Excessive salivation or sialorrhea is not only one of the commonest side effects of clozapine, it is very frustrating for patients, and we need to do more to identify it and to manage it.
Please also see the following related article on this website:
How to evaluate a patient with sialorrhea
But first, how common is it?
It occurs in about one-third of patients (sometimes reported in up to 91% of patients) on clozapine and is one of the commonest adverse effects of clozapine (Gürcan et al., 2024; Bird et al., 2011).
Patients often don’t report the hypersalivation to us, so we should specifically ask about it.
And, why is it such a big deal?
Hypersalivation can be quite bothersome to patients. It can result in:
– Waking up with a wet pillow.
– Impaired sleep. About a third of patients with hypersalivation are woken up at night because of it (Maher et al., 2016).
– Embarrassment
– Skin infection or maceration
– Swelling of the salivary glands, parotitis
– In extreme cases, aspiration and aspiration pneumonia.
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