulfate can be effective in reducing clozapine-induced hypersalivation. Key considerations in managing hypersalivation in patients on clozapine include:

  • Non-pharmacological approaches like sleeping with the head elevated, using a towel on the pillow, and practicing good oral hygiene
  • First-line pharmacological treatment with anticholinergic medications such as glycopyrrolate (1-2 mg twice daily) or hyoscine/scopolamine patches (1.5 mg every 72 hours)
  • Alternatives like amitriptyline (10-75 mg at bedtime) for nighttime drooling
  • Second-line options including clonidine (0.1-0.4 mg daily) or terazosin (1-5 mg daily) for inadequate response
  • Botulinum toxin injections into the salivary glands for treatment-resistant cases, as supported by earlier studies 2, 3 Treatment selection should be individualized based on the patient's comorbidities, with caution in patients with narrow-angle glaucoma, prostatic hypertrophy, or cognitive impairment, as noted in various studies 4, 5. Regular monitoring for side effects, particularly anticholinergic symptoms, is essential. Hypersalivation management is crucial as it affects up to 30% of clozapine users and can lead to treatment non-adherence if not addressed effectively.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.