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Medications for Sialorrhea

About Sialorrhea: 

Sialorrhea is the inability to control saliva so the saliva extends past the lip margin.  Normally if there is an increase in salivation or the sensation of too much saliva within the mouth we swallow restoring the saliva to a comfortable level. Sialorrhea can be caused by too much saliva being produced (hypersecretion of saliva), inability to recognize the saliva is present (sensory dysfunction), an inability to manage the salivary by swallowing (anatomical or motor dysfunction) or a combination of these factors.


Causes

Hypersecretion of saliva (too much saliva being produced)

  • Inflammation eg teething, oral infection, dental issues
  • Medication side effects eg clozapine, ketamine
  • Gastroesophageal reflux

Sensory dysfunction (inability to recognize the saliva is present)

  • Reduced nerve sensitivity or function of oral cavity or lips
  • Intellectual disability

Anatomical or motor dysfunction (swallowing issues)

  • Orthodontic problems
  • Jaw issues
  • Parkinson’s disease
  • Cerebral palsy
  • Stroke
  • Enlarged tongue (macroglossia)



Functions of Saliva

Most saliva is produced by six major salivary glands with a small amount secreted by hundreds of minor salivary glands.  The more obvious function of saliva includes lubrication of food as it is swallowed and enzymes within the saliva start to break down starches.  The other important role of saliva is to maintain good health of gums, teeth and mucosa by regulating oral pH, and inhibiting and preventing bacteria and fungal growth.


Complications of Sialorrhea

Sialorrhea causes both physical and psychosocial complications that range from mild to severe enough to negatively impact on the quality of life.  Saliva left on the skin can be irritating and predisposes the skin to chapping, maceration, secondary bacterial or fungal infections.  The amount of saliva produced daily ranges between 15 oz to 50 oz and in sialorrhea if this is not swallowed the patient can become dehydrated.  Social implications of sialorrhea is stigmatization, increased isolation due to embarrassment, and increased level of care required.


Treatments

Appropriate treatment options are dependent on causes and severity of sialorrhea, starting at the least invasive such as postural changes with occupational therapists, and progressing if necessary to medication, radiation therapy and surgical options.

Drugs Used to Treat Sialorrhea

The following list of medications are in some way related to, or used in the treatment of this condition.

Drug name Rx / OTC Pregnancy CSA Alcohol Reviews Rating Popularity
incobotulinumtoxinA C N Add review Rate

Generic name: incobotulinumtoxinA systemic

Brand name:  Xeomin

Drug class: skeletal muscle relaxants

For consumers: dosage, interactions,

For professionals: A-Z Drug Facts, AHFS DI Monograph

Xeomin C N Add review Rate

Generic name: incobotulinumtoxinA systemic

Drug class: skeletal muscle relaxants

For consumers: dosage, interactions, side effects

For professionals: AHFS DI Monograph, Prescribing Information

Learn more about Sialorrhea

Micromedex® Care Notes

Symptom checker

Legend

Off Label This medication may not be approved by the FDA for the treatment of this condition.
Prescription Only / Over the Counter
Rx Prescription Only
OTC Over the Counter
Rx/OTC Prescription or Over the Counter
Pregnancy
A Adequate and well-controlled studies have failed to demonstrate a risk to the fetus in the first trimester of pregnancy (and there is no evidence of risk in later trimesters).
B Animal reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled studies in pregnant women.
C Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use in pregnant women despite potential risks.
D There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use in pregnant women despite potential risks.
X Studies in animals or humans have demonstrated fetal abnormalities and/or there is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience, and the risks involved in use in pregnant women clearly outweigh potential benefits.
N FDA has not classified the drug.
Controlled Substances Act Schedule
N Is not subject to the Controlled Substances Act.
1 Has a high potential for abuse. Has no currently accepted medical use in treatment in the United States. There is a lack of accepted safety for use under medical supervision.
2 Has a high potential for abuse. Has a currently accepted medical use in treatment in the United States or a currently accepted medical use with severe restrictions. Abuse may lead to severe psychological or physical dependence.
3 Has a potential for abuse less than those in schedules 1 and 2. Has a currently accepted medical use in treatment in the United States. Abuse may lead to moderate or low physical dependence or high psychological dependence.
4 Has a low potential for abuse relative to those in schedule 3. It has a currently accepted medical use in treatment in the United States. Abuse may lead to limited physical dependence or psychological dependence relative to those in schedule 3.
5 Has a low potential for abuse relative to those in schedule 4. Has a currently accepted medical use in treatment in the United States. Abuse may lead to limited physical dependence or psychological dependence relative to those in schedule 4.
Alcohol
X Interacts with Alcohol.

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Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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