Dados do Trabalho

Título

EFFECTIVENESS OF BOTULINUM TOXIN TYPE A IN MANAGING SIALORRHEA IN SCHIZOPHRENIA PATIENTS TAKING CLOZAPINE: A CASE SERIES

Introdução

Clozapine (CZP) is an antipsychotic (AP) that began to gain prominence in the 1990s due to its notable control of psychotic symptoms in schizophrenia (SCZ). Despite not being a modern drug, it remains widely used today due to its potency. With strict laboratory monitoring, agranulocytosis, a severe adverse effect, has become less frequent, bringing other side effects into focus. In this context, sialorrhea has emerged as a significant issue, as the drug can increase saliva production in up to 80% of its users. Managing this symptom pharmacologically is particularly challenging, prompting trials with Botulinum Toxin Type A (BTA). Several reports in the literature indicate that BTA is effective in managing these symptoms, with beneficial effects lasting for weeks.

Objetivo

To profile pediatric SCZ patients from a tertiary center who used BTA for managing sialorrhea related to CZP.

Método

A retrospective descriptive study conducted between 2018 and 2024. The study analyzed data from psychiatric patients aged 12 to 18 who were taking CZP for a diagnosis of SCZ. These patients were referred to the Child Neurology Department for evaluation regarding the use of BTA for sialorrhea management.

Resultados

We identified 6 patients referred by Psychiatry to the Child Neurology Service due to sialorrhea associated with CZP use. The medication was administered in doses ranging from 350 to 750 mg. Four patients had previously used Atropine without satisfactory results, continuing to experience profuse sialorrhea with functional impairment. Four patients received 250 U of Dysport (75 U in each parotid gland and 50 U in each submandibular gland), while the other two received 150 U in each parotid gland. Upon re-evaluation, approximately 4 months after the injection, 66% (four patients) did not show improvement in symptoms, maintaining the same levels of salivation as before the procedure.

Conclusão

CZP, despite being a potent AP, also contributes to increased sialorrhea through direct stimulation of glandular secretion. Although there are few reports in the literature, all patients who used BTA for managing sialorrhea during CZP therapy experienced some reduction in saliva flow. Our patients did not achieve the expected reduction; 4 of them had no change in saliva flow, and only 2 showed slight reduction. BTA is a safe and effective medication with good evidence for treating sialorrhea and should be considered, even in conjunction with CZP. However, the response may vary from individual to individual.

Referências

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- ‌MASUD IQBAL, M. et al. Most Common Side Effects of Clozapine and Their Management. International Journal of Emergency Mental Health and Human Resilience, v. 18, n. 4, 2016.
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- ‌YEŞILYURT, S. et al. Pathophysiology of clozapine induced sialorrhea and current treatmant choices. Dusunen Adam: The Journal of Psychiatry and Neurological Sciences, p. 275–281, 30 dez. 2010.

Palavras Chave

Clozapine; sialorrhea; botulinum toxin