What medications increase salivary production?

From the Guidelines

Drugs that increase spit production, also known as sialogogues, include pilocarpine and cevimeline, which are primarily used to treat dry mouth caused by Sjögren's syndrome or other conditions. These medications work by stimulating muscarinic receptors in salivary glands, directly increasing saliva production 1. Pilocarpine is typically prescribed at 5-10 mg three times daily, while cevimeline is usually taken as 30 mg three times daily 1. Some key points to consider when using these medications include:

• They may cause side effects such as sweating, urinary frequency, and digestive issues 1
• Patients with certain conditions like uncontrolled asthma, narrow-angle glaucoma, or specific heart conditions should use these medications with caution or avoid them altogether 1
• Other options for increasing saliva production include over-the-counter substitutes like Biotène or XyliMelts, as well as simple measures like staying hydrated and using sugar-free candies or gum containing xylitol 1
• Cevimeline has been found to have a better tolerance profile compared to pilocarpine, with fewer adverse systemic side effects 1. It's essential to weigh the benefits and risks of these medications and consider individual patient needs and medical history when making treatment decisions 1.

From the FDA Drug Label

Cevimeline has been shown to improve the symptoms of dry mouth in patients with Sjögren’s Syndrome A 6-week, randomized, double blind, placebo-controlled study was conducted in 75 patients (10 men, 65 women) with a mean age of 53. 6 years (range 33-75). Seventy-six percent of the patients in the 30 mg tid group reported a global improvement in their dry mouth symptoms compared to 35% of the patients in the placebo group. A 12-week, randomized, double-blind, placebo-controlled study was conducted in 197 patients (10 men, 187 women) with a mean age of 54.5 years (range 23-74). Statistically significant global improvement in the symptoms of dry mouth (p=0. 0004) was seen for the 30 mg tid group compared to placebo, but not for the 15 mg group compared to placebo. Salivary flow showed statistically significant increases at both doses of cevimeline during the study compared to placebo. The 30 mg tid group showed a statistically significant increase in salivary flow from pre-dose to post-dose compared to placebo (p=0.0017). Increased Salivation 3%

Drugs that increase spit production are:

• Cevimeline 2
• Pilocarpine 3

Key points:

• Cevimeline and Pilocarpine have been shown to increase salivary flow and improve symptoms of dry mouth.
• Cevimeline has been shown to have a statistically significant increase in salivary flow at doses of 30 mg tid.
• Pilocarpine has been reported to have an adverse event of Increased Salivation in 3% of patients.

From the Research

Drugs that Increase Spit Production

• Pilocarpine is a cholinergic agonist that stimulates salivary secretion, increasing salivary flow rates 2- to 10-fold higher than placebo 4
• Cevimeline is a quinuclidine analogue with therapeutic and side effects similar to those of pilocarpine, and is also used to treat xerostomia 5, 6
• Muscarinic agonists, such as cevimeline, stimulate salivary secretion in animals and humans with normal salivary gland function and with impaired salivary secretion (xerostomia or oral dryness) 6
• Parasympathomimetic drugs, including pilocarpine, have been used to treat radiation-induced salivary gland dysfunction, with response rates of 42% to 51% 7

Mechanism of Action

• Pilocarpine and cevimeline work by stimulating the muscarinic receptors in the salivary glands, increasing salivary flow and reducing symptoms of xerostomia 4, 6
• The effects of these drugs are dose-dependent, with higher doses resulting in greater increases in salivary flow, but also potentially more side effects 7

Clinical Efficacy

• Pilocarpine has been shown to be effective in relieving symptoms of xerostomia, including oral dryness and difficulties in chewing, swallowing, and speaking, in patients with Sjögren's syndrome and those undergoing radiation therapy 4, 8
• Cevimeline has also been shown to be effective in relieving symptoms of xerostomia, with a longer duration of action than pilocarpine 6