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Pathophysiology and management of risperidone-induced sialorrhea: case report

BACKGROUND: Among antipsychotics, sialorrhea is most associated with clozapine, and when it occurs, it is uncomfortable, socially stigmatizing, and can contribute to medication non-adherence. Risperidone has a generally negligible muscarinic activity compared to clozapine, and yet, multiple reports...

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Autores principales: Torrico, Tyler, Kahlon, Angad
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10372792/
https://www.ncbi.nlm.nih.gov/pubmed/37520231
http://dx.doi.org/10.3389/fpsyt.2023.1185750
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author Torrico, Tyler
Kahlon, Angad
author_facet Torrico, Tyler
Kahlon, Angad
author_sort Torrico, Tyler
collection PubMed
description BACKGROUND: Among antipsychotics, sialorrhea is most associated with clozapine, and when it occurs, it is uncomfortable, socially stigmatizing, and can contribute to medication non-adherence. Risperidone has a generally negligible muscarinic activity compared to clozapine, and yet, multiple reports of severe sialorrhea associated with risperidone have been reported. CASE PRESENTATION: This case report describes risperidone-induced sialorrhea that was unintentionally masked by simultaneous clonidine administration that was intended to treat hypertension. Interestingly, sialorrhea was present but mild when clonidine was present; however, when risperidone was further titrated and clonidine removed, a significant worsening of sialorrhea developed. Sialorrhea did not respond to treatment with anticholinergic medication. CONCLUSION: The pathophysiology of antipsychotic-induced sialorrhea is complex and varies between antipsychotics. Risperidone-induced sialorrhea is suspected of having prominent adrenergic pathophysiology that is likely composed of highly viscoelastic saliva (high protein content), differing from the more commonly encountered clozapine-induced sialorrhea. Risperidone-induced sialorrhea is reported as more likely to respond to dose reduction and treatment with α2-adrenergic receptor agonists or β-adrenergic receptor antagonists and less likely to respond to anticholinergic (antimuscarinic) medications.
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spelling pubmed-103727922023-07-28 Pathophysiology and management of risperidone-induced sialorrhea: case report Torrico, Tyler Kahlon, Angad Front Psychiatry Psychiatry BACKGROUND: Among antipsychotics, sialorrhea is most associated with clozapine, and when it occurs, it is uncomfortable, socially stigmatizing, and can contribute to medication non-adherence. Risperidone has a generally negligible muscarinic activity compared to clozapine, and yet, multiple reports of severe sialorrhea associated with risperidone have been reported. CASE PRESENTATION: This case report describes risperidone-induced sialorrhea that was unintentionally masked by simultaneous clonidine administration that was intended to treat hypertension. Interestingly, sialorrhea was present but mild when clonidine was present; however, when risperidone was further titrated and clonidine removed, a significant worsening of sialorrhea developed. Sialorrhea did not respond to treatment with anticholinergic medication. CONCLUSION: The pathophysiology of antipsychotic-induced sialorrhea is complex and varies between antipsychotics. Risperidone-induced sialorrhea is suspected of having prominent adrenergic pathophysiology that is likely composed of highly viscoelastic saliva (high protein content), differing from the more commonly encountered clozapine-induced sialorrhea. Risperidone-induced sialorrhea is reported as more likely to respond to dose reduction and treatment with α2-adrenergic receptor agonists or β-adrenergic receptor antagonists and less likely to respond to anticholinergic (antimuscarinic) medications. Frontiers Media S.A. 2023-07-13 /pmc/articles/PMC10372792/ /pubmed/37520231 http://dx.doi.org/10.3389/fpsyt.2023.1185750 Text en Copyright © 2023 Torrico and Kahlon. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Psychiatry
Torrico, Tyler
Kahlon, Angad
Pathophysiology and management of risperidone-induced sialorrhea: case report
title Pathophysiology and management of risperidone-induced sialorrhea: case report
title_full Pathophysiology and management of risperidone-induced sialorrhea: case report
title_fullStr Pathophysiology and management of risperidone-induced sialorrhea: case report
title_full_unstemmed Pathophysiology and management of risperidone-induced sialorrhea: case report
title_short Pathophysiology and management of risperidone-induced sialorrhea: case report
title_sort pathophysiology and management of risperidone-induced sialorrhea: case report
topic Psychiatry
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10372792/
https://www.ncbi.nlm.nih.gov/pubmed/37520231
http://dx.doi.org/10.3389/fpsyt.2023.1185750
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