Excess saliva production (sialorrhea) is a very common problem in ALS patients. The disease does not cause the overproduction of saliva, like people often think, but instead weakens the throat muscles needed for regular swallowing. When not properly managed, sialorrhea can result in drooling, choking, or difficulty speaking.
For the management of excess saliva, we suggest drinking two glasses of tomato juice daily, if possible. Tomatoes contain high concentrations of lycopene, which is a natural reducer of salivary output. If stomach distress occurs, add a tablespoon of sugar to each glass to dilute the acid. Try packing sea salt on the tongue, or suck on olives or lemons. Additionally, prescription Nuedexta, used to treat PBA (pseudo-bulbar affect) and other bulbar symptoms, is very often successful in moderating saliva, mucus, and phlegm.
Equally as important as our recommendations for controlling excess saliva are the things we do NOT recommend. We do not suggest the use of beta-blocker/SSRI or tricyclic prescriptions (such as amitriptyline) unless absolutely necessary, and we never endorse the use of salivary gland Botox injections due to countless reports of adverse side effects. The risks associated with Botox simply outweigh any benefits, and we do not support treatments that may put patients in danger. There are equal or better medications, but without adverse side effects, discussed at the link below.
If all of the above or our other suggestions fail to control excess saliva, a reason may be the length of time that you or your loved one has had the disease. Those who have had ALS/MND for more than 5-7 years may be unable to benefit from these recommendations, due to the dysfunctional muscularity in the throat. If so, your only support may be the use of a suction machine.
How do YOU manage excess saliva? Let us know in an email, as we are always look for new solutions to share with our patients. ALS Worldwide encourages our patient community to help each other and we would love to hear from you, especially about something that is such a common problem. To learn more about reducing excess saliva as well as congestion, please visit our previous article.