An Investigation into the Use of Pilocarpine as a Sialagogue in Patients With Radiation Induced Xerostomia

Abstract

Background: Radiation therapy to the head and neck region can be an effective form of treatment for malignancies. Unfortunately damage to salivary glands may occur. Treatment of resultant dry mouth is at present very poor. The purpose of this pilot study was to investigate whether pilocarpine dissolved in artificial saliva and administered in a mouth spray would be effective in relieving such symptoms. Methods: Twenty-three patients with radiation induced hyposalivation were recruited for this randomized, double-blind investigation. Subjects were randomly allocated to placebo or control medicaments used for eight weeks. All subjects were evaluated for the severity of their xerostomia associated symptoms prior to administration of the spray and again eight weeks later. Results: The questionnaire and the visual analogue scale did not reveal any improvements in the dry mouth symptoms between cases and controls. Sideeffects were reported among cases, mostly mild and tolerable. All patients taking pilocarpine (with base salivary flow rates > 0ml/min) demonstrated improvement in stimulated and unstimulated salivary flow rates. Candida counts decreased among the cases and controls although decrease among the cases was much greater. Conclusions:The results obtained indicate that provided residual functioning salivary tissue exists, pilocarpine used as formulated is effective and warrants further investigation.

Dose- and Time-Related Effects of Pilocarpine Mouthwash on Salivation

“…Although topical use of pilocarpine as an alternative of systemic administration has been paid attention of dentistry, there are only small Pilocarpine produces the best effects when the dose is titrated to suit individual needs. 7) This study aimed to investigate pilocarpine mouthwash with various conditions concerning different concentrations (placebo, 0.1%, 0.5%, 1.0%, 1.5%, and 2.0%) and duration (1, 3, and 5 minutes) of the mouthwashes and performed the experiments on healthy volunteers prior to test xerostomic patients.…”

“…3) As saliva is difficult to reproduce and as yet an ideal replacement does not exist, 5) salivary stimulants, such as oral pilocarpine have mostly been used to relieve symptoms of oral dryness for patients with xerostomia. Unfortunately its non-specific stimulation of muscarinic receptors 6,7) causes a number of unwanted side effects including nausea, vomiting, epigastric distress, abdominal cramping, diarrhea, bladder tightness, urinary frequency, headache, syncope, sweating, tremor, flushing, hypotension, hypertension, bradycardia and arrhythmia. 8) Due to these adverse side effects, systemic use of pilocarpine may often be restricted in xerostomic patients who are predominantly middle-aged and elderly persons, possibly having 1 and more of systemic diseases.…”

The Stable Nitroxide Tempol Facilitates Salivary Gland Protection during Head and Neck Irradiation in a Mouse Model

“…For example, use of conformal and intensity-modulated radiation can diminish salivary gland damage; however, it is not widely available and is expensive (5,6). The use of sialagogues, such as pilocarpine, to increase salivary output has met with minimal success, as has the use of thiol-based radioprotectants (7,8). Recently, however, Amifostine (WR-2721), 2-[(3-aminopropyl)amino]ethylphosphorothioic acid, an established salivary gland radioprotectant in rats, has been approved for use in the United States for the prevention of xerostomia in head and neck cancer patients undergoing radiotherapy (9 -11).…”

Radioprotection of the murine submandibular gland by isoproterenol: autoradiography study with 3H-leucine

“…2 Reduced saliva secretion can impair oral functions, including mastication and swallowing, and lead to dental caries. [2][3][4][5] These adverse effect of radiotherapy can exacerbate the nutritional status of patients, and, in turn, worsen their prognosis. Hence, it is important to reduce radiation injury to the salivary glands.…”

“…2 Reduced salivary gland function is one result of radiation injury, and reduced secretion of saliva can cause dry mouth; problems with ingestion, mastication, and swallowing; or dental caries, and can exacerbate periodontal disease. [2][3][4][5] Moreover, these complications, particularly difficulties with ingestion, can lead to malnutrition, which further worsens the prognosis of radiotherapy patients.…”