Tropicamide eye drops reduce clozapine-induced hypersalivation: a case report
Yükleniyor...
Tarih
2016
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Elsevier France-Editions Scientifiques Medicales Elsevier
Erişim Hakkı
info:eu-repo/semantics/closedAccess
Özet
Clozapine-induced sialorrhea (CIS) is a common,
treatment-limiting and stigmatizing side effect. All systemic agents that are used for hypersalivationmay increase clozapine side effects such as blood pressure changes, constipation, or arrythmias. Oral
application of topical anti-muscarinic agents may be a low side effect option for treatment of CIS. Objective The aim of this case report was to propose an off-label treatment of tropicamide drops to CIS and to stimulate further investigation. Case report A 33-year-old male inpatient with schizophrenia has been on clozapine 800 mg and amisulpride 600 mg/day. His drooling was occasional and severe as drool drips off his chin during the day and night. Wet area over the pillow, visual analog scale (VAS), the short form of health survey (SF-36), UKU side effect rating scale, scale for the assessment of negative symptoms (SANS), scale for the assessment of positive symptoms (SAPS) were applied at baseline and in one-week intervals. Oral application of one drop
of tropicamide % 0.5 (5 mg/mL) to left and one drop to right sidedripped off his chin during the day and night. Tropicamide 1% (1 mg/ml) ophthalmic solution was applied orally via sublingual route 1–2 drops at each side of his mouth before going to bed as monotherapy for CIS. Wet area over the pillow, Visual Analogue Scale (VAS), Nocturnal Hypersalivation Rating Scale, the MOS 36-Item Short-Form Health Survey (SF-36),
Udvalg for Kliniske Undersøgelser Side Effect Rating Scale, the Scale for the Assessment of Negative Symptoms, and the Scale for the Assessment of Positive Symptoms were administered at baseline visit and at one-week intervals. No side effects were observed. On VAS, the patient rated his sialorrhea 5/7 at baseline, 4/7 after one 1 drop, and 3/7 after 2 drops. Nocturnal hypersalivation yielded score 4 before tropicamide was initiated. After 1 drop of tropicamide at each side of the mouth, the score was 3 and after 2 drops at each side, it was 2. Tropicamide ophthalmic solution might present as a low side effect, off-label option for treatment of CIS. The promising effect should be examined by randomized controlled trials to translate this into clinical practice.before going to bed in the first week and two drops to each side were administered subsequently. Informed consent was given by the patient. Results No psychological, neurological, autonomic and other side effects were observed associated with tropicamide. On VAS, the patient rated hypersalivation 5/7 at baseline, 4/7 after one drop each, 3/7 after two drops each. Conclusions The reduction of CIS by oral use of tropicamide eye
drops is promising and should be explored with randomized controlled trials. Disclosure of interest The authors have not supplied their declaration of competing interest.
Açıklama
Anahtar Kelimeler
Clozapine-Induced Sialorrhea (CIS), Clozapine, SANS, Schizophrenia
Kaynak
European Psychiatry
WoS Q Değeri
Q2
Scopus Q Değeri
Cilt
33
