From the Guidelines
Anticholinergic medications, such as glycopyrrolate and scopolamine, are the primary choice for drying oral secretions, as they block acetylcholine receptors and reduce saliva production. Glycopyrrolate (Robinul) is often used at doses of 1-2 mg orally three times daily or 0.1-0.2 mg intravenously every 4-6 hours, as seen in studies 1. Scopolamine patches (1.5 mg applied behind the ear every 72 hours) provide a convenient alternative. Atropine drops (1% solution, 1-2 drops sublingually every 4-6 hours) can be used off-label for this purpose. These medications work by blocking acetylcholine receptors, which reduces the production of saliva from the salivary glands.
Some key points to consider when using these medications include:
- Side effects may include dry mouth, blurred vision, constipation, urinary retention, and confusion, particularly in elderly patients, as noted in 1 and 1.
- Start with the lowest effective dose and monitor for side effects.
- These medications should be used cautiously in patients with glaucoma, prostatic hypertrophy, or cognitive impairment.
- Non-pharmacological approaches like proper positioning, regular oral care, and careful hydration management can complement medication therapy.
It's also important to note that while other medications like amitriptyline (10-25 mg at bedtime) may help with nighttime secretions while also providing mild sedation, the primary choice for drying oral secretions remains anticholinergic medications, as supported by the most recent evidence 1.
From the FDA Drug Label
The most common adverse reactions reported with glycopyrrolate oral solution are dry mouth, vomiting, constipation, flushing, and nasal congestion
- Dry mouth is a common adverse reaction, reported by 40% of glycopyrrolate oral solution-treated subjects in the placebo-controlled clinical trial.
- Glycopyrrolate oral solution can be used to dry oral secretions, as it has anticholinergic effects that can reduce saliva production.
- The recommended dose titration schedule for glycopyrrolate oral solution is provided in Table 1, with doses ranging from 0.3 mg to 3.0 mg, three times daily, depending on the patient's weight 2.
From the Research
Medications to Dry Oral Secretions
- Anticholinergic medications are used to reduce oral secretions, including atropine, glycopyrrolate, scopolamine, and scopolamine derivatives 3.
- These medications work by blocking the action of acetylcholine, a neurotransmitter that stimulates the production of saliva and other oral secretions.
Comparison of Medications
- A study comparing hyoscine and glycopyrronium found conflicting results, with one paper favoring hyoscine and the other favoring glycopyrronium 4.
- Another study found that subcutaneous glycopyrrolate, scopolamine hydrobromide, and scopolamine butylbromide were similar in their ability to reduce noisy respirations in hospice patients 3.
- A review of options for treating sialorrhea in amyotrophic lateral sclerosis found that anticholinergic drugs, including atropine, glycopyrrolate, and scopolamine, are often used, but there is limited evidence of their effectiveness 5.
Efficacy of Medications
- A systematic review of anticholinergic treatment for sialorrhea in children found that glycopyrrolate, scopolamine/hyoscine, trihexyphenidyl/benzhexol, benztropine, and atropine all showed evidence of efficacy, but adverse side effects were common 6.
- The review also found that significant heterogeneity exists in the studies' methodology and the variability of outcome measures used between studies precluded a meta-analysis 6.