National Institute for Health and Care Excellence (NICE) has recommended botulinum neurotoxin type A (Xeomin) as a treatment option for chronic sialorrhoea.
Botulinum neurotoxin type A is recommended for the treatment of adults with chronic sialorrhoea resulting from neurological conditions.
Botulinum neurotoxin type A is administered as an injection (5 units/0.1 mL) in the parotid and submandibular glands on both sides in the following doses:
- Parotid: 30 units/side, 0.6 mL/injection.
- Submandibular: 20 units/side, 0.4 mL/injection.
Treatment should be repeated based on the patient's clinical needs but should not be more frequent than every 16 weeks.
Current management options for chronic sialorrhoea include use of bibs, speech and language therapy and occupational therapy. Anticholinergic medications may be prescribed to some patients to decrease salivary production. Evidence from a randomised trial suggests that botulinum neurotoxin type A can effectively reduce the amount of saliva produced; however, there is no evidence to support improvement in quality of life with the treatment.
The drug is to be used only when provided by the company in agreement with the commercial arrangement. The recommendations should not affect patients whose treatment with the drug was started before the publication of the guidance.