Is clonidine useful for treatment of clozapine-induced sialorrhea?
Clozapine has shown superior efficacy in treatment of refractory schizophrenia, but its use is limited by emergent side-effects. Among other adverse effects, sialorrhea is a troublesome side-effect, its stigmatizing nature results in poor treatment compliance. Several hypotheses have been put forward in the etiology of clozapine-induced sialorrhea. 2 adrenergic antagonism is hypothesized to be involved in its pathophysiology, based on the response to clonidine and lofexidine. Oral clonidine (50 to 100 g/day) was tried on 12 stable outpatients of schizophrenia maintained on clozapine. Wet area over the pillow as reported by the patients was recorded at baseline and at 4 weeks of treatment along with the subjective response after the treatment. Most of the patients reported a decrease in sialorrhea without any adverse events. We describe encouraging results in an open case series of oral clonidine for clozapine-induced sialorrhea.
Senior Resident, Department of Psychiatry, Dr Ram Manohar Lohia Hospital, New Delhi, India. samirpsyche@yahoo.co.in
Samir Kumar
SK
Praharaj
Pankaj
P
Verma
Dipayan
D
Roy
Anuradha
A
Singh
D000316:Adrenergic alpha-Agonists / Q000627:therapeutic use*; D000328:Adult; D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D003000:Clonidine / Q000627:therapeutic use*; D003024:Clozapine / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012559:Schizophrenia / Q000150:complications / Q000188:drug therapy; D012798:Sialorrhea / Q000139:chemically induced* / Q000188:drug therapy*
D000316:Adrenergic alpha-Agonists; D014150:Antipsychotic Agents; D003024:Clozapine; D003000:Clonidine