Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Email this article to a Colleague Similar articles in this journal Alert me to new issues of the journal Add to My Articles & Searches Download to citation manager Citing Articles via Google Scholar Articles by Gajwani, P. Articles by Tesar, G. E. Search for Related Content Articles by Gajwani, P. Articles by Tesar, G. E. Syndromes Secondary to General Medical Disorders

Risperidone-Induced Sialorrhea

Key Words: Risperidone • Sialorrhea

TO THE EDITOR: Sialorrhea, or excessive salivation, has been reported as a treatment-induced adverse effect of antipsychotic medications, especially clozaril. Two percent of patients treated with risperidone can develop sialorrhea,¹ a troubling, socially stigmatizing side effect of antipsychotic treatment that can contribute to noncompliance. We report a case of risperidone-induced sialorrhea responsive to clonidine.

Case Report

Mr. A., a 22-year-old African American man with chronic paranoid schizophrenia, was being treated with lithium (900 mg/day per os) and haloperidol (10 mg/day per os) without significant adverse effects. Worsening of auditory hallucinations prompted an increase of haloperidol to 20 mg/day but extrapyramidal side effects forced resumption of the 10-mg daily dose.

Risperidone was added and gradually increased to 10 mg/day. Auditory hallucinations diminished but sialorrhea developed. The patient drooled from both sides of his mouth during the day and wetted his pillow at night. Cogentin was added and the dose was gradually increased to 6 mg/day with no improvement. The sialorrhea had become so distressing for the patient that he stopped his medications. Cogentin was discontinued in favor of clonidine (0.1 mg at bedtime) which was increased to 0.1 mg per os twice a day over 3 days. This coincided with a rapid and marked decrease in salivation. Blood pressure and pulse remained within normal range during the titration, and clonidine produced no adverse effects.

Discussion

Sialorrhea has occasionally been described with lithium treatment² but was not observed in our patient. There is also evidence of clozaril-associated sialorrhea³ and one case report of sialorrhea associated with olanzapine.⁴

Two mechanisms have been proposed for antipsychotic-induced sialorrhea:

1. Postsynaptic -adrenergic-mediated production of saliva rich in ptyalin, potassium, and bicarbonate. Clonidine, an ₂-autoreceptor agonist was used successfully to treat clozaril-induced sialorrhea.³
   
2. Muscarinic cholinergic-specific M-4 receptor stimulation. M-4 receptors are prominent in salivary glands.⁵ Pirenzepine, a selective M1/M4-muscarinic antagonist has been reported to reverse clozaril-induced sialorrhea.⁶
   

In this patient sialorrhea occurred after addition of risperidone. Like clozaril, risperidone activates ₂-adrenergic receptors. Unlike clozaril, risperidone has negligible effects on muscarinic receptors. Sialorrhea was relieved by clonidine. These findings support the notion that increased salivary gland adrenergic activity contributes to sialorrhea. Clonidine, therefore, should be added to the list of antidotes to antipsychotic-induced sialorrhea.

REFERENCES

1. Medical Economics: Physician's Desk Reference. Montvale, NJ, Medical Economics, 2000
2. Donaldson SR: Sialorrhea as a side effect of lithium: a case report. Am J Psychiatry. 1982; 139:1350–1351
3. Krishnan KR, Ellinwood EH, Jr., Nemeroff CB: Clonidine treatment of clozapine-induced hypersalivation. J Clin Psychopharm 1992; 12:69–70[Medline]
4. Perkins DO, Mclure RK: Hypersalivation coincident with olanzapine treatment. Am J chiatry 1998; 155:993–994
5. Szabadi E: Clozapine-induced hypersalivation. Br J Psychiatry 1997; 171:89
6. Fritze J, Elliger T: Pirenzepine for clozapine-induced hypersalivation. Lancet 1995; 346:1034[Medline]

Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Email this article to a Colleague Similar articles in this journal Alert me to new issues of the journal Add to My Articles & Searches Download to citation manager Citing Articles via Google Scholar Articles by Gajwani, P. Articles by Tesar, G. E. Search for Related Content Articles by Gajwani, P. Articles by Tesar, G. E. Syndromes Secondary to General Medical Disorders

Get information about faster international access.

Privacy Policy

Copyright © 2001 Academy of Psychosomatic Medicine. All rights reserved.

Home | Search | Current Issue | Past Issues | Subscribe | All APPI Journals | Help | Contact Us