From the Department of Pharmacy, University of Alabama at Birmingham Medical Center, Birmingham.
Auburn University, Harrison College of Pharmacy, Auburn.
J Clin Psychopharmacol. 2022;42(5):480-484. doi: 10.1097/JCP.0000000000001588. Epub 2022 Aug 8.
PURPOSE/BACKGROUND: Antipsychotic-associated sialorrhea is a problematic adverse effect with potentially negative consequences on quality of life and medication adherence. While clozapine is the antipsychotic that is most associated with sialorrhea, there have been published reports of other second-generation antipsychotics associated with sialorrhea, including aripiprazole, olanzapine, quetiapine, and risperidone. Although drooling is mentioned within the package insert for paliperidone, to date there have been minimal published reports in which paliperidone is implicated as the offending agent.
METHODS/PROCEDURES: Here, we present a case of sialorrhea in a 56-year-old man with schizoaffective disorder who had a supratherapeutic paliperidone level after both oral and intramuscular paliperidone use.
FINDINGS/RESULTS: Paliperidone was ultimately cross tapered to aripiprazole, and the patient was given atropine drops and benztropine with resolution of the sialorrhea. We provide a review of the literature regarding the other available reports of paliperidone-associated sialorrhea, possible mechanisms behind pathophysiology, as well as reports from the World Health Organization and Food and Drug Administration adverse event reporting systems.
IMPLICATIONS/CONCLUSIONS: Clinicians should be aware of the potential for paliperidone and other nonclozapine second-generation antipsychotics to be associated with sialorrhea, especially given the increased frequency of their use for a variety of psychiatric disorders.
目的/背景：抗精神病药相关的流涎是一种有问题的不良反应，可能对生活质量和药物依从性产生负面影响。氯氮平是与流涎关系最密切的抗精神病药，但已有报道称其他第二代抗精神病药也与流涎有关，包括阿立哌唑、奥氮平、喹硫平和利培酮。虽然培利哌酮的说明书中提到了流涎，但迄今为止，关于培利哌酮引起流涎的报道很少。
方法/程序：在这里，我们报告了一例 56 岁精神分裂症谱系障碍患者的流涎病例，该患者在口服和肌肉注射培利哌酮后出现了超治疗性的培利哌酮水平。
结果/发现：最终将培利哌酮交叉转换为阿立哌唑，并给患者使用了阿托品滴剂和苯海索，流涎得到缓解。我们回顾了有关培利哌酮相关流涎的其他可用报告的文献，以及病理生理学背后的可能机制，以及世界卫生组织和食品和药物管理局不良事件报告系统的报告。
意义/结论：临床医生应意识到培利哌酮和其他非氯氮平第二代抗精神病药可能与流涎有关，特别是考虑到它们在各种精神障碍中的使用频率增加。
