Drooling (Sialorrhea) Medication

Updated: Aug 29, 2019
  • Author: Neeraj N Mathur, MBBS, MS, DNB(ENT), MNAMS, FAMS; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Medication

Medication Summary

Anticholinergic agents inhibit activation at muscarinic receptors, and at best, decrease the volume of drooling. At tolerable anticholinergic doses, drooling is unlikely to completely cease.

Botulinum toxin leads to partial or complete muscle paralysis by inhibiting acetylcholine release at the neuromuscular synaptic end plate. It also blocks the release of acetylcholine at the cholinergic synapses of the autonomic nervous system; thus, this toxin can block cholinergic parasympathetic secretomotor fibers of the salivary gland. IncobotulinumtoxinA has received FDA approval for the treatment of chronic sialorrhea.

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Neuromuscular Blockers, Botulinum Toxins

Class Summary

Injection of incobotulinumtoxinA or rimabotulinumtoxinB into the parotid and submandibular glands has been approved by the FDA for adults with chronic sialorrhea owing to various neurologic disorders, including Parkinson disease, amyotrophic lateral sclerosis, cerebral palsy, and stroke.

IncobotulinumtoxinA (Xeomin)

Through inhibition of acetylcholine release from peripheral cholinergic nerve endings, incobotulinumtoxinA deters cholinergic transmission at the neuromuscular junction. It is indicated for adults with chronic sialorrhea.

RimabotulinumtoxinB (Myobloc)

Through inhibition of acetylcholine release from peripheral cholinergic nerve terminals, rimabolutinumtoxinB deters cholinergic transmission at the neuromuscular and salivary neuroglandular junction. It is indicated for treatment of chronic sialorrhea in adults.

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