Table 2

Example of anticholinergics used to treat sialorrhoea

Name of anticholinergicPreparationDoseSpecific characteristics and cautions
Hyoscine hydrobromideTransdermal patch0.5 mg patch per 72 hoursAssociated with a skin reaction at the site of the patch. Frequently altering the patch site and using topically applied steroid may improve tolerance.28
GlycopyrroniumTablet Oral solution (trialled in children)1–2 mg three times dailyGlycopyrronium has a quaternary ammonium structure that renders it less permeable to the blood–brain barrier. Consequently, it is likely to be less associated with CNS side effects.30 39–41
AmitriptylineTablet10–50 mg at bedtimeAmitriptyline has several other effects that may be exploited. These include sedative and antidepressant effects. However, the antidepressant dose is much higher than that typically used to treat sialorrhoea.42
Atropine0.5% Eye drops1–2 drops sublingually four to six times dailyCan be useful if related to meals as it can be administered when the problem occurs.43 44
  • CNS, central nervous system.