[DYSPHAGIA] drooling & medication

[Jill Ellyn Senner <[log in to unmask]>]

The following is a review of 
some recent literature on the use of medication to control 
drooling:

Drugs have been used to block either the sympathetic or 
parasympathetic innervation of saliva production. Drugs that block sympathetic 
innervation tend to alter the consistency of saliva produced while drugs 
blocking the parasympathetic innervation tend to alter the quantity of saliva 
produced (Johnson & Scott, 1993). The most commonly used drugs reported in 
the drooling literature are Transdermal Scopolamine (Dreyfuss, Vogel, & 
Walsh, 1991; Good & Crain, 1996; Lewis et al., 1994; Siegel & Klingbeil, 
1991), Glycopyrrolate (Blasco & Stansbury, 1996; Stern, 1997), Benztropine 
(Owen & Stern, 1992), and Benzhexol Hydrochloride (Reddihough et al., 1990). 

Transdermal Scopolamine blocks parasympathetic innervation to the 
salivary glands and has been reported to be successful in reducing saliva flow 
(Siegel & Klingbeil, 1991). Lewis et al. (1994) reported that over half of 
the subjects in their study had at least a two-fold reduction in drooling and in 
a third of the subjects drooling was eliminated. Side effects reported included 
irritation around the patch site, pupillary dilation (Lewis et al., 1994) and 
esotropia (Good & Crain, 1996), although in a few cases where the medication 
has been used to prevent motion sickness, hallucinations have been reported 
(Wilkinsoin, 1987; Zisking, 1988). Glycopyrrolate is a drug with anticholinergic 
properties that has been used as a preanasthetic agent. Stern (1997) reported 
the majority of subjects demonstrating a reduction in drooling while taking 
glycopyrrolate. Blasco & Stansbury (1996) also found that glycopyrrolate 
reduced drooling, but rarely eliminated the problem. A common side effect of the 
drug included problems with constipation (Blasco & Stansbury, 1996; Stern, 
1997) but other side effects were noted including thirst in hot weather, dilated 
pupils, and dry lips (Stern, 1997). Reddihough et al. (1990) reported reduction 
in drooling with Benzhexol Hydrochloride in 17 of 20 subjects. Side effects 
included behavioral changes (restlessness and overactivity). Benztropine has 
also been reported to significantly reduce drooling (Owen & Stern, 1992). 
Aside from side-effects, it has been suggested that a disadvantage of 
pharmacological treatment is the possibility of adaption in which the salivary 
glands adapt to a reduced level of stimulation and become hypersensitive. If 
adaption occurs, saliva production can return to pre-medication levels over the 
course of treatment (Johnson & Scott, 1993). 

References: 

Blasco, P. A., & Stansbury, J. C. K. (1996). Glycopyrrolate 
treatment of chronic drooling. Archives of Pediatric and Adolescent 
Medicine, 150, 932-935.

Dreyfuss, P., Vogel, D., & Walsh, 
N. (1991). The use of transdermal scopolamine to control drooling. American 
Journal of Physical Medicine and Rehabilitation, 70, 
220-222.

Good, W. V., & Crain, L. S. (1996). Esotropia in a child 
treated with a scopolamine patch for drooling. Pediatrics, 
126-127.

Johnson, H., & Scott, A. (1993). A Practical Approach to 
Saliva Control. Tuscon, AZ: Communication Skill Builders.


Lewis, 
D. W., Fontana, C., Mehallick, L., K., & Everett, Y. (1994). Transdermal 
scopolamine for reduction of drooling in developmentally delayed children. 
Developmental Medicine and Child Neurology, 36, 
484-486.

Owen, S. E., & Stern, L. M. (1992). Management of drooling 
in cerebral palsy: three single case studies. International Journal of 
Rehabilitation Research, 15(2), 166-169.

Reddihough, D., 
Johnson, H., Staples, M., Hudson, I., & Exarchos, H. (1990). Use of 
Benzhexol Hydrochloride to control drooling of children with cerebral palsy. 
Developmental Medicine & Child Neurology, 32, 
985-989.

Siegel, L. K., & Klingbeil, M. A. (1991). Control of 
drooling with transdermal scopolamine in a child with cerebral palsy. 
Developmental Medicine and Child Neurology, 33(11), 
1013-1014.

Stern, L. M. (1997). Preliminary study of glycopyrrolate in 
the management of drooling. Journal of Paediatric and Child Health, 
33, 52-54.