Pilocarpine is administered orally in 5-10-mg doses given three times daily for the treatment of xerostomia that follows head and neck radiation treatments or that is associated with Sjogren's syndrome, an autoimmune disorder occurring primarily in women in whom secretions, particularly salivary and lacrimal, are compromised. Side effects typify cholinergic stimulation, with sweating being the most common complaint. Bethanechol is an oral alternative that produces less diaphoresis. Cevimeline (evoxac) has activity at M3 muscarinic receptors, such as those on lacrimal and salivary gland epithelia. Cevimeline has a long-lasting sialogogic action and may have fewer side effects than pilocarpine. Cevimeline also enhances lacrimal secretions in Sjogren's syndrome.
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