What antipsychotic is known to produce sialorrhea despite its antimuscarinic effects?
Clozapine. Clozapine antagonizes muscarinic receptors, producing antimuscarinic effects in overdose. However, it paradoxically acts as an agonist at the M4 subtype receptor and produces sialorrhea.
Praharaj, Samir Kumar, Arora, Manu, & Gandotra, Sachin. (2006). Clozapine-induced sialorrhea: Pathophysiology and management strategies. Psychopharmacology, 185(3), 265-273.
Submitted by: Emily Kershner, MD on behalf of the Medical Toxicology Fellowship, Virginia Commonwealth University
Posted in Question Of The Day