Hyoscine for clozapine-induced hypersalivation: a double-blind, randomized, placebo-controlled cross-over trial

  title={Hyoscine for clozapine-induced hypersalivation: a double-blind, randomized, placebo-controlled cross-over trial},
  author={Aviv Segev and Anthony Evans and John Hodsoll and Eromona Whiskey and Rebecca Syed Sheriff and Sukhi S. Shergill and James Hunter MacCabe},
  journal={International Clinical Psychopharmacology},
Clozapine is the only evidence-based antipsychotic for treatment-resistant schizophrenia. However, it has considerable side effects, limiting its usability and reducing patients’ adherence. One of the most common and distressing side effects is hypersalivation, which can be debilitating, stigmatizing and potentially dangerous through its association with aspiration pneumonia. There is a paucity of evidence guiding possible treatment strategies for hypersalivation. This study aims to examine the… 

The effect of sublingual atropine sulfate on clozapine-induced hypersalivation: a multicentre, randomised placebo-controlled trial

Subjectively, more patients in the atropine group found their pillow to have less saliva the following morning and found their sleep to be better and more research is required to compare the effect of sublingual atropines with other anticholinergic medications and different dosage forms.

Glycopyrrolate in comparison to hyoscine hydrobromide and placebo in the treatment of hypersalivation induced by clozapine (GOTHIC1): a feasibility study

The feasibility study demonstrated that a trial of alternative medications in the treatment of CIH is feasible; patients were willing to be randomised to the trial and retention rate was high.

Clinical Effectiveness of Muscarinic Receptor-Targeted Interventions in Neuropsychiatric Disorders: A Systematic Review

Findings on muscarinic receptor-targeted interventions in several mental disorders are promising in terms of efficacy and safety, specifically in treating schizophrenia, mood disorders, and behavioural and psychiatric symptoms of Alzheimer’s disease.

Clozapine prescribing: comparison of clozapine dosage and plasma levels between White British and Bangladeshi patients

The findings point to the need for the broadening of data collection on ethnic differences in clozapine prescribing within big data-sets such as Prescribing Observatory for Mental Health (POM-UK) and Ethnopharmacological variations can inform more person-centred guidance on prescribing.



Treatment of clozapine-induced hypersalivation with ipratropium bromide: a randomized, double-blind, placebo-controlled crossover study.

OBJECTIVE Clozapine-induced hypersalivation (CIH) occurs in up to 57% of treated patients and can be the source of considerable subjective distress. Previous open-label studies suggest that

Pharmacological interventions for clozapine-induced hypersalivation.

The quality of reporting was poor with no studies clearly describing allocation concealment and much data were missing or unusable, all results are vulnerable to considerable bias, and current practice outside of well designed randomised trials should be clearly justified.

A natural study of the efficacy of replacement medications for the treatment of clozapine-induced hypersalivation

While hyoscine hydrobromide is the treatment of choice for clozapine-induced hypersalivation, a Cochrane Review has indicated that the evidence base for this treatment is weak and clinicians are forced to make pragmatic prescribing judgements in the absence of evidence.

Options in managing alternatives to hyoscine in clozapine-induced hypersalivation: a survey of secure services consultants.

  • Yasir Kasmi
  • Medicine, Psychology
    Psychiatric bulletin
  • 2014
In the absence of hyoscine hydrobromide, there was overall little confidence in alternatives, but clinicians tended to advocate one or two, and the wide range of options and lack of evidence does not support clinicians in their attempts to continue treatment.

Clozapine-induced hypersalivation: an estimate of prevalence, severity and impact on quality of life

Clozapine-induced hypersalivation is the most prevalent adverse effect experienced by patients treated with clozapines and negatively impacts on quality of life, particularly if daytime drooling is present.

The Effect of Glycopyrrolate on Nocturnal Sialorrhea in Patients Using Clozapine: A Randomized, Crossover, Double-Blind, Placebo-Controlled Trial

Glycopyrrolate seemed to be a tolerable anticholinergic agent in the treatment of clozapine-associated sialorrhea, and was not superior to placebo, whereas 2 mg showed a significant clinical improvement of nocturnal sIALorrhea compared with placebo.

Clozapine-induced sialorrhea: pathophysiology and management strategies

Judicious use of pharmacological agents along with behavioral methods will reduce this troublesome side effect and enhance compliance and no drug has been found to be superior.

Clozapine v. first- and second-generation antipsychotics in treatment-refractory schizophrenia: systematic review and meta-analysis

Clozapine is superior for treatment-refractory disorder but if there is no response by 6 months medications with lower adverse reactions should be considered.

Prevalence and nature of side effects during clozapine maintenance treatment and the relationship with clozapine dose and plasma concentration

The side-effect burden associated with maintenance clozapine treatment is high and the true extent can only be ascertained by systematic inquiry, so the use of target plasma concentrations below those used for acute treatment should be explored as a strategy for minimizing side effects.

Trihexyphenidyl treatment of clozapine‐induced hypersalivation

Results indicate that at least some; chronic schizophrenic patients with clozapine-induced nocturnal hypersalivation may benefit from anticholinergic treatment.