Treatment strategies for clozapine-induced sialorrhea: a systematic review and meta-analysis
Open accessAbstract
Background Clozapine is the most effective medication for treatment-refractory schizophrenia. However, it has a high burden of adverse events, including common adverse events such as sialorrhea. Sialorrhea can lead to severe physical complications such as aspiration pneumonia, as well as psychological complications including embarrassment and low self-esteem. Compromised adherence and treatment discontinuation can occur due to intolerability. There have been no meta-analyses examining strategies to mitigate clozapine-induced sialorrhea. Methods We systematically searched Chinese and Western research databases for randomised controlled trials examining agents for clozapine-induced sialorrhea. No limit to language or date were applied to the search. Where sufficient data for individual agents was available, pairwise meta-analyses were conducted. Results were provided as risk ratios and number needed to treat. Sensitivity analysis was conducted by study quality. Adverse events were provided as number needed to harm. Results 19 studies provided data for use in the meta-analysis. Improvement in clozapine-induced sialorrhea was seen in meta-analyses of propantheline (studies = 6, risk ratio [RR] 2.38, 95% confidence interval [CI] 1.52-3.73; number needed to treat [NNT] 3, 95% CI 1.9-2.7), diphenhydramine (studies = 5, RR 3.09, 95% CI 2.36-4.03; NNT 2, 95% CI 1.5-2.0), chlorpheniramine (studies = 2, RR 2.37, 95% CI 1.59-3.55; NNT 3, 95% CI 1.6-3.5), and benzamide derivatives (odds r…
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This overreliance is mainly due to outdated mental health legislation and policies.
“This is mainly due to outdated mental health legislation and policies.313”
From The Lancet Psychiatry Commission: a blueprint for protecting physical health in people with mental illness (2019) · cites this paper as [313]
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(2021) · Publons reviews and discussion · doi:10.1111/acps.13328/v1/review1
Review for "Monitoring for Myocarditis during Treatment Initiation with Clozapine"
(2021) · Publons reviews and discussion · doi:10.1111/acps.13328/v1/review2
Sadek, J. R. (2020) · Springer eBooks · doi:10.1007/978-3-030-60766-1_5
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- Authors
- Chen, S.-Y., Ravindran, G., Zhang, Q., Kisely, S., & Siskind, D.
- Affiliations
- The University of Queensland (AU)
- Corresponding author
- Siskind, Dan
- Venue
- CNS Drugs
- Published
- 2019-02-13
- Volume
- 33
- Issue
- 3
- Pages
- 225-238
- ISSN
- 1172-7047 (ISSN-L)
- 1179-1934
- OpenAlex
- W2913045055
- Cited by
- 66
- References
- 43
- Citations by year
- 2026: 6 · 2025: 13 · 2024: 9 · 2023: 10 · 2022: 9 · 2021: 9 · 2020: 6 · 2019: 4
- FWCI
- 1.18
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Licence
- other-oa
- www.springer.com/tdm (tdm)
- Locations
- CNS Drugs (publishedVersion)
- PubMed (publishedVersion)
- Griffith Research Online (submittedVersion, other-oa)
- Funders
- National Health and Medical Research Council (APP1111136)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Health Sciences › Medicine › Physiology › Salivary Gland Disorders and Functions
- Health Sciences › Medicine › Surgery › Nausea and vomiting management
- Keywords
- clozapine, drooling, anticholinergic agents, propantheline, diphenhydramine, chlorpheniramine, benzamide derivatives, trihexyphenidyl, cyproheptadine, doxepin, treatment-resistant schizophrenia, adverse drug reactions, constipation, medication adherence, number needed to treat, number needed to harm
- MeSH terms
- Antidepressive Agents, Clozapine, Histamine Antagonists, Humans, Medicine, Chinese Traditional, Salivation, Schizophrenia, Sialorrhea, Antipsychotic Agents, Randomized Controlled Trials as Topic, Muscarinic Antagonists
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