Clozapine and the development of salivary gland swelling: a case study.

BACKGROUND

Clozapine is a novel antipsychotic that is effective in 30% to 50% of treatment-resistant schizophrenia. It is known to cause sialorrhea in 23% of patients. This phenomenon is paradoxical and poorly understood since clozapine is known to have potent anticholinergic effects. We have observed the development of transient salivary gland swelling in four patients on clozapine therapy. Although not clearly related to sialorrhea, this phenomenon may share a similar pathophysiology.

METHOD

A retrospective chart review was performed on the 4 of 27 patients started on clozapine treatment during a 6-month period who developed salivary gland swelling.

RESULTS

Four patients, none of whom had previously complained of sialorrhea, developed salivary gland swelling after starting clozapine treatment. In all cases, the swelling resolved within days. A possible etiology may be the formation of a calculus that blocks the duct and causes swelling, which resolves when the stone passes.

CONCLUSION

Clinicians should be aware that salivary gland swelling may be a possible side effect of clozapine use.