| 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. |
