title: Potential use of ipatropium bromide for the treatment of clozapine-induced hypersalivation: a preliminary report.
abstract: Sialorrhea is reported by 31% of patients taking clozapine. Anticholinergic agents and adrenergic agonists are used for its treatment based on empirical evidence. In the present study, 10 patients who failed to respond to anticholinergic or adrenergic agents received intranasal ipatropium bromide (IPB) to minimize anticholinergic systemic absorption. Intranasal IPB was given to 10 patients for clozapine-induced sialorrhea who failed to respond to benztropine or clonidine. Pre-, post- and 6 month follow-up values were recorded on a single-item, 5-point Hypersalivation Rating Scale. The sign test was used for statistical comparison (P < 0.05). Eight patient reported initial improvement in sialorrhea values. Two patients reported no change and two patients discontinued IPB. At 6 months, six patients maintained improvement. Side-effects for IPB were minor. A significant trend was observed in the values pre- and post-treatment with IPB (P < 0.004). Improvement was maintained at 6 month follow-up (P < 0.008). This case series demonstrates the possible utility of intranasal IPB for clozapine-induced sialorrhea. Intranasal IPB lacks significant systemic anticholinergic effects when prescribed along with clozapine. This study shows only qualitative differences in salivation values and large controlled-comparative trials are needed.
authors.affiliation: Wayne State University/Detroit Medical Center, Department of Psychiatry and Behavioral Neurosciences, Blumberg Health Center, Michigan 48235, USA. doco-jc@msn.com
authors.forename: J
authors.initials: J
authors.lastname: Calderon
authors.forename: E
authors.initials: E
authors.lastname: Rubin
authors.forename: W L
authors.initials: WL
authors.lastname: Sobota
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001590:Benztropine / Q000009:adverse effects / Q000627:therapeutic use; D018680:Cholinergic Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D003024:Clozapine / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D009241:Ipratropium / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D018727:Muscarinic Antagonists / Q000009:adverse effects / Q000627:therapeutic use; D011569:Psychiatric Status Rating Scales; D012559:Schizophrenia / Q000150:complications / Q000188:drug therapy; D012798:Sialorrhea / Q000139:chemically induced* / Q000188:drug therapy*
chemical_list: D014150:Antipsychotic Agents; D018680:Cholinergic Antagonists; D018727:Muscarinic Antagonists; D001590:Benztropine; D009241:Ipratropium; D003024:Clozapine