Efficacy of Cevimeline vs. Pilocarpine in the Secretion of Saliva

Methods: A randomized, cross-over clinical trial was designed with a 1-week washout period. 15 patients with diagnosis of xerostomia were randomly assigned to take either 5mg of pilocarpine (Salagen TM) or 30mg of cevimeline (Evoxac TM) three times a day for four weeks. After the 1-week washout period, each patient was then given the other medication with the same dosing regimen. Unstimulated and stimulated salivary flow rates were measured during the initial baseline, the first month, and second month appointments. Patients were also given weekly journals to describe and rate their experienced side-effects of the current medication. Statistical analysis was carried out with repeated-measures analysis of variance (ANOVA) and post hoc t-tests, and included all patients randomized into the study. Factors for the repeated-measures ANOVA were drug sequence (pilocarpine/cevimeline or cevimeline/pilocarpine) and baseline saliva.

Results: 12 patients completed both medication treatments and are included in the final analysis. Of the 3 patients who discontinued the study, 2 did so during pilocarpine treatment and 1 did so during cevimeline treatment. Although both medications proved to increase salivary secretion, there was no significant difference between pilocarpine and cevimeline; both provided a similar added benefit. Also, the perceived side-effects between the two medications were similar.

Conclusion: Both pilocarpine and cevimeline helps in improving the secretion of saliva (both unstimulated and stimulated) at the end of four weeks of each treatment. Although there is a slightly higher increment in saliva by pilocarpine, the difference is not statistically significant. Also, there is no statistically significant difference for the various side-effects perceived between pilocarpine and cevimeline.