From the Guidelines
Pilocarpine and cevimeline are the primary medications used to treat dry mouth caused by sleep apnea machines (CPAP or BiPAP). These prescription medications stimulate saliva production by activating specific receptors in the salivary glands. Pilocarpine (Salagen) is typically prescribed at 5-10 mg three times daily, while cevimeline (Evoxac) is usually taken as 30 mg three times daily 1. Over-the-counter options include artificial saliva products like Biotène or XyliMelts, which can provide temporary relief. Before starting medication, try simpler approaches like using a heated humidifier with your sleep apnea machine, ensuring proper mask fit to prevent air leakage, and staying well-hydrated throughout the day. Using a nasal mask instead of a full-face mask may also help reduce mouth breathing and dryness. These medications work by mimicking the action of acetylcholine, a neurotransmitter that naturally stimulates fluid secretion in the mouth.
Key Considerations
- Side effects may include sweating, headache, and urinary frequency, so discuss with your doctor whether these medications are appropriate for your specific situation 1.
- It is essential to weigh the benefits and risks of these medications, considering the potential for adverse events, particularly with pilocarpine 1.
- Cevimeline may have a better tolerance profile compared to pilocarpine, as reported in a retrospective study 1.
Additional Measures
- Using a humidifier with your sleep apnea machine can help maintain a moist environment and reduce dry mouth symptoms.
- Ensuring a proper mask fit and using a nasal mask instead of a full-face mask can also help minimize mouth breathing and dryness.
- Staying well-hydrated throughout the day is crucial to help alleviate dry mouth symptoms.
From the FDA Drug Label
INDICATIONS AND USAGE Pilocarpine hydrochloride tablets are indicated for 1) the treatment of symptoms of dry mouth from salivary gland hypofunction caused by radiotherapy for cancer of the head and neck; and 2) the treatment of symptoms of dry mouth in patients with Sjogren’s Syndrome.
The FDA drug label does not answer the question.
From the Research
Medication for Dry Mouth Caused by Sleep Apnea Machine
To treat dry mouth (xerostomia) caused by a sleep apnea machine, several medications can be considered. The primary goal is to stimulate salivary production or provide symptomatic relief.
- Pilocarpine: A muscarinic cholinergic agonist that has been proven to be efficacious in treating radiation-induced xerostomia and symptoms of dry mouth in Sjögren's patients 2, 3. It increases salivary flow and provides relief in dry mouth symptoms.
- Cevimeline: Another muscarinic agonist that is safe and effective for treating dry mouth in patients with Sjögren's syndrome, particularly those with less severe salivary gland destruction 4.
- Salagen and Evoxac: FDA-approved salivary stimulants that are effective and safe for treating dry mouth, given awareness of their indications, contraindications, potential adverse effects, and patient's tolerance 5.
Treatment Approach
The treatment approach may involve a trial-and-error method to determine a successful regimen 6. Patients should have regular oral and dental examinations to detect complications, and satisfaction with the efficacy and tolerability of treatment should be monitored frequently.
Key Considerations
- Muscarinic stimulators like pilocarpine or cevimeline can be used if topical saliva substitutes are not effective.
- Immunosuppressive therapy is being investigated for the treatment of dry mouth in primary Sjögren's syndrome.
- Patients should be aware of the potential adverse effects and contraindications of the medications used to treat dry mouth.