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Palliative : Anti-Secretory Agents
Excessive Secretions/Death Rattle
Transdermal Anticholinergics for the Treatment of "Death Rattle" and
Excessive Secretions
Difficulty clearing upper airway secretions (death rattle) is a problem for
half of all dying patients. Treatment often includes the use of anticholinergic
drugs, such as scopolamine (also known as hyoscine) or atropine. Transdermal
scopolamine has several indications for symptom control in patients with end-stage
disease: control of excess salivary secretions, management of terminal secretions,
and control of nausea.
Palliat Med. 2002 Sep;16(5):369-74
J Pain Symptom Manage. 2002 Apr;23(4):310-7
Prescrire Int. 2001 Aug;10(54):99-101
Otolaryngol Head Neck Surg. 1990 Oct;103(4):615-8
Reduction of salivary flow with transdermal scopolamine: a four-year
experience.
Talmi YP, Finkelstein Y, Zohar Y.
Department of Otolaryngology, Hasharon Hospital, Golda Medical Center, Petah
Tikvah, Israel.
Click
here to access the PubMed abstract of this article.
Drooling is a serious social handicap experienced by some neurologically impaired
patients. No one method has been identified to control drooling for all patients,
however, anticholinergic drugs have been utilized. In the following case study,
transdermal scopolamine was found to be effective for controlling drooling
in a traumatic brain-injured patient for whom more conservative methods failed.
From a baseline saliva flow rate, saliva flow decreased up to 59%. No significant
side effects were observed with treatment, and the decrease in drooling was
maintained for a 4-month period. Although transdermal scopolamine may represent
one acceptable facet of long-term treatment, it must be stressed that efficacy
is variable across patient populations and that treatment approaches must be
individualized.
Am J Phys Med Rehabil. 1991 Aug;70(4):220-2
The use of transdermal scopolamine to control drooling.
A case report.
Dreyfuss P, Vogel D, Walsh N.
Department of Rehabilitation Medicine, University of Texas Health Science Center,
San Antonio 78284-7798.
Click
here to access the PubMed abstract of this article.
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