The use of oral pilocarpine in xerostomia and Sjögren's syndrome.
OBJECTIVE
To analyze the role of oral pilocarpine in the treatment of xerostomia of Sjogren's syndrome (SS).


METHODS
The medical literature was reviewed for all studies using oral pilocarpine to treat xerostomia caused by SS or radiotherapy registered in the MedLine Silver Platter database from 1966 to 1998.


RESULTS
All the studies identified excluded elderly individuals with cardiac or pulmonary disease. Patients with postradiation xerostomia and incomplete resection of the salivary glands were more likely to benefit from oral pilocarpine when there was sufficient residual glandular function than patients with radical surgery for head and neck cancer (HNC). However, patients with SS and other inflammatory disorders seemed to benefit from oral pilocarpine, when compared with patients with postradiation xerostomia. The optimal dose of oral pilocarpine, which was less likely to cause side effects, was 5 mg four times daily. A recent multi-center study in SS patients suggests that oral pilocarpine is effective and safe for long-term administration. Although some studies did not show evidence for increased salivary gland secretion rate as measured by sialometry, symptoms improved, perhaps because of increased secretion from the minor salivary glands or better conditioning of the oral mucosa.


CONCLUSIONS
Oral pilocarpine is likely to benefit patients with SS by reducing the symptoms of xerostomia, even if the salivary gland secretion rate does not increase. Further controlled studies are needed in patients with SS and should include elderly patients with cardiovascular disease treated with moderate doses of oral pilocarpine.
Division of Medicine, the Hadassah University Hospital and Hebrew University-Hadassah School of Medicine, Jerusalem, Israel. samjack@shani.net
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Nusair
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Rubinow
D000284:Administration, Oral; D006258:Head and Neck Neoplasms / Q000532:radiotherapy; D006801:Humans; D018721:Muscarinic Agonists / Q000008:administration & dosage / Q000627:therapeutic use*; D010862:Pilocarpine / Q000008:administration & dosage / Q000627:therapeutic use*; D011832:Radiation Injuries / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D012463:Saliva / Q000378:metabolism; D012469:Salivary Glands / Q000503:physiopathology / Q000528:radiation effects; D012859:Sjogren's Syndrome / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D014987:Xerostomia / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology
D018721:Muscarinic Agonists; D010862:Pilocarpine