Excess saliva

[MareeHaute]

Hi,My father has PSP and is really struggling with excessive saliva production. Someone has suggested Botox might help. Does anyone have experience of this?

[carehope]

Hi MareeHaute 🤗In past posts about the problem of excess saliva I remember reading that some people had success with Atropine eye drops placed under the tongue. I'm sure that if you look that up on the site , you'll be able to find out more about it. I think that if there were no contraindications re: your Dad that this may be worth trying before botox.

Best of luck to you and your Dad ❣️

Elise

[Bergenser in reply to carehope]

I can echo that - my husband was prescribed Atropine eyedrops to place under the tongue as needed. It worked, and was easy to start/stop/adjust.

Beware if the GP tries to prescribe patches - they are often suggested as the first option but should not be used with PSP; there are potential side effects.

The excessive saliva production might be just a phase (for my husband, it was only a short term problem, and only at night), but if it persists, it may be that Botox is helpful.

Best wishes xx

[Zerachiel]

Hi, below is a copy/paste of a reply I gave in an earlier post...

Glycopyrronium which you can get in liquid form for administering by tube, this is probably the best solution for people with PSP

Atropine drops which you place under the tongue

Hyoscine, of which there are two types of Hyoscine patches (Hyoscine Hydrobromide or Scopolamine) and Hyoscine injections (Hyoscine Butylbromide)

DO NOT allow the use of the patches as it crosses the blood/brain barrier and can cause people with PSP to be impulsive and loose any regard for their safety, my wife would get up and fall over you would pick her up and she would do the same 2 minutes later which resulted in many injuries.

I will also paste below one of the warnings for Hyoscine injections, the reason is they may have a raised heart rate and PSP can cause constipation due to muscle control ...

" If you have any of these health problems: Chest pain, enlarged colon, glaucoma, a fast heartbeat, heart failure (weak heart), myasthenia gravis, stomach or bowel block or narrowing, or trouble passing urine"

[LuisRodicioRodicio]

Hi MareeHaute,

I have compiled the following information;

• Excess salivation - drooling: In our case and at the moment it is working:

• Drink plenty of liquid. In this case we use juice of “mango” and the juice of 1/4 lemon (*) for each 250 c.c. of mango juice, adding thickener until it reaches an adequate viscosity so as not to have choking problems.

• After hydrating with the mango fruit and lemon juice, the patient nibbles the remains of lemon Pulp (*). The pure lemon (*) is astringent and makes it easy to control excess salivation.

(*) It is necessary to test the use of lemon as there are cases that produce the opposite effect.

• Some caregivers have mentioned that the physician has prescribed Botox for drooling problems. In addition, the doctor who does the injections also prescribes pill, glycopyrrolate, that seems to extends and enhances the effect but on a recent paper of Dr. James Rowe (2021-07) points out that it primarily aids chest secretions and may have systemic side effects.

• Zerachiel point out: The drooling can be controlled using drugs and/or botox injections to the saliva glands. This needs to be done to stop him aspirating on the saliva, make sure you give good mouth care to keep the bacteria down in his mouth.

I know of three drugs for saliva control, Glycopyrronium which you can get in liquid form, Atropine drops which you place under the tongue and Hyoscine; there are two types of Hyoscine injections which are used in hospital and Hyoscine patches, DO NOT allow the use of the patches as it crosses the blood brain barrier and can cause people with PSP to be impulsive and loose any regard for their safety, my wife would get up and fall over you would pick her up and she would do the same 2 minutes later which resulted in many injuries and hospital trips.”

• Others have described the use of a sublingual drop in the morning and in the evening of Atropine (used in ophthalmology) to significantly reduce excess salivation.

• On our case, excessive salivation is a PSP symptom which decrease but not disappears as the illness progresses.

• Caregiver “key4u” pointed out: “Travel sickness patch called Scopdern blocked the choking on saliva which gave more energy for swallowing.”

• pspaireland.ie/quick-index/...

• Croz2307_2022 proposses: “If the patient is well enough, he can find improvement with a simple remedy that is "Chewing gum" without side effects or additional medications. Its only drawback is that it can be used only when the patient is awake and conscious”.

• Zerachiel pointed out: “As you loose the ability to swallow you tend to get a build up of saliva in the mouth and throat, the Ahem would be trying to clear it. Carbocisteine is very often prescribed to make the secretions more watery so they go down easier and don't build up”.

Hug and luck.

Luis