Question about Meds

[psychgeek]

Has anyone heard of uncontrollable drooling as a side effect of Abilify? Excessive saliva production is listed among its possible side effects, but uncontrollable drooling seems more than simply excessive saliva production.

I need to know this information for a testing report. As you might imagine this difficulty pretty severely impacts the patient’s functioning, and I want to be able to recommend some sort of intervention but first I need to figure out all of the reasons this might be happening.

Thanks in advance

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[OldPsychDoc]

Has anyone heard of uncontrollable drooling as a side effect of Abilify? Excessive saliva production is listed among its possible side effects, but uncontrollable drooling seems more than simply excessive saliva production.

I need to know this information for a testing report. As you might imagine this difficulty pretty severely impacts the patient’s functioning, and I want to be able to recommend some sort of intervention but first I need to figure out all of the reasons this might be happening.

Thanks in advance

I knew it was too good to be true....

That level of sialorrhea is usually associated with clozapine, but anything's possible. Haven't seen it myself yet, tho'.

 

[50960]

I saw this once and it was kept in check by a mild anticholinergic med. We used chlorpheniramine. There are many reasons not to use something anticholinergic so make sure you have ruled all those out before trying it.

 

[Anasazi23]

I knew it was too good to be true....

That level of sialorrhea is usually associated with clozapine, but anything's possible. Haven't seen it myself yet, tho'.

Abilify isn't normally associated with sialorrhea. As OldPsych said, it's much more extensively studied in clozapine, which psychiatrists see all the time. The mechanism is thought to be muscarinic M4 or adrenergic agonism. Understanding the pharmacology of abilify vs. clozapine, however, makes the pharmacological mechanism of action somewhat less clear.

Some psychiatrists use anticholinergics, ophthalmic atropine, or scopolamine patch (I used a patch in the ER the other day for a death rattle...first time for me with that.)

Another theory is that since some neuroleptics (ie clozapine) disrupt circadian rhythm, and since most drooling occurs at night, the excessive drooling during the day is secondary to a disruption in that rhythm.

It's important for a physician to monitor the patient if they choose to keep the patient on the same neuroleptic dose, and add the anticholinergic agent, as this causes significant pharmacological and physiological actions, especially in psych patients with comorbid medical conditions.