Transdermal Scopolamine in the Treatment of Sialorrhea in Neurological Pathology: Literature Review
DOI:
https://doi.org/10.25759/spmfr.448Keywords:
Nervous System Diseases/complications, Scopolamine/administration & dosage, Sialorrhea/drug therapy, Sialorrhea/etiology, Transdermal PatchAbstract
Sialorrhea is a frequent symptom and can affect the neurological patient in various ways. Despite multiple therapeutic options being available, it remains a challenge to manage. The aim of this narrative review is to analyse the scientific evidence regarding transdermal scopolamine in the treatment of sialorrhea in patients with neurological disorders.
We performed a search in PubMed database and selected 7 studies, published between 1988 and 2020, according to inclusion and exclusion criteria.
Transdermal scopolamine has demonstrated a positive effect in improving sialorrhea and caregiver’s satisfaction as well as reducing the incidence of complications (aspiration and hospital readmissions). All studies report side effects, particularly local cutaneous reactions, xerostomy, constipation, behavioural changes and ophthalmologic effects. The suspension of the use due to side effects tends to increase with follow-up time, reaching 82% after 1 year. These studies have limitations that relate to the study design, small number of patients, loss of follow-up and outcome measures.
When managing sialorrhea it is essential to consider the balance between symptomatic relief and the side effects of the different treatment options. Scopolamine in its transdermal formulation showed good effect in the management of sialorrhea in patients with neurological conditions, revealing, however, increasing rates of treatment suspension with longer periods of usage, due to side effects. Its use for short periods can be beneficial and it may be a useful alternative for the management of sialorrhea in patients with neurological disorders, as long as its contraindications are acknowledged and side effects are monitored. Due to the scarcity of evidence, we cannot yet conclude about the best line of treatment for sialorrhea.
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