ALS : Treatments for Drooling

By Debi Klein, ALS Association

The following is an interview with Craig Sherman MD, Medical Director of Hope Pharmaceuticals, the manufacturer of Sal-Tropine tablets.

D. Klein: How would you categorize the varying degrees of drooling that can complicate the life of a person afflicted with ALS?

Dr. Sherman: Drooling is the condition in which saliva inappropriately escapes from the mouth. In addition to stigmatizing social effects, drooling can cause skin breakdown and infection, produce foul odors, and soil clothes and furniture. It can be caused by excessive salivation, inability to control facial muscles, or both. When determining a treatment plan for a patient, a doctor must consider both the cause of the drooling and also its severity; whether it is mildly, moderately, or significantly disruptive to the patient's quality of life.

D. Klein: Dr. Sherman, what treatments are available to relieve drooling?

Dr. Sherman: Consultation with an Occupational Therapist is a good starting point to learn helpful behavioral techniques that can be readily implemented. These include maintaining proper head position, exercising facial muscles, and facilitating frequent swallowing. For persons with mild conditions, these techniques may be sufficient to control the drooling.

Persons with moderately severe drooling may require medication along with behavioral techniques. The goal of this combination therapy is not to eliminate saliva, but to significantly reduce it to the point where one can control the residual flow. A medication specifically indicated for this use is atropine sulfate. Low dose atropine tablets (Sal-Tropine) are available by prescription through pharmacies nationwide. Because the salivary glands are exquisitely sensitive to atropine, one can take a relatively low dose to achieve the desired oral effects. To minimize the potential for side effects, it is important to take the lowest dose possible. Working with one's doctor, a patient starts at a conservative dose and increases it until the lowest dose is found that provides the desired reduction of saliva flow. Persons with severe conditions whose drooling continued despite optimal conservative therapy may consider surgery.

D. Klein: You mentioned "quality of life" before. How is "quality of life" considered in the choice of treatments?

Dr. Sherman: All treatments have predictable benefits, but they also have potential side effects. It is important to resolve the drooling without creating new problems. A comprehensive treatment plan can help create a synergistic benefit between different therapies, such as when medication is combined with behavior techniques to reduce salivation and to control residual flow respectfully. Working closely with your doctor, you can tailor a treatment plan best suited to your needs to maintain good skin hygiene, preserve dental health, and restore social interactions.

Detailed information on the medication to control drooling associated with ALS is available online at ALS-drooling information at www.hopepharm.com.