Management of drooling in disabled patients with scopolamine patches. Breaking news southern health nhs foundation trust. The problem can be compounded by the coprescribing of antimuscarinic drugs like hyoscine with clozapine to counteract troublesome hypersalivation. Clozapine induced hypersalivation this bulletin is an update to a previously issued bulletin about clozapine induced hypersalivation vol 11 no 3, oct 20. Hypersalivation has been reported as a side effect of atypical antipsychotics such as clozapine. Hyoscine patches in clozapineinduced hypersalivation volume 25 issue 7 j. First line for antipsychoticinduced hypersalivation unlicensed indication, as per oxford health medicines information bulletin management of clozapineinduced hypersalivation. It is also sometimes used before surgery to decrease saliva. Drug interactions are reported among people who take valium and clozapine together. Updated practice guidelines for the use of clozapine in adult. Clozapine is the most effective antipsychotic for reducing positive symptoms and hospitalisations among people with treatmentresistant schizophrenia.
In this report, we present a case of hypersalivation induced by olanzapine with fluvoxamine in a patient who suffered from delusional disorder. Hyoscine patches in clozapine induced hypersalivation. Although efficacious, a common and unpopular side effect of clozapine treatment is clozapine induced hypersalivation cih, which can contribute to nonadherence. Clozapineinduced hypersalivation treatment options during hyoscine hydrobromide shortage feb 17 mhra drug safety update. Incremental efficacy of adding bupropion to the nicotine patch for smoking.
Sialorrhea in children with cerebral palsy sciencedirect. How to remedy excessive salivation in patients taking. Clozapine induced hypersalivation is a condition potentially difficult to manage. Aug 21, 2014 metoclopramide as treatment of clozapine induced hypersalivation the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Clozapineinduced hypersalivation was experienced by 92% of participants, with nocturnal hypersalivation more prevalent compared to daytime hypersalivation 85% versus 48%. Pathophysiology of clozapine induced sialorrhea and. Current pharmacologic treatment options for clozapineinduced sialorrhea are limited in number and. Amisulpride, similar to sulpiride, is a substitute benzamide derivative with higher selective binding to the d 2 d 3 dopamine receptor.
Treatment of clozapineinduced hypersalivation ipratropium. Rmoc materials on adalimumab are below under medicines. Clozapine is an atypical antipsychotic agent with proven efficacy in refractory schizophrenia, but its widespread use is limited by adverse effects such as agranulocytosis, seizures, sedation, weight gain, and sialorrhea. Druginduced hypersalivation what treatment options are available. Clozapine definition of clozapine by medical dictionary. Mazhar osman research and training hospital for psychiatry, neurology and neurosurgery, rasit. The usual treatment is hysoscine hydrobomide tablets kwells, or joyrides but there is a national shortage, so alternative treatments are required. This cks topic is largely based on expert opinion in an international consensus statement recognition, diagnosis, and treatment of primary focal hyperhidrosis hornberger et al, 2004 and in a canadian consensus statement a comprehensive approach to the recognition, diagnosis, and severitybased treatment of focal hyperhidrosis. Treatment of clozapine induced parotid gland swelling. Sialorrhea in children with cerebral palsy, scielo. Pharmacological strategies for clozapine induced hypersalivation. However, this medication can have some severe side effects, including. Clozapineinduced hypersalivation cih is a significant side effect affecting about onethird of patients treated with clozapine. This restricted any further increase in the dose of clozapine, despite the patients continued psychotic symptoms.
In circumstances where patients do not respond to hyoscine, the. Clonidine treatment of clozapine induced hypersalivation. Hyoscine, also known as scopolamine, is a medication used to treat motion sickness and postoperative nausea and vomiting. Hyoscine patches in clozapineinduced hypersalivation. Our repository of good practice supports the who medication without harm global patient. By michael dixon, lead pharmacist for medicines information. Clozapineinduced hypersalivation this bulletin is an update to a previously issued bulletin about clozapineinduced hypersalivation vol 11 no 3, oct 20. Clozapineinduced hypersalivation cih is a common side effect of clozapine treatment and is disliked by clozapine patients, potentially threatening adherence to clozapine treatment.
Sep 28, 2006 treatment of clozapine induced hypersalivation ipratropium bromide the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. History of an allergic reaction to hyoscine hydrobromide 3. Treatment of clozapineinduced hypersalivation ashtons. Clozapineinduced hypersalivation occurs very commonly, with reported incidences ranging from 30% to 80%. In circumstances where patients do not respond to hyoscine, the most popular choice was sublingual atropine. Hyoscine hydrobromide patch when back in stock apply 1 patch every 72 hours all of the above are not licensed for hypersalivation but options 25 are licensed for other indications in the uk whereas option 1 is not licensed at all in the uk.
Salivation is regulated by both cholinergic and adrenergic neural systems perkins and mcclure, 1998, bai et al. The beneficial effect of sulpiride augmentation of clozapine therapy for treatmentresistant schizophrenia patients is enhanced by its antisalivatory effect on clozapineinduced hypersalivation cih. The beneficial effect of sulpiride augmentation of clozapine therapy for treatmentresistant schizophrenia patients is enhanced by its antisalivatory effect on clozapine induced hypersalivation cih. When clozapine induced constipation has been diagnosed the recommended steps are. Scopolamine patch for clozapineinduced sialorrhea letter. Sublingual atropine solution 1% was commenced one drop up to 3 timesday. Within these patients, a significant subgroup developed secondary obsessivecompulsive symptoms during treatment with clozapine.
Most common side effects of clozapine and their management. Heavier shading indicates greater network coverage. Reducing clozapineinduced hypersalivation mdedge psychiatry. Learn more about the rmocs, view recommendations and resources, and raise a topic. Clozapineinduced delirium the journal of neuropsychiatry. Any of the following contraindications to hyoscine as stated in the british national formulary and electronic medicines compendium. Dec 12, 20 patients with schizophrenia often experience comorbid obsessivecompulsive symptoms. Yaylaci s, yilmaz eu, guclu e, kumsar na, tamer a, karabay o, clozapine induced febrile neutropenia and cellulitis, turkish journal of emergency medicine, 2014 mar. In this paper, we report on four cases in which adjunctive therapy with aripiprazole was tested to alleviate obsessivecompulsive symptoms in schizophrenia. For general population patients, ie, those without ben, treatment should be interrupted if neutropenia is suspected to be clozapine induced for anc less than cells per microliter. Treatment of clozapineinduced parotid gland swelling. Excess saliva hypersalivation or siallorrhoea is a distressing clozapine side effect which can occur in about 30% of patients. Fourteen inpatients diagnosed with treatmentresistant schizophrenia, treated with clozapine and suffering from hypersalivation were randomized to receive hyoscine 0. Available to purchase over the counter as scopoderm patches, kwells and joyrides for motion sickness.
A questionnairebased study of the views of schizophrenia patients. The clozapineinduced hypersalivation and its treatment. This study investigated the efficacy of the anticholinergic agent scopolamine butylbromide against clozapineinduced hypersalivation. This study aims to examine the efficacy of hyoscine scopolamine for clozapineinduced hypersalivation. Yaylaci s, yilmaz eu, guclu e, kumsar na, tamer a, karabay o, clozapineinduced febrile neutropenia and cellulitis, turkish journal of emergency medicine, 2014 mar. The prevalence of sialorrhea is between 10% and 58% in cerebral palsy and has. Clozapine, atypical antipsychotics, schizophrenia, side effects. Buckinghamshire formulary shared care protocol for oxfordshire joint formulary 3ts formulary bcap formulary melatonin is restricted to secondary care prescribing, with the exception of buckinghamshire, where there is a shared care arrangement for under 18 year olds the shared care protocol includes circadin mr only. Hypersalivation caused by clozapine can lead to sleep deprivation, salivary gland swelling, 1 and aspiration pneumonia. Sublingual atropine for the treatment of severe and hyoscine. Druginduced hypersalivation what treatment options are. Daytime drooling was severe in 18% of cases and was present on a frequent or constant basis for 20% of individuals. Hypersalivation induced by olanzapine with fluvoxamine.
Hyoscine hydrobromide tablets 300mcgs are again widely available and available for clozapine induced hypersalivation. The aim of the present study was to test for an association between the cyp1a2. Aripirazole augmentation in clozapineassociated obsessive. We concluded the hypersalivation was due to olanzapine, and it was decided to discontinue olanzapine without any change of fluvoxamine dose. The usual dose by mouth for the treatment of anxiety is up to 30 mg daily in divided doses. Nov 21, 2016 clozapine is the only medication licensed for the treatment of resistant schizophrenia in the uk. Current treatment strategies for clozapineinduced sialorrhea. A guide to medications inducing salivary gland dysfunction. Hyoscine patches in clozapine induced hypersalivation volume 25 issue 7 j. Glycopyrrolate in comparison to hyoscine hydrobromide and. Anxiety see the cks topic on generalized anxiety disorder for more information. For acute or severe anxiety an initial dose of 50 to 100 mg of the hydrochloride has been given by injection, followed if.
Anxiety treatment guidelines bipolar guidelines anticoagulation guidelines management of depression for adults and older people guidelines feel free to email stephen. However, studies on this are scarce and have been conducted with either various antipsychotics or only in small samples of patients receiving clozapine. A total of 458 articles were obtained, of which 158 were analyzed as they were associated with sialorrhea in children. It may also be used by mouth and as a skin patch common side effects include sleepiness, blurred vision, dilated pupils.
Questions for self assessment third edition timothy gk mant bsc ffpm frcp senior medical advisor, quintiles, guys drug research unit, and visiting professor, kings college london school of medicine at guys, kings and st thomas hospitals, london, uk. Hypersalivation improved significantly with hyoscine. Pdf sublingual atropine for the treatment of severe and. Clozapineinduced hypersalivation is socially embarrassing and potentially life threatening. In the meantime we have procured a supply of hyoscine from australia don notified when we have stock available. Find amr networks and contacts at regional, stp and ccg level. Do any of the problems associated with clozapine treatment make you anxious. Options in managing alternatives to hyoscine in clozapine. Chronic drooling can be defined as the unintentional loss of saliva from the mouth. Cih can be stigmatizing, can affect quality of life, and can result in discontinuation of clozapine treatment. Wellington icu drug manual v2 20 precautions general prescribing cefotaxime in the absence of a proven or strongly suspected bacterial infection or a prophylactic indication is unlikely to provide benefit to the patient and increases the risk of the development of drugresistant bacteria.
M is a 44yearold male with an 18year history of schizophrenia characterized by somatic delusion, delusion of persecution, and episodes of. Cytochrome p450 1a2 gene cyp1a2 polymorphisms have been suggested to be associated with increased side effects to antipsychotics. Sps specialist pharmacy service the first stop for. How to remedy excessive salivation in patients taking clozapine. Scopolamine, a transdermal used to prevent motion sickness, significantly reduced disabling hypersalivation in patients who wore a 1mg patch behind the ear for 72. When used by injection, effects begin after about 20 minutes and last for up to 8 hours. Amisulpride treatment of clozapineinduced hypersalivation. You can find out drug interactions, minor or serious, reported by people like you. Medical conditions that could influence hypersalivation e. Secondary generalized hyperhidrosis may be caused by a range of conditions including anxiety, heart failure, infections, malignancy, endocrine or metabolic conditions, parkinsons disease, epilepsy, drugs or alcohol. Rechallenge with clozapine after prior clozapineinduced neutropenia is a complex issue.
Clozapine induced sialorrhea cis is bothersome and has socially stigmatizing adverse effects, which result in poor treatment compliance. The secondary outcomes were change in the mass of the pillowcase, anxiety, depression and quality of life. The standard treatment for cih in the uk is hyoscine hydrobromide but this may aggravate cognitive deficits in patients with. The wide range of options and lack of evidence does not support clinicians in their attempts to continue treatment. This effect typically commences at the onset of treatment and can diminish with time. Accordingly, some patients who are disturbed by their hypersalivation refuse to continue with clozapine treatment. Effect of scopolamine butylbromide on clozapineinduced. These results indicate that at least some schizophrenic patients with clozapineinduced hypersalivation would benefit from scopolamine. Use of atropine eye drops for clozapine induced hypersalivation. Reducing the clozapine dose can help, which can be achieved by augmenting with another antipsychotic.
A 54% reduction compared to 20% on placebo on the nhrs and a 32% reduction compared to 15% on placebo on the dss p and colleagues thus provide preliminary evidence for a potentially welltolerated treatment that could be initiated in patients with clozapine induced hypersalivation. Hypersalivation can also be an adverse effect of drug treatment for example, clozapine. Clozapinetreated patients with schizophrenia and psychiatric healthcare. Medicationinduced salivary gland dysfunction misgd, xerostomia sensation of oral. Amisulpride treatment of clozapineinduced hypersalivation i. Metoclopramide may be effective for clozapineinduced. Clozapine induced hypersalivation cih is a common side effect of clozapine treatment and is disliked by clozapine patients, potentially threatening adherence to clozapine treatment. We hypothesized that addon amisulpride would also be. Apr 01, 2008 the hematological, metabolic changes, sedation, and lowering of seizure threshold of clozapine is well known, but the occurrence of clozapine induced delirium has been less reported. It can lead to poor medication adherence, which is of concern for patients in secure settings. Listing a study does not mean it has been evaluated by the u. Hypersalivation is an inconvenient, potentially embarrassing aspect of clozapine treatment that can cause avoidable distress. Comparative efficacy and tolerability of benztropine and terazosin in the treatment of hypersalivation secondary to clozapine. Olanzapine, a dibenzodiazepine derivative, has also been reported to cause hypersalivation, although to a lesser extent than clozapine chengappa et al.
Pdf current treatment strategies for clozapineinduced sialorrhea. It is not clear at what dosage clozapine causes sialorrhea, but the higher the dosage the more severe the problem. Chapter 10 endocrine drugs pdf free online publishing. It should be noted hyoscine hydrobromide is not licensed for the treatment of hypersalivation either. Clozapineinduced hypersalivation is a condition potentially difficult to manage. Safety and efficacy of atropine for salivary hypersecretion.