Assessment of the use of sialogogues in the clinical management of patients with xerostomia

Authors

  • Nita Chainani-Wu DMD, MS, PhD,

    Corresponding author
    1. Health Science Assistant Clinical Professor, Department of Orofacial Sciences, University of California, San Francisco, Calif
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  • Meir Gorsky DMD,

    1. Professor of Oral Medicine, School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
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  • Priscilla Mayer MS, MT (ASCP),

    1. Clinical Laboratory Technologist, Department of Orofacial Sciences, University of California, San Francisco, Calif
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  • Alan Bostrom PHD,

    1. Specialist, Department of Epidemiology and Biostatistics, University of California, San Francisco, Calif
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  • Joel B. Epstein DMD, MSD, FRCDCC),

    1. Medical-Dental Staff, British Columbia Cancer Agency and Vancouver Hospital and Health Sciences Center, Vancouver BC, Canada, and Professor, Department of Oral Medicine and Diagnostic Sciences, and Director of the Interdisciplinary Program in Oral Cancer, University of Illinois, Chicago
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  • Sol Silverman Jr. MA, DDS

    1. Professor of Oral Medicine, Department of Orofacial Sciences, University of California, San Francisco, Calif
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*nitacwu@itsa.ucsf.edu

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.

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