Medicines to reduce drooling in spinal muscular atrophy
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One potentially hazardous symptom of the neurodegenerative disorder spinal muscular atrophy (SMA) is excessive drooling, which, in addition to having negative emotional side effects, can lead to choking among patients. Medications are available that can help alleviate drooling in people with SMA, and may be prescribed by a patient’s healthcare team as part of the individual’s care strategy after a diagnosis of SMA is confirmed.
Excessive drooling, a condition called sialorrhoeam, occurs in SMA not from an overproduction of saliva, but due to weakness of the mouth and throat muscles that causes jaw spasms and difficulty swallowing. SMA, caused by inherited mutations in the SMN1 gene, is characterized by progressive muscle weakness and atrophy (shrinkage).
When too much saliva pools in the mouth, it may cause choking for patients when food is being eaten or is inhaled (called aspiration) into the lungs. Drooling also can 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, the Drooling Severity and Frequency Scale, the Blasco Index for the assessment of drooling, and the Teacher Drool Scale.
Sialorrhoea should be treated by healthcare professionals who are familiar with the condition and can help find the right treatment to ease a patient’s drooling. 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 also are available)
- AtroPen (atropine)
- benztropine
- Botox (onabotulinumtoxinA)
- Cuvposa (oral glycopyrrolate)
- glycopyrrolate (formerly marketed under the brand name Robinul in the U.S., where generic versions also are available)
- scopolamine (hyoscine).
These drooling treatments typically work by inhibiting the cholinergic system, part of the regulatory network of the body.
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 also is 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, known as the salivary glands, that secrete saliva.
AtroPen
AtroPen (atropine) is used to treat nerve agent poisoning, decrease saliva production, and reduce muscle spasms of the gastrointestinal tract, as well as the urinary and gallbladder systems.
For patients with sialorrhoea, 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 also is commonly used off-label as a drooling treatment to manage excessive saliva production.
The medication 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 both 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.
Glycopyrrolate
Glycopyrrolate is an antispasmodic agent that also acts as an anticholinergic, reducing the production of acetylcholine and drooling.
Given by injection, glycopyrrolate is administered into the salivary glands.
Scopolamine
Also known as hyoscine, the medication scopolamine blocks the activity of acetylcholine that leads to drooling.
Scopolamine is approved for preventing nausea and vomiting after surgery or from motion sickness. It also may be prescribed for excessive drooling in people with disabilities. The therapy is worn as a skin patch.
SMA News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.
FAQs about medicines to reduce 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, as well as jaw spasms and difficulty swallowing. It can lead to saliva pooling in the mouth until it overflows as drool. An SMA treatment plan may include medicines that reduce drooling.
Certain medications may help decrease drooling in people living with spinal muscular atrophy (SMA). Always consult a healthcare provider before taking medications for drooling.
Excessive saliva in the mouth, which can lead to drooling, may be dangerous as it can cause choking when eating food or aspiration (inhaling) into the lungs.
Regular injections of botulinum toxin, commonly known as Botox, into the salivary glands has been shown to reduce drooling in children with sialorrhea, or excessive saliva production, and in adults with other neurological diseases. Other medications also are available that can be used to reduce drooling.
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.
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