Side effects from a high-dose clozapine treatment for a schizophrenic patient led to massive compliance problems. The dose of clozapine could be halved without recurrence of an acute psychotic symptomatology by concomitantly administering amisulpride The side effects, especially hypersalivation, disappeared almost entirely, which in turn led to good compliance. In a short review we would like to present the pathophysiology and therapeutic options of clozapine-induced hypersalivation.

Despite various attempts at explanation and therapeutic approaches, hypersalivation under clozapine remains a side effect that is sometimes very difficult to get under control. As in our case report, it can lead to quite relevant compromises in compliance. The cause for the observable paradoxical hypersalivation under clozapine which can occur in spite of the anticholinergic effect remains unexplained.

The combination of clozapine and amisulpride with its overall good tolerability represents an option for reducing the sometimes inevitably high doses of a monotherapy, and the associated side effects, such as in our case with clozapine. In addition, making use of synergetic effects and in turn, improving the patients’ compliance would be possible.