Assessment of the use of sialogogues in the clinical management of patients with xerostomia.
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.
Chainani-Wu
Nita
N
Department of Orofacial Sciences, University of California, San Francisco, Calif, USA. nitacwu@itsa.ucsf.edu
Gorsky
Meir
M
Mayer
Priscilla
P
Bostrom
Alan
A
Epstein
Joel B
JB
Silverman
Sol
S
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
D018721:Muscarinic Agonists; D011812:Quinuclidines; D013876:Thiophenes; D018723:Bethanechol; D010862:Pilocarpine; C059240:cevimeline