From the FDA Drug Label
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From the Research
Management of hypersalivation in the first trimester of pregnancy should begin with non-pharmacological approaches, and if necessary, proceed to pharmacological treatments with caution, prioritizing the safety of both the mother and the fetus, as recommended by the most recent guidelines 1. The goal of treatment is to reduce symptoms, improve quality of life, and minimize potential complications. Non-pharmacological approaches include:
- Encouraging frequent small sips of water
- Chewing sugar-free gum or sucking on ice chips to help manage excess saliva
- Maintaining good oral hygiene with regular brushing and alcohol-free mouthwash
- Dietary modifications, such as avoiding starchy foods and acidic beverages that can stimulate saliva production For more troublesome cases, antihistamines like diphenhydramine (Benadryl) 25mg every 6 hours as needed can be considered, as they have anticholinergic properties that reduce salivary secretion and are generally considered safe in pregnancy 1. In severe cases affecting hydration or quality of life, a short course of anticholinergic medications like glycopyrrolate 1-2mg twice daily might be considered after discussing risks and benefits, though these should be used cautiously in pregnancy, as supported by recent updates in treatment guidelines 2, 1. It's essential to note that hypersalivation typically improves after the first trimester as hormone levels stabilize, so reassurance about its temporary nature is important. The condition results from hormonal changes affecting autonomic nervous system regulation of salivary glands, often exacerbated by nausea and reduced swallowing frequency during pregnancy. The use of botulinum toxin injection into the salivary glands has shown safe and effective results with long-lasting saliva reduction, but its use in pregnancy should be approached with caution and considered on a case-by-case basis, as the majority of evidence for its use is not specific to pregnant populations 3. Ultimately, the management of hypersalivation in pregnancy requires a multidisciplinary approach, considering the unique needs and risks of the pregnant patient, and prioritizing interventions that minimize risk while maximizing benefit for both mother and fetus.