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.