From the Guidelines
Ptyalism gravidarum should be managed with vitamin B6 as the first line of treatment, given its safety and potential benefits in alleviating symptoms associated with nausea and vomiting of pregnancy, as suggested by the expert review in Gastroenterology 1. When considering the treatment for ptyalism (excessive salivation) in pregnancy, it's crucial to prioritize approaches that are safe for both the mother and the fetus. The management of ptyalism gravidarum can involve several strategies:
- Simple measures such as frequent small sips of water, chewing sugar-free gum or hard candies to help swallow excess saliva, and using a cup to spit saliva if swallowing is difficult.
- Dietary modifications, including eating smaller, more frequent meals and avoiding spicy or acidic foods that may stimulate saliva production.
- For more severe cases, considering medications that are safe in pregnancy, with vitamin B6 (pyridoxine) at 10-25mg three times daily being a potential option, especially if ptyalism is associated with nausea and vomiting of pregnancy, as indicated by the recent clinical practice update 1. Key considerations in the treatment of ptyalism gravidarum include the safety of the medication for the fetus and the potential for the treatment to alleviate symptoms without causing significant side effects. Given the information from the expert review in Gastroenterology 1, focusing on vitamin B6 as a first-line approach, due to its mention in the context of managing nausea and vomiting of pregnancy, seems prudent. It's essential to consult with a healthcare provider before starting any medication during pregnancy to ensure safety for both mother and baby.
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.
The treatment for ptyalism (excessive salivation) in pregnancy (gravidarum) may be glycopyrrolate, as it reduces the rate of salivation by inhibiting the action of acetylcholine on salivary glands. However, it is essential to note that there are no available data in pregnant women for glycopyrrolate oral solution to inform decisions concerning any drug-associated risks 2.
From the Research
Treatment Options for Ptyalism Gravidarum
- Hypnosis has been reported as a successful treatment for ptyalism gravidarum in some cases, with one study finding that symptoms resolved after hypnosis sessions 3, 4.
- Acupuncture has also been mentioned as a potential treatment, with one study reporting that two women experienced resolution of symptoms after hypnosis with acupuncture treatment 3.
- Pharmacological and homoeopathic therapies have been discussed in the literature, but their effectiveness and safety for mother and infant are not well established 5.
- Psychotherapy has been advised as a potential treatment option, with one study suggesting its use in managing the condition 6.
- In some cases, ptyalism gravidarum may recover spontaneously or after delivery, suggesting that watchful waiting may be an appropriate approach in some instances 7.
Key Considerations
- Ptyalism gravidarum is often associated with hyperemesis gravidarum, and treatment of the underlying condition may be necessary to manage symptoms 3, 5, 4.
- The condition can cause significant emotional distress and social difficulties, highlighting the need for supportive care and attention in antenatal care settings 3, 5.
- While ptyalism gravidarum is not typically associated with adverse perinatal outcomes, it is essential to monitor the condition and adjust treatment as needed to optimize pregnancy outcomes 3, 5, 7.