Antimuscarinics are the first line medicine option for sialorrhoea, but care should be taken to ensure that the drug does not overly dry up secretions.^1,17

Options include:¹⁷

·     - oral tablets (crushed or dissolved in water if necessary, suitable for feeding tubes): hyoscine butylbromide, hyoscine hydrobromide, glycopyrronium bromide, clonidine (low dose), low dose tricyclic antidepressants (beware of sedation);

·     - oral suspensions (suitable for feeding tube): glycopyrronium, tricyclic antidepressants;

·     - dermal patch: hyoscine hydrobromide;

·     - parenteral formats including continuous infusion by syringe pump: hyoscine, glycopyrronium;

·     - sublingual: atropine eye drops given under the tongue.

With fewer CNS side effects, glycopyrronium is recommended where cognitive impairment is a factor.¹

A barrier cream may help protect against soreness. Oral suction using a Yankauer suction catheter can help remove saliva, mucus and food particles from the mouth.^1,17,20

More advanced options include botulinum toxin injections into the salivary glands (although this can increase dysphagia), radiotherapy to destroy salivary glands, or surgery.¹⁷