{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T07:16:46Z","timestamp":1791357406894,"version":"4.3.1"},"reference-count":41,"publisher":"SAGE Publications","issue":"5","license":[{"start":{"date-parts":[[2011,5,1]],"date-time":"2011-05-01T00:00:00Z","timestamp":1304208000000},"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":["Ann Pharmacother"],"published-print":{"date-parts":[[2011,5]]},"abstract":"<jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>To provide an understanding of the underlying pathophysiology and current treatment options for clozapine-induced sialorrhea.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data Sources:<\/jats:title>\n                    <jats:p>Literature was retrieved through MEDLINE (1977-February 2011) using the key search terms clozapine, sialorrhea, hypersalivation, drooling, and treatment. In addition, reference citations from identified publications were reviewed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Selection and Data Extraction:<\/jats:title>\n                    <jats:p>All articles published in English identified from the data source were evaluated and included in the review.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data Synthesis:<\/jats:title>\n                    <jats:p>Sialorrhea is a common and disabling adverse effect of clozapine use. Current treatment options include topical and oral antimuscarinic medications and \u03b1-adrenergic agents. New areas of investigation include glycopyrrolate, botulinum toxin, and substitute benzamide derivatives. Thirteen clinical trials (2 retrospective, 5 open-label, 6 double-blind) and 13 case reports were reviewed. Overall, there are weak data on use of antimuscarinic agents, consisting mostly of small open-label or retrospective studies. Glycopyrrolate, however, demonstrated significant reduction of hypersalivation in a randomized controlled trial. Medications with activity at \u03b1-adrenergic receptors have shown positive results in case reports, retrospective evaluations, and an open-label trial, but have not been investigated in a double-blind, controlled fashion. Botulinum toxin also significantly improved sialorrhea in both a case report and double-blind study, although the trial included hypersalivation from other etiologies in addition to clozapine. Substitute benzamide derivatives have demonstrated significant improvements in randomized controlled trials; however, they are not available in the US. Overall, few treatment strategies have been evaluated in controlled settings, warranting further randomized controlled trials to identify more effective treatment options.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Current pharmacologic treatment options for clozapine-induced sialorrhea are limited in number and efficacy. Although few randomized controlled trials have been conducted, this review identifies potential treatment alternatives for this common and sometimes severe adverse effect.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1345\/aph.1p761","type":"journal-article","created":{"date-parts":[[2011,5,3]],"date-time":"2011-05-03T22:06:39Z","timestamp":1304460399000},"page":"667-675","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":52,"title":["Current Treatment Strategies for Clozapine-Induced Sialorrhea"],"prefix":"10.1177","volume":"45","author":[{"given":"Angela M","family":"Bird","sequence":"first","affiliation":[{"name":"College of Pharmacy, The University of Texas, Austin, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tawny L","family":"Smith","sequence":"additional","affiliation":[{"name":"PGY 1 and PGY 2 (Psychiatry), Seton Family of Hospitals; Assistant Professor, Department of Psychiatry, The University of Texas Southwestern Medical Center at Seton Family of Hospitals; Adjunct Assistant Professor, College of Pharmacy, The University of Texas, Austin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy E","family":"Walton","sequence":"additional","affiliation":[{"name":"The University of Texas Southwestern Medical Center at Seton Family of Hospitals"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2011,5,3]]},"reference":[{"key":"bibr1-aph.1P761","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.1988.01800330013001"},{"key":"bibr2-aph.1P761","doi-asserted-by":"publisher","DOI":"10.1093\/schbul\/sbj067"},{"key":"bibr3-aph.1P761","volume-title":"Clozaril (clozapine)","author":"Product 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