The cholinergic system | Amitriptyline | AtroPen | Benztropine | Botox | Cuvposa | Robinul | Scopolamine | FAQs |Â
Spinal muscular atrophy (SMA) is a neurodegenerative disorder caused by inherited mutations in the SMN1 gene. It is characterized by progressive muscle weakness and atrophy (shrinkage). After a diagnosis of SMA is confirmed, patients, their families, and the healthcare team should work together to develop a care strategy.
A symptom of SMA is drooling , which can be excessive – a condition called sialorrhoea. Drooling in SMA is not from an overproduction of saliva but due to weakness of the mouth and throat muscles that causes jaw spasms and difficulty swallowing.
Excessive saliva pooling in the mouth may cause choking while food is being eaten or is inhaled (called aspiration) into the lungs. Drooling can also have emotional side effects, including feelings of distress, embarrassment in social situations, and lowered self-esteem.
Parents, caregivers, and people living with SMA can gauge the severity of the drooling and its effect on quality of life by filling out specific questionnaires about the condition.
These questionnaires include the Drooling Infants and Preschoolers Scale, Drooling Severity and Frequency Scale, Blasco Index for the assessment of drooling, Teacher Drool Scale, among others.
Sialorrhoea should be treated by healthcare professionals who are familiar with the condition and can help find the right drooling treatment. Medications that help decrease drooling may be part of SMA treatment. These include:
- amitriptyline (formerly marketed under the brand name Elavil in the U.S., where generic versions are also available)
- AtroPen (atropine)
- benztropine
- Botox (onabotulinumtoxinA)
- Cuvposa (oral glycopyrrolate)
- Robinul (glycopyrrolate)
- scopolamine (hyoscine).
These drooling treatments typically work by inhibiting the cholinergic system.
What is the cholinergic system?
The cholinergic system is a part of the nervous system that uses acetylcholine, a neurotransmitter (or chemical messenger), to transmit nerve signals.
Nerve cells release neurotransmitters after receiving stimulus from the brain or another nerve cell. These neurotransmitters then bind to receptors on the surface of a nearby cell. The cell may be another nerve cell, a muscle cell, or a gland cell.
When neurotransmitters bind to muscle cells, they may trigger muscle contraction. When they bind to gland cells, they may cause the secretion of fluids such as saliva.
The cholinergic system is also known to affect the sleep-wake cycle. It also plays a role in emotions, cognition, and mobility.
Amitriptyline
Amitriptyline is an oral medication for the treatment of depression, pain, and migraines.
The medication works as a drooling treatment by blocking acetylcholine receptors in the glands that secrete saliva (salivary glands).
AtroPen
AtroPen (atropine) is used to treat nerve agent poisoning, decrease saliva production, and reduce muscle spasms of the gastrointestinal tract, as well as urinary and gallbladder systems.
AtroPen may help reduce drooling by blocking the effects of acetylcholine on the salivary glands. The therapy is administered via injection.
Benztropine
Benztropine is approved to treat Parkinson’s disease symptoms and tremors caused by other medications. It is also commonly used off-label as a drooling treatment to manage excessive saliva production.
Benztropine reduces the effect of acetylcholine by blocking its receptors on the salivary glands, ultimately helping to stop drooling. The therapy is taken by mouth as tablets.
Botox
Botox is a neurotoxic protein from the bacterium Clostridium botulinum. It inhibits the release of acetylcholine.
Data indicate that Botox treatment can decrease drooling in SMA patients, and reduce jaw spasms and the production of saliva. The therapy is administered via injection into the salivary glands.
Cuvposa
Cuvposa (glycopyrrolate) is a pediatric medication that prevents the stimulation of acetylcholine receptors in the salivary glands. Cuvposa has been studied in children with neurodevelopmental disabilities and found to be effective as a drooling treatment.
The therapy is available as an oral solution.
Robinul
Robinul (glycopyrrolate) is an antispasmodic agent that also acts as an anticholinergic, reducing the production of acetylcholine and drooling.
The therapy is administered via injection into salivary glands.
Scopolamine
Scopolamine, also known as hyoscine, blocks the activity of acetylcholine that leads to drooling.
Scopolamine is approved for preventing nausea and vomiting after surgery or from motion sickness. It may also be prescribed for excessive drooling in people with disabilities. The therapy is worn as a skin patch.
FAQs about medicines to reduce drooling
Why does SMA cause drooling?
One of the symptoms of spinal muscular atrophy (SMA) is bulbar weakness, which affects the mouth and throat areas. Bulbar weakness causes loss of control over the mouth, jaw spasms, and difficulty swallowing. It can lead to saliva pooling in the mouth until it overflows as drool. A SMA treatment plan may include medicines that reduce drooling.
Can medication stop drooling?
Certain medications may help decrease drooling in people living with spinal muscular atrophy. Always consult a healthcare provider before taking medications for drooling.
Is drooling dangerous?
Excessive saliva in the mouth may be dangerous as it can cause choking when eating food or aspiration (inhaling) into the lungs.
Does botox help with drooling?
Regular injections of botulinum toxin (botox) into the salivary glands has been shown to reduce drooling in children with sialorrhea (excessive saliva production) and in adults with other neurological diseases.
What are the potential side effects of drooling reduction medicines?
Potential side effects for drooling treatments range from dry mouth and dizziness to an allergic reaction, and changes in mood and behavior. Always contact a healthcare professional when experiencing side effects from taking any medication.
