|
Pharmacologic
interventions
There are
many systemic agents that are capable of increasing salivary output
(Brennan
et al., 2002).
Pilocarpine
HCl
The drug with
the most extensive clinical evidence is pilocarpine HCl. Pilocarpine
is a parasympathomimetic agent with mild beta-adrenergic stimulating
properties. It has been proposed as a treatment for dry mouth
for over 100 years (Wiseman
and Faulds, 1995).
A number of
well-designed and well-controlled studies of substantial size
have examined the affects of pilocarpine on dry mouth and salivary
function in patients with Sjögren's syndrome and post-radiation
salivary gland hypofunction (Vivino
et al., 1999; Johnson
et al., 1993; LeVeque
et al., 1993; Fox
et al., 1991). These clinical trials have consistently demonstrated
that at doses of 5 to 10 mg three or four times daily, pilocarpine
can significantly improve symptoms of dry mouth and increase salivary
output. Salivary secretion is maximally stimulated approximately
one hour after dosing with pilocarpine and increases over baseline
salivary output are found for three to four hours. No tolerance
to the secretogogue effects of pilocarpine has been reported,
nor has long term improvement in baseline salivary function been
found. Increased salivary output is transient, dose-related and
consistent.
Serious adverse
events are rare with pilocarpine. While side effects such as sweating,
flushing, and urinary frequency are common, they are typically
of mild or moderate intensity and of relatively short duration.
Use of pilocarpine is contraindicated in patients with uncontrolled
asthma, narrow-angle glaucoma, or iritis.
|