Example of anticholinergics used to treat sialorrhoea
| Name of anticholinergic | Preparation | Dose | Specific characteristics and cautions |
|---|---|---|---|
| Hyoscine hydrobromide | Transdermal patch | 0.5 mg patch per 72 hours | Associated with a skin reaction at the site of the patch. Frequently altering the patch site and using topically applied steroid may improve tolerance.28 |
| Glycopyrronium | Tablet Oral solution (trialled in children) | 1–2 mg three times daily | Glycopyrronium 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 |
| Amitriptyline | Tablet | 10–50 mg at bedtime | Amitriptyline 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 |
| Atropine | 0.5% Eye drops | 1–2 drops sublingually four to six times daily | Can be useful if related to meals as it can be administered when the problem occurs.43 44 |
CNS, central nervous system.