title: Treating sialorrhea with transdermal scopolamine. Exploiting a side effect to treat an uncommon symptom in cancer patients.
abstract: BACKGROUND
  Sialorrhea is a distressing symptom accompanying oral cancer and many heterogeneous cancer-related conditions (chemotherapy-induced nausea, bowel subocclusion, pharmacologic side effects), but its incidence is low in cancer patients. Conversely, it is frequent in patients with neurological damage, and some therapeutic options have been attempted such as botulinum toxins, anticholinergic agents, and surgical procedures.
  
  
  METHODS
  We report the case of an 80-year-old woman with peritoneal carcinomatosis and bowel subocclusion, suffering from distressing nausea and sialorrhea that rapidly improved using transdermal scopolamine. No relevant side effects occurred during the treatment, and the reduction of the abnormal salivation allowed the recovery of oral feeding.
  
  
  CONCLUSIONS
  Anticholinergic drugs are classified as secondary options in the treatment of sialorrhea of patients with Parkinson's disease or cerebral palsy, owing to the relevant side effects occurring during prolonged treatments. However, they could be useful in cancer patients with bowel subocclusion, as the reduction of gastrointestinal secretions and intestinal motility (frequent side effects of anticholinergic drugs) could be effective in controlling nausea, vomiting, and abdominal pain. Moreover, the transdermal or sublingual route of administration can be of some interest, avoiding other more invasive parenteral approaches.
authors.affiliation: Department of Oncology, City Hospital, Rimini, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Tassinari
authors.forename: Barbara
authors.initials: B
authors.lastname: Poggi
authors.forename: Manuela
authors.initials: M
authors.lastname: Fantini
authors.forename: Emiliano
authors.initials: E
authors.lastname: Tamburini
authors.forename: Sergio
authors.initials: S
authors.lastname: Sartori
mesh_terms: D000279:Administration, Cutaneous; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000150:complications*; D005260:Female; D006801:Humans; D018727:Muscarinic Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D010534:Peritoneal Neoplasms / Q000150:complications*; D012601:Scopolamine / Q000008:administration & dosage / Q000627:therapeutic use*; D012798:Sialorrhea / Q000188:drug therapy* / Q000209:etiology*; D016896:Treatment Outcome
chemical_list: D018727:Muscarinic Antagonists; D012601:Scopolamine