Abstract

Clozapine-induced sialorrhea (CIS) is a common, treatment-limiting, and stigmatizing side effect. All systemic agents that are used for CIS may increase clozapine side effects such as blood pressure changes, constipation, or arrhythmias or may have a negative impact on cognition. Sublingual application of Atropine might be a low side effect option for treatment of CIS. Our aim is to propose an off-label treatment option of atropine 1% ophthalmic solution given orally via sublingual route for CIS and stimulate further examination. As presented in the three cases below Atropine 1% (1 mg/ml) ophthalmic solution was applied orally via sublingual route 2-3 drops before going to bed initially and then thrice a day. Subjective improvement along with improvement were seen by measuring wet area over the pillow, The Drooling Severity and Frequency Scale (DSFS), Drooling Impact Scale (DIS), Nocturnal Hyper salivation Rating Scale(NHRS), Constipation Assessment Scale(CAS) at baseline visit and at one-week intervals. No side effects were observed. The promising effect should be examined by randomized controlled trials to translate this into clinical practice.