Starting to excessively drool

[kmendsley]

Ok, besides this being so embarrasing, I am noticing lately that I have been drooling excessively lately. Not to the point that it is always coming out of my mouth, but whenever I eat, drink, or lay down seconds later I am mopping up drool that is pouring from my mouth. I also am choking quite frequently while eating, drinking, or even when I put my head back while sitting up...choking on my own spit.

I have seen from other threads the cause of this is sylvia that is just produced too much and inability to swallow it all. Any advice from PALS or CALS. And is this normal to already be having this when I can still talk and walk?( I thought it is seen more in the further progressing cases...I may be wrong...please correct me if this is the case. ) Thanks all. ;-)

[michael0314]

I have the same problem and I still swallow fairly well. I think it is a normal part of the desease. When you know your going to swallow tuck your chin to your chest. It helps close the airway. Sticking your tongue between your teeth and swallowing does the same thing. I cant do that one though, I just bite my tongue.

[Ms. Pie]

Kel, I heard there are some medications out there that will dry you up a bit. Some are harsh but some are pretty good from what I've read. Take care!!

[sadiemae]

Amytriptyline is a good one for this. Drys you up, helps you sleep, and controls EL.

[joni51]

Lori what is that? When Bruce chokes he has spit going everywhere, and I have noticed drooling a little.

[sadiemae]

"Amitriptyline is used to treat symptoms of depression. Amitriptyline is in a class of medications called tricyclic antidepressants. It works by increasing the amounts of certain natural substances in the brain that are needed to maintain mental balance."

Also called Elavil. It is a 3 or 4 in one drug!!

[joni51]

Thanks Lori:)

[sadiemae]

Drooling may be one of the most distressing symptoms for patients with bulbar ALS. When excess saliva spills into the airway, bronchospasm can result. Mechanical suction devices are useful in preventing aspiration. Medications that suppress sialorrhea include anticholinergic drugs such as atropine, in a dosage of 0.4 mg four times daily, or scopolamine (Transderm-Scop), one 0.5-mg transdermal patch applied every three days. Some antihistamines, such as diphenhydramine (Benadryl), in a dosage of 25 to 50 mg three times daily, may also be helpful in suppressing sialorrhea.


Tricyclic antidepressants are widely used in the treatment of ALS because of their multiple effects. Amitriptyline, in a dosage of 5 to 100 mg at bedtime, can provide antidepressant and antisialorrheic actions as well as nocturnal sedation, potentiation of analgesia and possible weight gain. Doxepin (Sinequan) and imipramine (Tofranil) have similar actions. Tricyclic agents have potential hypotensive, cardiac, sedative and anticholinergic side effects. The selection of agent and dosage requires balancing the desired effects and potential adverse effects.


Depression and anxiety are common in ALS and require individualized therapy. Supportive counseling is appropriate for all patients and their families, and antidepressant medication may also be helpful. An adequate dosage of a tricyclic agent may relieve the patient's depression, with the advantage that the side effects (dry mouth, sedation and weight gain) actually help to counter symptoms of ALS. Selective serotonin reuptake inhibitors such as fluoxetine (Prozac), in a dosage of 20 mg once or twice daily, are effective but have the potential adverse effects of insomnia and agitation. Benzodiazepines may relieve anxiety and insomnia but can cause daytime sedation.

[sadiemae]

Managing Excessive Saliva


Patients who experience swallowing problems often notice that they seem to salivate more. The fact is, they may not be salivating more, but the saliva is pooling in the mouth because of an inability to swallow it. Excessive saliva can be one of the most frustrating symptoms of ALS to manage. It can also be life threatening, since it frequently causes choking, especially at mealtimes when saliva secretion is increased and chance of aspiration is greatest.


Early in the course of the disease, excess salivation can be controlled by simply being aware of the problem and making a conscious effort to swallow the saliva or wipe it away with tissues. To some degree, these problems can be managed by controlling the intake of very sweet or very sour foods that cause hypersecretion. It may also be helpful to increase or decrease (as the case may be) foods of high water or fluid content.

With progression of the disease, however, patients may find that excess saliva has become a nuisance and an embarrassment, and needs to be controlled by other means. One helpful measure is to have a suction machine available in the home. Modern technology has provided portable, battery-operated suction machines for those “on the go”.

Your physician may prescribe certain medications to control saliva. The following is a list of prescription medications that have been used successfully in controlling saliva. If a single dose does not work, a combination may be tried. Most common side effects of these drugs are mild sedation, dizziness, difficulty in urination, and tachycardia. They are in the order most often used.

Glycopyrrolate (Robinul) 1-2 mg. every four hours. Robinul is also available in injectable form – 0.1 mg. every four hours or 3-4 times/day. Maximum dose – 0.2 mg 4 times/day.

Propantheline (Pro-Banthine) 15 mg. one half hour before meals three times a day.

Amitriptyline (Elavil) 10 mg. three times a day or 10-25 mg. at bedtime. Amitriptyline is also available in injectable form – 2 to 5 mg. IM to start. Elavil is also used as an antidepressant.

Nortriptyline HCL (Pamelor) 10-25 mg. at bedtime.

Scopolamine (Transderm Scop) transdermal patch 1.5 mg. programmed to deliver medication over 72 hour period. Reported by patients to reduce saliva by 75-80%. Caution – may cause glaucoma.

[smwelder]

Amytriptyline woks great im on it for drooling i take it at night and it works

[kmendsley]

Thanks all for the advice. I will definately bring up these possible options to my neuro at my next appt. :)

[BarryG]

I tried amytriptyline but it lowered my blood pressure so I now do 5ml of Glycopyrrolate three times a day and it works for me.

[Tom's Support]

Tom was given amitriptyline but refuses to take it because it makes him "spinny in the head" He is adament that he will not take anti=depressants or as he fondly calls them looney pills. What a guy. They WERE, however, working on the saliva/phlegm.