Does anyone have any suggestions for something to help drooling???
My husband cannot take Parkinson medication because of his LBD and
has some terrible drooling problems I would like to resolve.

HELP.

THANKS

Fran

Hi Fran,
My Husband was on Amitriptyline 10mg 1x daily, it did help alot, not really sure if anything else is also used! Good Luck!

Irene, Is that an anti-depressant??? Did your husband take it for
drooling specifically???

Fran

Hi Fran,
I believe you are right but thats what the Dr prescribed and it did help, I know there are drugs out but none that we tried!
irene

There are at least two drugs to reduce drooling: atropine eye drops that are used on the tongue (not the eyes) and Robinul (I remember this medication because it's name is similar to mine

Hi Robin,
Is that in the class of drugs as Hyoscyamine? Hospice used this near the very end, I remember my sister who is a Nurse flew in the stayed with me for Jim's last week mentioned the drug Atropine, I remember her telling me it was eye drops but used on the tongue.

Irene,
I don't think so. Are you familiar with rxlist.com? It's a good place to go to have these sorts of general questions about medications answered. According to rxlist.com, HYOSCYAMINE is an antispasmodic. I don't think either atropine or Robinul are antispasmodics.
Robin

Robin, I'll check these out with Dick's doctor and see what she says.
Thanks for the tip

Fran

Hi Robin and Fran,
Thank you very much , no hurry on the info I don't need it anymore but I like to keep notes on certain things going on with LBD.

Dear Fran, Robin and Irene -

An important topic to me, as my mom's drooling has become very heavy in the past few months. I did a lot of Internet research in clinical literature - it's a major issue in neurological diseases of all kinds. Even has a unique name - sialorrhea - and multiple treatment approaches. Because I am leery of most meds for my mom, I also wrote to the MDs who staff the "Ask The Doctor" daily forum at the National Parkinson Foundation web site. These are nationally-known docs who treat PD and related dementias.

The answer was that several meds, including certain low-dose antidpressants, glycopyrrolate, benzotropine and scopalamine are used to dry out the mouth; there is surgery to "reroute the submandibular duct"; and there is botox injection. As I'd reported my mom has LBD as well as PD, the MD recommended the botox injection, which generally needs to be repeated every few months. He also said chewing gum or sucking hard candies lessens the salivary production - we have noticed that effect when Mom chews gum. Of course, he recommends sugar-free.

The effects and treatments for this disease never cease to amaze me!

Peace,
Lin

Hi Lin,
The information you provided here is good and I have already made notes on it for future use, when my Husband started the drooling earlier on the Dr wrote a script for Amitrptyline 10 mg 1x daily, I know that is an antidepressant, the drug I spoke of in an earlier Post here
(Hyoscyamine) was used more towards the end for the saliva build up that was causing contant chocking and great discomfort to my Husband.

The real challenge in treating drooling (sialorrhea) is that all the medications useful for this are anticholinergics, which one isn't supposed to give the elderly or those with dementia. Anticholinergics used to treat drooling include atropine (eye drops that are actually placed under the tongue), scopolamine (which comes in a patch), and Robinul.

This recently published abstract is about ipratropium bromide spray under the tongue to treat drooling. (Brand name is Atrovent Nasal Spray.) The authors "hypothesized that sublingual application of ipratropium bromide spray, an anticholinergic agent that does not cross the blood brain barrier, may reduce drooling without systemic side effects." Patients either received a placebo spray or Atrovent.

The results: "Ipratropium bromide spray had no significant effect on weight of saliva produced. There was a mild effect of treatment on subjective measures of sialorrhea. There were no significant adverse events." (The subjective measures were patient entries in home diaries.)

Robin



Movement Disorders. 2007 Sep 17; [Epub ahead of print]

Ipratropium bromide spray as treatment for sialorrhea in Parkinson's disease.

Thomsen TR, Galpern WR, Asante A, Arenovich T, Fox SH.
Movement Disorders Centre, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada.

Sialorrhea is a significant problem in advanced Parkinson's disease (PD). Current treatment options include systemic anticholinergics which frequently cause side effects. We hypothesized that sublingual application of ipratropium bromide spray, an anticholinergic agent that does not cross the blood brain barrier, may reduce drooling without systemic side effects. We performed a randomized, double blind, placebo-controlled, crossover study in 17 subjects with PD and bothersome drooling. Patients were randomized to receive ipratropium bromide or placebo (one to two sprays, maximum of four times per day) for 2 weeks followed by a 1 week washout and crossover for further 2 weeks of treatment. The primary outcome was an objective measure of weight of saliva production. Secondary outcomes were subjective rating of severity and frequency of sialorrhoea using home diaries, United Parkinson's Disease Rating Scale (UPDRS) part II salivation subscore, parkinsonian disability using UPDRS, and adverse events. Ipratropium bromide spray had no significant effect on weight of saliva produced. There was a mild effect of treatment on subjective measures of sialorrhea. There were no significant adverse events. Ipratropium bromide spray was well tolerated in subjects with PD. Although it did not affect objective measures of saliva production, further studies in parkinsonism may be warranted.

PubMed ID#: 17876852

Let's add radiotherapy to the list of treatment for drooling....

In this just published abstract, the Dutch authors conclude that radiotherapy to the salivary glands "is an effective and safe treatment of sialorrhea on the long term in patients with parkinsonism."

Robin


Movement Disorders. 2007 Oct 25; [Epub ahead of print]

Radiotherapy to the salivary glands as treatment of sialorrhea in patients with parkinsonism.

Postma AG, Heesters M, van Laar T.
Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.

This study investigated retrospectively the long-term efficacy and safety of radiotherapy (RT) to the major salivary glands as treatment of sialorrhea in patients with parkinsonism. Twenty-eight patients received a bilateral dose of 12 Gy to the parotid and part of the submandibular glands between 2001 and 2006. Severity of sialorrhea and adverse events were assessed at 1 and 6 months post-RT and finally in the first quarter of 2007. Item 6 of the activities of daily living-section of the Unified Parkinson's Disease Rating Scale was used as primary endpoint. Quality of life (QoL) pre- and post-RT was investigated using a shortened Parkinson's Disease Questionnaire-8. Sialorrhea had improved significantly at 1 month post-RT and this effect was maintained for at least 1 year. Most frequent adverse events were loss of taste and a dry mouth; however, 75% of these adverse events were transient. QoL had improved significantly on the long term. The clinical global impression scores at the final follow-up showed that 80% of patients were satisfied. It was concluded that RT is an effective and safe treatment of sialorrhea on the long term in patients with parkinsonism.

PubMed ID#: 17960826

Re:drooling, my spouse for months has what looks like blood where he drooled on the pillowcase and bed 2 or 3 times a week. I've mentioned it to at least three of his doctors, and they don't seem interested. Husband says it comes from a sore tooth and is irritated when I tell the doctor, so I haven't pushed the docs for a solution. Husband doesn't have a sore tooth. I don't care unless sympton of something else going on we need to know about. Any suggestions?

Once when this occurred my dad had bitten his own tongue, and there was blood coming from that! Sadly, he was unable to unlock his jaw muscles so if the tongue got caught, it got caught.

Another time, he had either vomited blood or gastric juices. We took him to the ER, and learned he had a fecal impaction. He was in lots of pain that time.