Pilocarpine

pilocarpine salagen and evoxac cervimeline

Pilocarpine and Cevimeline for dry mouth

Pilocarpine is a parasympathomimetic sialogogue that we use to increase salivary flow. Before anyone should use these medications they should exhaust all other options for dry mouth treatment.

Pilocarpine (Salagen) and Cevimeline (Evoxac)

These two medications can be given to those suffering with dry mouth. These drugs are cholinergics and shouldn’t be taken lightly. Typically a rheumatologist, oral medicine specialist, or maybe a dentist will prescribe these.

What are the contraindications of Pilocarpine?

Anyone with glaucoma, asthma, COPD, acute iritis, cardiac arrhythmias or significant cardiac issue can not take these medications. Basically no respiratory issues, heart conditions or open-angle glaucoma.

What are the side effects of Salagen?

The side effects can be severe enough that the benefits are not worth the side-effects. Using the medication topically instead of taking the pill does decrease the side-effects. The side effects are excessive sweating & urination, gastritis, heart palpitations, chills/flushing, headache/dizziness. Other side effects can be tearing, tiredness, nausea, vomiting, and diarrhea.

How to use these medications?

Some will start with Pilocarpine and move to Cevimeline if Pilocarpine isn’t cutting it. Some insurances will not cover Cevimeline unless Pilocarpine has been shown to not be effective enough. It takes several months to get the full effect of these medications.

What is the prescription amount for these medications and who makes the medication.

pilocarpine salagen and evoxac cervimeline

 

A compounding pharmacy will be necessary for the lozenges or lollipops that the patient can use prn. A patient can just do a few licks and replace the lollipop into it’s container. This method helps to keep the effects more local. Gibson BDJ 2007 and Laffleur 2019 shown methods of topical oral delivery. A mucoadhesive tablet seem to be least likely to cause adverse effects and is what Gusmão 2021 GD  uses in their study.

 

Disp 1 lolli, 5 mg pilocarpine lollipop sweetened with xylitol. Sig: place lolli in mouth for 3 to 10 seconds up to 5 times a day. Refrigerate between use.