Prevalence of clozapine-induced sialorrhea and its effect on quality of life

• Published in: Psychopharmacology Vol. 240; no. 1; pp. 203 - 211
• Main Authors: Sanagustin, D., Martin-Subero, M., Hogg, B., Fortea, L., Gardoki, I., Guinart, D., Roldán, M., Angelats, M., Cerro, L., Navas, D., Jiménez, J. D., Ortiz, L., Ros, R., Polo, X., Ventura, Y., Contreras, J., Moreno-Alcázar, A., Pérez-Sola, V., Amann, B. L., Valiente-Gómez, A.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.01.2023; Springer; Springer Nature B.V
• Subjects: Antipsychotic Agents - adverse effects; Antipsychotics; Biomedical and Life Sciences; Biomedicine; Clinical trials; Clozapine; Clozapine - adverse effects; Complications and side effects; Cross-Sectional Studies; Diurnal; Health aspects; Humans; Mental disorders; Neurosciences; Nocturnal; Original Investigation; Patients; Pharmacology/Toxicology; Prevalence; Psychiatry; Quality of Life; Saliva; Schizophrenia; Sialorrhea - chemically induced; Sialorrhea - drug therapy; Sialorrhea - epidemiology; Side effects; Statistics; Spain; Treatment-resistant schizophrenia; Clozapine; Adverse drug reaction; Sialorrhea
• ISSN: 0033-3158; 1432-2072; 1432-2072
• DOI: 10.1007/s00213-022-06294-3

Rationale Clozapine has proven to be superior to other antipsychotic drugs in the treatment of schizophrenia but is under-prescribed due to its potentially severe side effects. Clozapine-induced sialorrhea (CIS) is a frequent and extremely uncomfortable side effect, which remains understudied. Objectives To examine the prevalence of diurnal and nocturnal CIS in a sample of patients treated with clozapine, and to evaluate its impact on quality of life. Methods We conducted a cross-sectional, observational study of 130 patients with schizophrenia spectrum disorders treated with clozapine. The prevalence of CIS was evaluated via specific sialorrhea scales. None of the patients included in the study was receiving a specific treatment for hypersalivation during the study period. Possible associations between sialorrhea and clinical and quality of life variables were analyzed. Results Of 130 subjects, 120 (92.3%) suffered from CIS. Eighty-one (62.31%) suffered from diurnal CIS, 115 (88.56%) from nocturnal CIS, and 85 (65.38%) suffered from both. Significant positive associations between quality of life and diurnal CIS ( B  = 0.417; p  = 2.1e − 6, R 2  = 0.156) and nocturnal CIS ( B  = 0.411; p  = 7.7e − 6, R 2  = 0.139) were detected. Thirty per cent of the subjects reported a moderate to severe negative impact of sialorrhea on their quality of life. Conclusions The present study suggests that CIS is highly prevalent in patients with schizophrenia and has an important impact on quality of life in one-third of our sample. Therefore, the inclusion of a systematic evaluation and treatment of CIS in standard clinical practice is highly recommended. Trial registration Clinical Trials ( https://clinicaltrials.gov ) under reference NCT04197037.