cevimelina

Cevimelina, also spelled cevimeline in some languages, is a muscarinic receptor agonist used to treat xerostomia (dry mouth), particularly in people with Sjögren's syndrome. It is taken by mouth and is available in hydrochloride form under brand names such as Evoxac. It is prescribed to improve salivary and, to a lesser extent, lacrimal gland secretion to relieve oral and ocular dryness.

Mechanism of action: Cevimeline is a parasympathomimetic agent with activity at muscarinic acetylcholine receptors, especially M3 receptors on exocrine glands. Activation of these receptors stimulates secretion from salivary and lacrimal glands, increasing saliva and tear production and thereby reducing subjective dryness.

Administration and dosing: The usual starting regimen is 30 mg taken three times daily with meals. If saliva production remains insufficient and tolerability is good, the dose may be increased to 45 mg three times daily, with the daily total generally not exceeding about 135 mg. Dosing is individualized and should be adjusted by a clinician based on response and side effects.

Adverse effects and safety: Common cholinergic side effects include increased sweating, salivation, flushing, nausea, abdominal cramps, diarrhea, and blurred vision due to pupil constriction. Less frequent effects can include bronchospasm or wheezing in susceptible individuals. Cevimeline should be used with caution in people with asthma or COPD, peptic ulcer disease, urinary retention, or significant liver or kidney impairment. It is contraindicated in individuals with known hypersensitivity to the drug and in certain ocular or systemic conditions; pregnancy and breastfeeding require medical advice.

Interactions: Cevimeline can interact with other cholinergic or anticholinergic medications, potentially altering its effectiveness or side-effect profile. Patients should inform their clinician of all medicines they use.