Clozapine-Induced Hypersalivation

Abstract

OBJECTIVE:

To review underlying pathophysiology and possible treatments for clozapine-induced hypersalivation.

DATA SOURCES:

Primary literature was accessed through MEDLINE (1966–May 1999). Key search terms included clozapine, hypersalivation, sialorrhea, and treatment.

DATA SYNTHESIS:

Hypersalivation occurs in up to 54% of patients receiving clozapine. An evaluation of studies and case reports focusing on management of clozapine-induced hypersalivation was conducted.

CONCLUSIONS:

It is unclear whether clozapine increases salivation through its muscarinic M₄ receptor activation and/or blockade of α₂-adrenoceptors, or by causing a distortion in swallowing reflex. Treatment options include chewing gum, reducing the dosage of clozapine, or prescribing pharmacologic agents such as anticholinergics or α₂-adrenoceptor agonists.