What medications do you find helpful to reduce drooling associated with antipsychotics?

Atropine Ophthalmic Solution 1%: 1 GTT SL QHS.

The two leading theories explaining the mechanism of sialorrhea are:

1. Potent agonism at muscarinic M4 receptors.
2. Blockade of alpha-2 adrenergic receptors. Both mechanisms increase salivary flow.

Atropine Ophthalmic Solution is absorbed locally. It shou...

Atropine drops have been my first-line treatment. I've also used glycopyrrolate in the 1-3 mg range. Caution for constipation for that one.

Other options, citing from "The Clozapine Handbook" by Meyer and Stahl:

• Clonidine
• Botox to the salivary glands
• Ipratropium bromide 0.06% spray, 1-3 sprays und...

This is not an uncommon problem with some of my patients who are on clozapine. I had the best results with benztropine. However, side effects can be problematic, especially constipation or tachycardia which I have to carefully monitor.

I am posting a review article here. I would be hesitant about using benztropine (constipation, urinary retention, cognitive effects). Clozapine patients are prone to constipation to begin with. Here is the article by Syed et al., PMID 18646130.

The first line is localized anticholinergics, such as atropine sublingual TID or ipratropium. If needed, then glycopyrrolate. It’s a peripheral anticholinergic and does not cross the BBB like cogentin does.