Drug-Induced Sialorrhea Caused by Chronic Kidney Disease

Abstract

Introduction. Sialorrhea is described as an excessive production of saliva which cannot be alleviated by swallowing. There are only a few drugs that can cause drooling, therefore excessive salivation is a relatively infrequent side effect. However, chronic kidney disease(CKD) can lead to accumulation of the medication in the body and so increases the risk of the occurance of side effects, as well as sialorrhea. Case description. 80 year–old male who had renal function impairment since 2019 was diagnosed with stage 3 CKD in October 2021. Patient’s complaints were frequent urination, nocturia and episodic leg swelling. Objectively: renal function is stable, glomerular filtration rate (GFR) is 40,1ml/min/1,73m2 and progression risk is high. Patient also has comorbidities: arterial hypertension, ischemic heart disease and benign prostatic hyperplasia. Treatment applied was Ranolazine, Bisoprolol/Amlodipine, Tamsulosin. One week after the diagnosis the patient had his another outpatient visit complaining with tiring excessive thick brown sialorrhea at night. As patient believed, saliva included blood. Patient was examined by otorhinolaryngologist and no abnormalities were found. Laterhe underwent a gastroenterological examinationt including esophagogastroduodenoscopy which showed the presence of gastroesophageal reflux disease without the reflux and hada positive Helicobacter pyllori detecting stool test. Patient was prescribed with Amoxicillin, Clarithromycin, Esomeprazol in usual dosage. However, the undergoing treatment was not helpful. Later patient noticed balance disorders, dizziness and vomited. He was consulted neurologically and vertebrobasilar artery disease was detected. Finally, doctors found out that drooling was caused by high doses of Tamsulosin and reduction of it led to milder side effects. Summary. This case represents how important it is to calculate the GFR and medication doses before the usage. Conclusions. Patients with CKD and consuming large amounts of drugs should be taken into consideration very carefully to avoid the undesirable side effects.