The Mechanism of Nitrazepam-Induced Drooling and Aspiration

Abstract

Nitrazepam, a benzodiazepine anticonvulsant, is used in the treatment of myoclonic, akinetic, absence, generalized tonic–clonic, and complex partial epilepsies.^{1 2 3 4 5 6 7 8 9 10 11 12 13 14 15} Adverse reactions to the drug include sedation, hypotonia, ataxia, nausea, and vomiting.^{1 2 3 4 5 6 7 8 9 , 12 , 13 , 16 17 18 19} Nitrazepam-induced drooling,^{4 , 7 8 9 , 12} eating difficulty,⁹ and aspiration pneumonia^{5 , 7 8 9 , 13} have been attributed to (unproved) salivary and bronchial hypersecretion.^{5 , 8 , 9 , 12 , 13} We conducted manometric examinations of two children with nitrazepam-induced drooling and aspiration and found that the onset of the cricopharyngeal relaxation during swallowing was delayed until after the onset of the hypopharyngeal contraction. This abnormality was not seen in any age-matched controls. These cases of drug-induced cricopharyngeal incoordination indicate that the drooling and . . .