PD Sialorrhoea – Sublingual Atropine — SCE Neurology MCQ

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ModerateMovement DisordersPD Sialorrhoea – Sublingual AtropineSCE Neurology

A 60-year-old man with Parkinson's disease presents with drooling (sialorrhoea) that is socially embarrassing and causes skin maceration. Oral glycopyrrolate has been tried but caused constipation and urinary retention. What alternative treatment should be considered?

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Correct answer: B — Atropine eye drops sublingual

Explanation lettering: C = shown as A · E = shown as B · A = shown as C · B = shown as E

When systemic anticholinergics are not tolerated, sublingual atropine 1% eye drops (used off-label) are a practical alternative for sialorrhoea in PD. They provide local anticholinergic effect on salivary glands with fewer systemic side effects. Botulinum toxin injection into the salivary glands is also effective (B is also a reasonable answer) but sublingual atropine is more accessible and less invasive as a next step. In practice, both B and E are valid — but atropine drops are typically tried before botulinum toxin. A: Levodopa does not treat sialorrhoea. C: Surgery is excessive. D: Pilocarpine increases salivation.

Reference: NICE NG71 Parkinson's Disease (2017); BNF