From the Research
Antipsychotics and Sialorrhea
- Sialorrhea is a common adverse effect associated with antipsychotic medications, particularly clozapine 1.
- The pathophysiology of antipsychotic-induced sialorrhea is complex and varies between antipsychotics, with clozapine being the most commonly associated with this side effect 2, 3.
- Other antipsychotics, such as risperidone, paliperidone, and aripiprazole, have also been reported to cause sialorrhea, although the frequency and severity of this side effect may be lower compared to clozapine 2, 4.
Comparison of Antipsychotics
- A study comparing the reporting patterns of sialorrhea among users of clozapine and other antipsychotics found that sialorrhea was relatively more frequently reported in clozapine users (1.1%) compared to other antipsychotics (0.31%) 1.
- Another study reported that risperidone-induced sialorrhea is suspected to have a prominent adrenergic pathophysiology, differing from the more commonly encountered clozapine-induced sialorrhea 2.
- Paliperidone, a second-generation antipsychotic, has also been associated with sialorrhea, although the frequency of this side effect is relatively low compared to clozapine 4.
Treatment of Sialorrhea
- Treatment of antipsychotic-induced sialorrhea typically involves dose reduction, discontinuation of the offending agent, or addition of anticholinergic medications 3, 5.
- A systematic review and network meta-analysis of randomized trials found that several interventions, including metoclopramide, cyproheptadine, and sulpiride, were effective in reducing sialorrhea in patients taking clozapine 5.
- However, the efficacy of these interventions may vary depending on the specific antipsychotic and individual patient factors, and shared decision-making with the patient is recommended to guide treatment decisions 5.