Clozapine Induced Hypersalivation (Sialorrhoea) – Clinical Importance and Pharmacological Options for Management
Clozapine is an evidence-based treatment in treatment-resistant schizophrenia. It is known to reduce all-cause mortality in schizophrenia and also has anti-suicidal effects. Clozapine’s efficacy has to be weighed up against rare serious side effects such as agranulocytosis, myocarditis, cardiomyopathy and thromboembolic phenomenon. [Cardiac complications of clozapine]
Common side effects such as weight gain and hypersalivation can affect compliance and therefore should be proactively managed.
Approximately 30%-80% of patients report hypersalivation as a side effect. One study reported a rate of 91%. [Maher S et al., 2016]
Day time drooling is reported as the top three adverse effects with clozapine.
It is associated with significant distress, social embarrassment, low self-esteem, insomnia and in severe cases can lead to aspiration pneumonia. It is one of the important factors associated with non-adherence to clozapine. [Gupta s et al., 2020]