cevimeline

Cevimeline is a synthetic parasympathomimetic agent used to treat xerostomia (dry mouth) in adults with Sjögren's syndrome. It is an oral muscarinic receptor agonist that increases the secretory activity of exocrine glands, particularly the salivary and lacrimal glands. It is sold under the brand name Evoxac and is available by prescription.

The mechanism of action involves selective stimulation of M3 muscarinic receptors on salivary and other exocrine glands, which enhances saliva and tear production. This cholinergic effect can help alleviate symptoms of dryness and improve oral comfort and swallowing.

Indications and dosing: Cevimeline is indicated for relief of xerostomia due to Sjögren's syndrome in adults. The usual dose is 30 mg taken three times daily after meals (approximately 90 mg per day), with dose adjustments made by a clinician based on tolerance and response. The drug should be continued only as long as benefit is demonstrated and under medical supervision. Cevimeline is contraindicated in certain conditions (see below) and requires medical assessment before use.

Contraindications and cautions: It should not be used in individuals with uncontrolled asthma or COPD, narrow-angle glaucoma, urinary or gastrointestinal tract obstruction, or active peptic ulcers. It is also contraindicated in hypersensitivity to cevimeline. Caution is advised in pregnancy, in patients with significant cardiovascular disease, and when combined with other cholinergic medications or anticholinergic drugs, as interactions can alter efficacy and safety.

Adverse effects and interactions: Common adverse effects include sweating, excessive salivation, flushing, nausea, abdominal cramps, diarrhea, and rhinitis. Bronchospasm can occur in susceptible individuals. Cevimeline effects may be enhanced by other cholinergic agents and reduced by anticholinergic drugs. Careful monitoring is advised in patients with cardiovascular or respiratory conditions.