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Tijdschrift voor Psychiatrie 61 (2019) 6, 403 - 410

Review article

Sublingual use of atropine for clozapine-induced sialorrhoea: literature review and two case reports

T. van der Poorten, M. De Hert

background In patients taking clozapine, about 30% experience sialorrhoea, with its related potentially important medical and psychosocial implications. Until now, systemic treatments have been unsuccessful and also have unfavourable side-effects.
aim To examine the current evidence regarding the use of local atropine in clozapine-induced sialorrhoea (cis), as well as for sialorrhoea of other etiology.
method PubMed and Google Scholar were searched using the keywords ‘sialorrhea’, ‘clozapine’ and ‘atropine’ to investigate the use of sublingual atropine for cis, as well as for sialorrhoea of other etiology. Two patients are described and discussed.
results Of 24 identified patients, 21 experienced a beneficial effect on cis with sublingually administered atropine eye drops or 1% ipratropium bromide nasal spray (0.03%). Side-effects, such as a dry mouth, unpleasant taste and short duration of action of the eye drops, were reported. Of the 67 patients treated with local atropine for sialorrhoea of other etiology, generally a beneficial effect and few side-effects were reported.
conclusion The sublingual administration of atropine appears to be effective in the treatment of cis, as well as in sialorrhoea of other etiology. The dose is usually 1-2 eye drops, two to three times per day.

keywords atropine, clozapine, sialorrhoea, sublingual