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Clozapine and Treatment-Refractory Illness
Published in Ragy R. Girgis, Gary Brucato, Jeffrey A. Lieberman, Understanding and Caring for People with Schizophrenia, 2020
Ragy R. Girgis, Gary Brucato, Jeffrey A. Lieberman
Clozapine is definitively superior to other antipsychotic medications for treatment-refractory conditions. It has, however, some disadvantages. Regular blood draws, as well as the risk for potentially fatal agranulocytosis, cause many individuals to refuse to take this medication. Additionally, the further side-effect burden of clozapine is substantial. More than any other antipsychotic medication, clozapine can cause marked weight gain, as well as increases in lipid levels, especially trigylcerides, and abnormalities in blood glucose levels, sometimes leading to overt diabetes. Clozapine tends to be sedating and can also cause orthostatic hypotension. Clozapine also substantially decreases one’s seizure threshold. Because of this, it is very important to very slowly up-titrate the dose. Clozapine can cause severe hypersalivation, or sialorrhea, especially while sleeping. It is not uncommon for people to wake up with their pillow drenched from saliva.
Antiepileptic Drugs in Children
Published in Stanley R. Resor, Henn Kutt, The Medical Treatment of Epilepsy, 2020
W. Edwin Dodson, James D. Reggin
The benzodiazepines are safe but aggravating to administer because of the high frequency of adverse effects. Allergic reactions are rare in children as in adults. Sedation, irritability, and signs of inebriation are common. In young children hypersalivation with drooling is a frequent nuisance. High doses of CZP and NZP have been associated with increased seizure frequency (10,11). Levels of CZP above 70 ng/ml can cause absence or minor motor status. The differences in toxicity between CZP and clorazepate seem to relate to differences in potency. DZP has a low antiepileptic therapeutic index and is not recommended for chronic antiepileptic treatment in children.
Non-Neoplastic Salivary Gland Diseases
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
Stephen R. Porter, Stefano Fedele, Valeria Mercadante
Although excess salivation is uncommon, it can be distressing to both patients and carers. True excess salivation is extremely unusual, although it may sometimes arise following drug therapy. The majority of patients with excess salivation have difficulties in salivary control rather than hypersalivation.
Understanding and managing respiratory infections in children and young adults with neurological impairment
Published in Expert Review of Respiratory Medicine, 2023
Marijke Proesmans, Francois Vermeulen, Mieke Boon
Drooling and/or hypersalivation is a common problem in the NI patient population and is related to ineffective swallowing. While anterior drooling may not be associated with increased risk of aspiration (although it could also indicate ineffective swallowing?), posterior drooling may carry a higher risk for aspiration but it is more difficult to assess. Drooling may be decreased by medication such as glycopyrrolate [24]. Although relatively safe, main side effects are constipation, dry mouth or thickened secretions (which may lead to mucus plugging) and urinary retention. Moreover, it has a short half life time and thus should be given several times a day [25]. Scopolamine transdermal patches have a longer half-life and are an alternative to diminish the severity of drooling. Again, studies on their effectiveness in the population discussed here is limited. In a retrospective study in 44 children with non-progressive neurodevelopmental disability scopolamine patches significantly decreased drooling as well as drooling related complaints such as choking [26].
A critical review of incobotulinumtoxinA in the treatment of chronic sialorrhea in pediatric patients
Published in Expert Review of Neurotherapeutics, 2021
Wolfgang H. Jost, Armin Steffen, Steffen Berweck
Sialorrhea, also known as hypersalivation, ptyalis, or drooling, is excessive saliva beyond the lip margin, associated with neurological disorders or localized anatomical abnormalities in the oral cavity that inhibit complete closure of the laryngeal inlet [1,2]. Sialorrhea can be classified as anterior or dorsal pooling; anterior sialorrhea is the salivary incontinence or involuntary spillage of saliva over the lower lip that manifests as drooling, whereas dorsal sialorrhea is the flowing of saliva from the tongue to the pharynx [3]. Drooling is common in normally developing infants, but is generally considered pathologic after 4 years of age [4–6]. The most common cause of sialorrhea in children is cerebral palsy [7,8]; less common neurological disorders frequently associated with sialorrhea in children include Dravet, Rett, Goldenhar, and Angelman syndromes [9]. In addition, malformations and traumatic defects can cause a lack of integrity of the mouth and jaw region, resulting in sialorrhea [10].
A comprehensive review of swallowing difficulties and dysphagia associated with antipsychotics in adults
Published in Expert Review of Clinical Pharmacology, 2019
Giuseppe Cicala, Maria Antonietta Barbieri, Edoardo Spina, Jose de Leon
Paradoxically, the most anticholinergic antipsychotic, clozapine, may frequently cause sialorrhea. Hypersalivation is presumably explained by the differential activity of clozapine at some muscarinic receptor subtypes, being an antagonist at M3 and an agonist at M4 [72]. It is hypothesized that clozapine’s agonism at M4 may outweigh the antagonism at M3, thereby producing hypersalivation. In addition, norclozapine, the major clozapine metabolite, is an allosteric agonist of M1 muscarinic receptors, thereby potentiating the clozapine-induced sialorrhea [73,74].