Intraoral application of atropine sulfate ophthalmic solution for clozapine-induced sialorrhea [1]

Results:The patient's positive symptoms of schizophrenia were in remission during Leponex treatment. However, he developed sialorrhea soon after the initiation of Leponex. The sialorrhea was attributed to Leponex, as the only other medication he was taking at that time was ranitidine and no medication change was made during the time of the onset of sialorrhea. The sialorrhea worsened at night, affecting the patient's sleep and quality of life. He rated the sialorrhea as moderate in severity. Considering the schizophrenia treatment refractory, it was then decided to treat the man for sialorrhea rather than changing the schizophrenia medication. The patient was advised to swish 2 drops of atropine sulfate ophthalmic solution 1% in his mouth twice daily and then swallow if after a few seconds. Within 2 weeks, the patient reported a decrease in hypersalivation and no other adverse effects due to the atropine solution. Since then, he has been using the atropine ophthalmic solution intraorally, with complete resolution of sialorrhea.

AdverseEffects:1 patient developed sialorrhea.

AuthorsConclusions:Oral use of 1% atropine sulfate ophthalmic solution may be safe, efficacious treatment for clozapine-induced sialorrhea. Further large-scale studies are needed to corroborate the findings of this case.

FreeText:The patient had a 23 year history of chronic paranoid schizophrenia and presented to the Leponex clinic for his bimonthly visit. His medical history was significant for gastroesophageal reflux disease, for which he was taking ranitidine 150 mg bid. The patient had been last hospitalized 5 years earlier in a long-term inpatient facility for exacerbation of his symptoms that included bizarre behavior, paranoid thoughts, and auditory hallucinations. During the hospitalization, he failed to respond to trials of haloperidol and chlorpromazine and was subsequently prescribed Leponex.

Indications:1 patient with refractory chronic paranoid schizophrenia. Coexisting disease was gastroesophageal reflux disease.

Patients:One 55 year old African man (in-/outpatient).

TypeofStudy:Intraoral application of atropine sulfate ophthalmic solution for Leponex-induced sialorrhea presented in a case report. Letter to the editor.

DosageDuration:350 mg at bedtime. Duration not stated.