What medications are effective for treating antipsychotic-induced hypersalivation?

From the Research

Effective Medications for Antipsychotic-Induced Hypersalivation

The following medications have been found to be effective in treating antipsychotic-induced hypersalivation:

• Metoclopramide, cyproheptadine, sulpiride, propantheline, diphenhydramine, benzhexol, doxepin, amisulpride, chlorpheniramine, amitriptyline, and atropine have been shown to outperform placebo in reducing sialorrhea 1
• Antimuscarinics, benzamides, tricyclic antidepressants (TCAs), and antihistamines have also been found to be effective in treating antipsychotic-induced sialorrhea 1
• Glycopyrrolate has been shown to significantly reduce hypersalivation in a randomized controlled trial 2, 3
• Botulinum toxin has also been found to be effective in treating refractory cases of antipsychotic-induced sialorrhea 4, 2

Mechanism of Action

The mechanism of action of these medications involves:

• Reducing cholinergic tone, either systemically or locally, to decrease saliva production 4
• Increasing adrenergic tone to reduce saliva production 4
• Blocking muscarinic receptors to reduce saliva production 1, 2

Treatment Options

Treatment options for antipsychotic-induced hypersalivation include:

• Topical and oral antimuscarinic medications 2
• α-adrenergic agents 2
• Glycopyrrolate 2, 3
• Botulinum toxin 4, 2
• Substitute benzamide derivatives 2