目的:药物引起的唾液分泌过多是精神药物常见的药物不良事件。口腔中这种过多的唾液聚集可导致患者生活质量受损,导致药物依从性低。因此,唾液过度的最佳管理对于改善患者护理至关重要。迄今为止,没有关于限制药物诱导的唾液分泌过度的建议发表.在这项研究中,我们进行了系统评价,以研究旨在减少药物引起的唾液分泌过度的干预措施的有效性.
方法:根据病例报告和临床研究,于2021年5月从PubMed寻求药物引起的流涕的治疗。谷歌学者和科学直接(关键词:“治疗”,"唾液分泌过多"“诱导”,"毒品"“氯氮平”)。这项研究包括1966年至2021年5月之间发表的有关药物诱导的唾液分泌过多治疗的文章。
结果:本叙述性综述选择了67篇文章。首先,与非药物相关管理相关的患者教育对于提高患者对诱导唾液分泌过度的药物的依从性至关重要.非药物相关管理应随着口香糖吞咽频率的增加而开始。在无效的情况下,可根据患者的反应和他/她的病史(即减少剂量或分配日剂量)调整流涕的药物反应剂量。最后,如果问题仍然存在,可以根据流涎的类型(昼夜或夜间)添加对症治疗,患者首选盖仑,药物的耐受性和可用性。已经测试了几种药物来减少氯氮平引起的唾液分泌过多(61/67),利培酮(3/67)喹硫平(2/67)和阿立哌唑(2/67)。在针对特定矫正治疗的63篇文章中,抗胆碱能药物在文献中描述最多(63例中的41例)与阿托品,格隆溴铵和东pol碱(各6/41)。其他药物被描述为临床上有效的过度唾液化:多巴胺拮抗剂(9/63)与氨磺必利(5/9),α-2-肾上腺素能激动剂(5/63)与可乐定(3/5),肉毒杆菌毒素(4/63),和特拉唑嗪,莫洛贝胺,安非他酮和N-乙酰半胱氨酸(每1/63)。
结论:在药物诱导的唾液分泌过多的情况下,在非药物治疗失败和病因治疗的剂量优化后,可以启动抗胆碱能药物。如果反应不足,所提供的不同治疗方法可以根据盖伦形式使用,宽容和获得这些药物。风险收益平衡的评估应该是系统的。研究的异质性,关于唾液流量调节的药理机制的知识很少和纠正药物的缺乏是导致治疗优化复杂性的不同因素。
OBJECTIVE: Drug-induced hypersalivation is a frequent drug adverse event of psychotropic drugs. This excess salivary pooling in the mouth can cause an impairment of a patient\'s quality of life leading to low rates of medication adherence. The optimal management of hypersalivation is thus crucial to improve patient care. To date, no recommendations for limiting drug-induced hypersalivation have been published. In this study, we conducted a systematic review to investigate the effectiveness of interventions aimed at reducing drug-induced hypersalivation.
METHODS: Treatment of drug-induced sialorrhea based on case reports and clinical studies were sought in May 2021 from PubMed, Google Scholar and Science Direct (keywords : « treatment », « hypersalivation », « induced », « drug », « clozapine »). Articles published between 1966 to May 2021 on the treatment of drug-induced hypersalivation were included in this study.
RESULTS: Sixty-seven articles were selected in this narrative review. First, patient education associated with non-drug related management are essential to improve the compliance to drugs inducing hypersalivation. The non-drug related management should be initiated with an increase in the frequency of swallowing with chewing gum. In the case of ineffectiveness, the dosage of drug responsive of sialorrhea can be adjusted according to the patient\'s response and his/her medical history (i.e. reducing the dose or splitting the daily dose). Finally, if the problem persists, a symptomatic treatment can be added according to the type of sialorrhea (diurnal or nocturnal), preferred galenic by patient, tolerance and availability of drugs. Several drugs have been tested to reduce hypersalivation induced by clozapine (61/67), risperidone (3/67), quetiapine (2/67) and aripiprazole (2/67). Among the 63 articles targeting a specific corrective treatment, anticholinergic agents were most described in the literature (41 cases out of 63) with atropine, glycopyrrolate and scopolamine (6/41 each). Other agents were described as clinically effective on hypersalivation: dopamine antagonists (9/63) with amisulpride (5/9), alpha-2-adrenergic agonists (5/63) with clonidine (3/5), botulinic toxin (4/63), and terazosine, moclobemide, bupropion and N-acetylcysteine (for each 1/63).
CONCLUSIONS: In the case of drug-induced hypersalivation, after failure of non-drug therapies and dosage optimization of the causative treatment, an anticholinergic drug can be initiated. In case of insufficient response, the different treatments presented can be used depending on the galenic form, tolerance and access to those medications. The assessment of the risk-benefit balance should be systematic. The heterogeneity of the studies, the little knowledge about the pharmacological mechanism of saliva flow modulation and the unavailability of corrective drugs are different factors contributing to the complexity of therapeutic optimization.