{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,18]],"date-time":"2026-07-18T21:09:05Z","timestamp":1784408945158,"version":"3.55.0"},"reference-count":12,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T00:00:00Z","timestamp":1782691200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Pharmacy Practice"],"abstract":"<jats:p>Sialorrhea, or excessive drooling, is a distressing side effect of certain antipsychotic medications, including aripiprazole, clozapine, and olanzapine. We present the case of a 53-year-old female with bipolar I disorder who presented with altered mental status, dysphagia, a 2-day history of excessive drooling, and acute hypoxic respiratory failure. Despite being alert and responsive, she required intubation due to the inability to manage oral secretions. At the time, she had been taking aripiprazole 20\u00a0mg once daily and lithium 450\u00a0mg twice daily for about three months for bipolar 1 disorder, which were continued inpatient. Aripiprazole was discontinued on the third day of hospitalization. Standard treatments for sialorrhea, including anticholinergics such as scopolamine, glycopyrrolate, and sublingual atropine, were ineffective. Substantial improvement only occurred after the initiation of dexmedetomidine, an alpha-2 adrenergic agonist, on day nine, leading to decreased oral secretions and successful extubation. The patient was transitioned to oral clonidine, another alpha-2 adrenergic agonist, and remained extubated for the rest of her hospital stay. Upon further improvement, she was discharged on glycopyrrolate, a 3-day taper of clonidine, and trazodone, with bipolar I disorder management switched to valproic acid monotherapy. This case highlights the potential role of alpha-2 adrenergic agonists in managing refractory aripiprazole-induced sialorrhea, offering a viable alternative when traditional anticholinergic therapies are ineffective.<\/jats:p>","DOI":"10.1177\/08971900261466364","type":"journal-article","created":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T09:26:39Z","timestamp":1782725199000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Aripiprazole and Unexpected Salivation: A Case of Drug-Induced Sialorrhea Refractory to Anticholinergics"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-5401-2845","authenticated-orcid":false,"given":"Charlie","family":"Yang","sequence":"first","affiliation":[{"name":"Pharmacy Department, Wingate University School of Pharmacy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keren","family":"Eagers","sequence":"additional","affiliation":[{"name":"Pharmacy Department, Atrium Health Pineville"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Desiree","family":"Kosmisky","sequence":"additional","affiliation":[{"name":"Pharmacy Department, Atrium Health Cabarrus"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristen","family":"Nagy","sequence":"additional","affiliation":[{"name":"Pharmacy Department, Atrium Health Behavioral Health-Charlotte"},{"name":"Pharmacy Department, Sandra and Leon Levine Psychiatry Residency Program"},{"name":"Pharmacy Department, Mercer University Savannah\/Gateway Behavioral Health Services"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,6,29]]},"reference":[{"issue":"11","key":"e_1_3_5_2_2","first-page":"2628","article-title":"Sialorrhea: a review of causes and treatment","volume":"69","author":"American Academy of Family Physicians","year":"2004","unstructured":"American Academy of Family Physicians. Sialorrhea: a review of causes and treatment. Am Fam Physician. 2004;69(11):2628-2634.","journal-title":"Am Fam Physician"},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41380-023-02266-x"},{"key":"e_1_3_5_4_2","doi-asserted-by":"publisher","DOI":"10.7150\/ijms.12912"},{"key":"e_1_3_5_5_2","doi-asserted-by":"publisher","DOI":"10.1111\/odi.15337"},{"key":"e_1_3_5_6_2","doi-asserted-by":"publisher","DOI":"10.1081\/CLT-53095"},{"key":"e_1_3_5_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.pnpbp.2008.12.016"},{"key":"e_1_3_5_8_2","doi-asserted-by":"publisher","DOI":"10.5455\/jmood.20170804094052"},{"key":"e_1_3_5_9_2","doi-asserted-by":"publisher","DOI":"10.1111\/prd.12116"},{"key":"e_1_3_5_10_2","doi-asserted-by":"publisher","DOI":"10.1586\/14737175.5.3.297"},{"key":"e_1_3_5_11_2","doi-asserted-by":"publisher","DOI":"10.1192\/bja.2021.49"},{"key":"e_1_3_5_12_2","doi-asserted-by":"publisher","DOI":"10.1007\/s40263-015-0278-3"},{"key":"e_1_3_5_13_2","doi-asserted-by":"publisher","DOI":"10.1177\/02537176211025789"}],"container-title":["Journal of Pharmacy Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/08971900261466364","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/08971900261466364","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/08971900261466364","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T09:47:33Z","timestamp":1782985653000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/08971900261466364"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,29]]},"references-count":12,"alternative-id":["10.1177\/08971900261466364"],"URL":"https:\/\/doi.org\/10.1177\/08971900261466364","relation":{},"ISSN":["0897-1900","1531-1937"],"issn-type":[{"value":"0897-1900","type":"print"},{"value":"1531-1937","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,29]]},"article-number":"08971900261466364"}}