Description

Drooling of saliva is an uncomfortable, undignified and inconvenient symptom of advanced oro-facial and pharyngo-oesophageal malignancies, neurological disease and also general weakness in terminal illness. Zeppetella describes three case reports of the successful use of nebulised Scopolamine Hydrobromide in the treatment of this problem (Zeppetella G. – Nebulized Scopolamine in the Management of Oral Dribbling: Three Case Reports. J Pain Symptom Manage 1999; 17: 293-295). In each of the cases Scopolamine (hyoscine) hydrobromide was administered in dosage of 800µgm bd, tds or prn, made up to 4mls in 0.9% saline and administered over approximately 15 minutes via a Porta-neb 50 ensuring small particle size (80% particles less than 5 µm). Whereas transdermal scopolamine had already been unsuccessful in two of the three patients, causing urinary retention in one of these, and sublingual scopolamine had also failed in the same two patients, with dizziness in the fir st and inability to retain the medication in the second due to previous oral surgery, nebulized scopolamine achieved effect without toxicity. In view of the lack of systemic side effects, a local anti-cholinergic effect on the salivary glands is postulated. Use of scopolamine topically has been considered to facilitate dental work.