From the Guidelines
Sialogogues, such as pilocarpine and cevimeline, should be considered for patients with moderate glandular dysfunction, as they may improve symptoms of dry mouth, although their use should be weighed against potential adverse events 1. When considering the use of sialogogues, it is essential to evaluate the severity of glandular dysfunction and the potential benefits and risks of treatment.
- Pilocarpine and cevimeline are two muscarinic agonists licensed for the treatment of oral dryness, with pilocarpine being licensed worldwide 1.
- These medications have been shown to improve visual analogue scale (VAS) dry mouth and salivary flow rates in patients with Sjögren's syndrome, although they are associated with a high frequency of adverse events 1.
- The evidence for the use of sialogogues in patients with primary Sjögren's syndrome (pSjS-2002) is limited, and their use should be approached with caution due to the unfavorable safety profile of these drugs 1.
- Non-pharmacological stimulation, such as increasing water intake, using alcohol-free mouthwash, and avoiding caffeine and tobacco, may be sufficient for managing milder cases of dry mouth.
- In patients with moderate glandular dysfunction, a trial of muscarinic agonists, such as pilocarpine or cevimeline, may be offered, taking into account the potential benefits and risks of treatment 1.
From the FDA Drug Label
Pilocarpine, in appropriate dosage, can increase secretion by the exocrine glands The sweat, salivary, lacrimal, gastric, pancreatic, and intestinal glands and the mucous cells of the respiratory tract may be stimulated. In a study of 12 healthy male volunteers there was a dose-related increase in unstimulated salivary flow following single 5 mg and 10 mg oral doses of pilocarpine hydrochloride tablets. Cevimeline has been shown to improve the symptoms of dry mouth in patients with Sjögren’s Syndrome Salivary flow showed statistically significant increases at both doses of cevimeline during the study compared to placebo.
Sialogogues are drugs that stimulate the production of saliva.
- Pilocarpine and cevimeline are two examples of sialogogues.
- They work by stimulating the muscarinic receptors in the salivary glands, which increases the production of saliva.
- Both pilocarpine and cevimeline have been shown to be effective in increasing salivary flow in patients with Sjögren's Syndrome and head and neck cancer 2, 3.
From the Research
Sialogogues
- Sialogogues are substances that stimulate saliva production, which can help alleviate dry mouth symptoms 4, 5.
- Examples of sialogogues include sugar-free gum and sugar-free candies, which can stimulate salivary glands and increase saliva production 5.
- Pharmacological stimulants, such as Salagen and Evoxac, are also available to increase salivary output and are FDA-approved for the treatment of dry mouth in patients with Sjögren's syndrome 5.
Non-Pharmacological Interventions
- Non-pharmacological interventions, such as acupuncture and electrostimulation, have been studied as potential treatments for dry mouth 4, 6, 7.
- Acupuncture has been shown to result in a small increase in saliva production in patients with dry mouth following radiotherapy, although the evidence is of low quality 4, 7.
- Electrostimulation devices have been studied, but there is insufficient evidence to determine their effects on dry mouth symptoms or saliva production in patients with Sjögren's syndrome 4, 7.
Diagnosis and Treatment
- Diagnosis of dry mouth can be done using salivary flow rates and patient-completed questionnaires, as well as objective measurements of changes in mechanical properties of saliva 8.
- Treatment of dry mouth can include lubricating, thickening, adhesive, and moisturizing agents, although these may only provide short-lived relief 8.
- Innovative technologies, such as self-assembly, emulsion, liposomes, and microgels, are emerging as novel saliva substitutes and may hold promise for alternative approaches to moistening and lubricating the oral mucosa 8.