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sialorrhea; hypersalivation; ptyalism

Excessive secretions of the salivary glands. Etiology: 1) neurodevelopmental disorders a) oromotor dysfunction b) cerebral palsy 2) dementia 3) autonomic dysfunction a) Parkinson's disease b) parkinson plus syndromes 4) cholinergic agonists a) muscarinic receptor agonists b) cholinesterase inhibitors Management: 1) glycopyrrolate (Robinul) for neurodevelopmental disorders [2] a) start 0.04 mg/kg BID-TID b) increment dose weekly c) maximum: 0.2 mg/kg TID d) evening dose may be unnecessary 2) scopolamine patch [3] 3) atropine eye drops, sublingual 4) ipratropium nasal spray, sublingual 5) Botox injected into submandibular gland (bilaterally) undergeneral anesthesia [3]

Related

salivary gland salivation xerostomia (asialism, aptyalism, dry mouth, hyposalivation)

General

sign/symptom salivary gland disease

References

  1. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 1050
  2. Journal Watch 21(1):10, 2001 Mier RJ, Bachrach SJ, Lakin RC et al Treatment of sialorrhea with glycopyrrolate: A double-blind, dose-ranging study. Arch Pediatr Adolesc Med 154:1214,2000 PMID: 11115305
  3. Prescriber's Letter 13(10): 2006 Alternative or 'Off-label' Routes of Drug Administration Detail-Document#: 221012 (subscription needed) http://www.prescribersletter.com
  4. Wolff A, Joshi RK, Ekstrom J et al A Guide to Medications Inducing Salivary Gland Dysfunction, Xerostomia, and Subjective Sialorrhea: A Systematic Review Sponsored by the World Workshop on Oral Medicine VI. Drugs R D. 2017 Mar;17(1):1-28. PMID: 27853957 Free PMC article. Review.
  5. Dashtipour K, Bhidayasiri R, Chen JJ et al RimabotulinumtoxinB in sialorrhea: systematic review of clinical trials. J Clin Mov Disord. 2017 Jun 6;4:9 PMID: 28593050 PMCID: PMC5460542 Free PMC article
  6. Ruiz-Roca JA, Pons-Fuster E, Lopez-Jornet P. Effectiveness of the Botulinum Toxin for Treating Sialorrhea in Patients with Parkinson's Disease: A Systematic Review. J Clin Med. 2019 Mar 6;8(3):317. PMID: 30845700 Free PMC article. Review.