Clozapine-induced hypersalivation

OBJECTIVE: To review underlying pathophysiology and possible treatments for clozapine-induced hypersalivation. DATA SOURCES: Primary literature was accessed through MEDLINE (1966-May 199 9). Key search terms included clozapine, hypersalivation, sialorrhea, and t reatment. DATA SYNTHESIS: Hypersalivation occurs in up to 54% of patients receiving c lozapine. An evaluation of studies and case reports focusing on management of clozaine-induced hypersalivation was conducted. CONCLUSIONS: It is unclear whether clozapine increases salivation through i ts muscarinic M4 receptor activation and/or blockade of alpha 2-adrenocepto rs, or by causing a distortion in swallowing reflex. Treatment options incl ude chewing gum, reducing the dosage of clozapine, or prescribing pharmacol ogic agents such as anticholinergics or alpha(2)-adrenoceptor agonists.