{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T13:34:28Z","timestamp":1791380068561,"version":"4.3.3"},"reference-count":10,"publisher":"MedWorks Media","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Psychopharmacol Bull"],"abstract":"<jats:p>We discuss a case with off-label sublingual administration of atropine for clozapine-induced sialorrhea (CIS) after failure of two commonly used agents to manage CIS. Atropine had a demonstrable efficacy, as measured by means of sialometry conducted before and after its administration. The salivary rate, initially measured at 0.60 g\/min one hour before atropine administration, reduced to 0.23 g\/min two hours after administration. Sublingual administration of atropine was found to be an efficacious option for this patient, but safety issues particularly tachycardia and pragmatics such as risk of inadvertent overdose led to its discontinuation after the initial dose. Developing micro-dosing devices for sublingual atropine could enhance administration precision, reduce side effects, and provide a cost-effective solution. The case report also underscores the need to employ sialometry for the objective assessment of treatment outcomes in future research trials for hypersalivation.<\/jats:p>","DOI":"10.64719\/pb.4507","type":"journal-article","created":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T11:39:16Z","timestamp":1761046756000},"page":"124-130","source":"Crossref","is-referenced-by-count":2,"title":["Sublingual Atropine Administration for Clozapine-Induced Sialorrhea in Bipolar Disorder: A Case Report Highlighting its Efficacy, Safety Concerns and Challenges"],"prefix":"10.64719","volume":"54","author":[{"given":"Omar","family":"Afroz","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaurya","family":"Garg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amit","family":"Kumar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Preethy","family":"Kathiresan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deepika","family":"Mishra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raman","family":"Deep","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"54175","published-online":{"date-parts":[[2025,8,12]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","unstructured":"Delgado A, Velosa J, Zhang J, Dursun SM, Kapczinski F, De Azevedo Cardoso T. Clozapine in bipolar disorder: A systematic review and meta-analysis. Journal of Psychiatric Research. 2020;125:21\u201327. doi: 10.1016\/j.jpsychires.2020.02.026. doi:","DOI":"10.1016\/j.jpsychires.2020.02.026"},{"key":"ref2","doi-asserted-by":"publisher","unstructured":"Li XB, Tang YL, Wang CY, De Leon J. Clozapine for treatment-resistant bipolar disorder: a systematic review. Bipolar Disord. 2015;17(3):235\u2013247. doi: 10.1111\/bdi.12272. doi:","DOI":"10.1111\/bdi.12272"},{"key":"ref3","doi-asserted-by":"publisher","unstructured":"Iqbal MM, Rahman A, Husain Z, Mahmud SZ, Ryan W, Feldman J. Clozapine: A clinical review of adverse effects and management. Ann of Clinical Psychiatry. 2003;15(1):33\u201348. doi: 10.3109\/10401230309085668. doi:","DOI":"10.3109\/10401230309085668"},{"key":"ref4","doi-asserted-by":"publisher","unstructured":"Syed R, Au K, Cahill C. Cochrane Database of Systematic Reviews. John Wiley & Sons, Ltd; 2008. Pharmacological interventions for clozapine-induced hypersalivation; p. CD005579. In: The cochrane collaboration, ed. doi:","DOI":"10.1002\/14651858.CD005579.pub2"},{"key":"ref5","doi-asserted-by":"publisher","unstructured":"Maher S, Cunningham A, O\u2019Callaghan N et al. Clozapine-induced hypersalivation: an estimate of prevalence, severity and impact on quality of life. Therapeutic Advances in Psychopharmacology. 2016;6(3):178\u2013184. doi: 10.1177\/2045125316641019. doi:","DOI":"10.1177\/2045125316641019"},{"key":"ref6","doi-asserted-by":"publisher","unstructured":"Ben-Aryeh H, Jungerman T, Szargel R, Klein E, Laufer D. Salivary flow-rate and composition in schizophrenic patients on clozapine: Subjective reports and laboratory data. Biological Psychiatry. 1996;39(11):946\u2013949. doi: 10.1016\/0006-3223(95)00296-0. doi:","DOI":"10.1016\/0006-3223(95)00296-0"},{"key":"ref7","doi-asserted-by":"publisher","unstructured":"Bird AM, Smith TL, Walton AE. Current treatment strategies for clozapine-induced sialorrhea. Ann Pharmacother. 2011;45(5):667\u2013675. doi: 10.1345\/aph.1P761. doi:","DOI":"10.1345\/aph.1P761"},{"key":"ref8","doi-asserted-by":"publisher","unstructured":"Mubaslat O, Lambert T. The effect of sublingual atropine sulfate on clozapine-induced hypersalivation: a multicentre, randomised placebo-controlled trial. Psychopharmacology. 2020;237(10):2905\u20132915. doi: 10.1007\/s00213-020-05627-4. doi:","DOI":"10.1007\/s00213-020-05627-4"},{"key":"ref9","doi-asserted-by":"crossref","unstructured":"Taylor DM, Barnes TRE, Young A. 14th. 2021. The Maudsley Prescribing Guidelines in Psychiatry. Wiley Blackwell.","DOI":"10.1002\/9781119870203"},{"key":"ref10","doi-asserted-by":"publisher","unstructured":"Leung JG, Schak KM. Potential problems surrounding the use of sublingually administered ophthalmic atropine for sialorrhea. Schizophrenia Research. 2017;185:202\u2013203. doi: 10.1016\/j.schres.2016.12.028. doi:","DOI":"10.1016\/j.schres.2016.12.028"}],"container-title":["Psychopharmacology Bulletin"],"original-title":[],"deposited":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T19:33:01Z","timestamp":1791315181000},"score":1,"resource":{"primary":{"URL":"https:\/\/medworksmedia.com\/pb-article\/sublingual-atropine-administration-for-clozapine-induced-sialorrhea-in-bipolar-disorder-a-case-report-highlighting-its-efficacy-safety-concerns-and-challenges\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,12]]},"references-count":10,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,8,12]]}},"URL":"https:\/\/doi.org\/10.64719\/pb.4507","relation":{},"ISSN":["2472-2448"],"issn-type":[{"value":"2472-2448","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,12]]}}}