title: Assessment of the use of sialogogues in the clinical management of patients with xerostomia.
abstract: This study was conducted to assess the clinical efficacy and adverse effects of pilocarpine, bethanechol and cevimeline in patients with xerostomia. In this open-label crossover assessment in 20 patients with xerostomia, a one- to two-week course of each medication with a one-week washout period was prescribed. Side effects, symptoms, whole stimulated and unstimulated saliva were measured. Each sialogogue was found to increase saliva and decrease symptoms. A mixed-effects analysis showed a greater increase in stimulated saliva on bethanechol compared to pilocarpine (0.106, p = 0.0272). Increased sweating was the most common side effect, experienced more frequently with pilocarpine as compared to bethanechol (p = 0.0588) or cevimeline (p = 0.0143). A carryover effect beyond the washout period was seen. Effects on saliva and side effects vary between sialogogues, suggesting a benefit of trials with different sialogogues to determine individual patient preference. The observed carryover effect suggests that intermittent treatment may be an alternative to continuous treatment with sialogogues.
authors.affiliation: Department of Orofacial Sciences, University of California, San Francisco, Calif, USA. nitacwu@itsa.ucsf.edu
authors.forename: Nita
authors.initials: N
authors.lastname: Chainani-Wu
authors.forename: Meir
authors.initials: M
authors.lastname: Gorsky
authors.forename: Priscilla
authors.initials: P
authors.lastname: Mayer
authors.forename: Alan
authors.initials: A
authors.lastname: Bostrom
authors.forename: Joel B
authors.initials: JB
authors.lastname: Epstein
authors.forename: Sol
authors.initials: S
authors.lastname: Silverman
mesh_terms: D018723:Bethanechol / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D002175:Candida / Q000302:isolation & purification; D002180:Candidiasis, Oral / Q000188:drug therapy; D015169:Colony Count, Microbial; D018592:Cross-Over Studies; D003679:Deglutition / Q000187:drug effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D018721:Muscarinic Agonists / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D010862:Pilocarpine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D011812:Quinuclidines / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D012463:Saliva / Q000737:chemistry / Q000187:drug effects; D012472:Salivation / Q000187:drug effects; D013060:Speech / Q000187:drug effects; D013546:Sweating / Q000187:drug effects; D013649:Taste / Q000187:drug effects; D013876:Thiophenes / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D014987:Xerostomia / Q000188:drug therapy* / Q000382:microbiology
chemical_list: D018721:Muscarinic Agonists; D011812:Quinuclidines; D013876:Thiophenes; D018723:Bethanechol; D010862:Pilocarpine; C059240:cevimeline