Treatment of radiation side effects with oral pilocarpine

Schuller, David E.; Stevens, Philip; Clausen, Kathryn P.; Olsen, John O.; Gahbauer, R.; Martin, Melanie R.

doi:10.1002/jso.2930420414

Cited by 60 publications

(35 citation statements)

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“…Evidence indicates that pilocarpine also stimulates the production of mucin and of several other salivary constituents. 18,19) Even a small increase in salivary flow may induce symptomatic improvement for xerostomic patients. 16,18,20) However, due to increased risk for adverse side effects, systemic pilocarpine has limitation to prescribe in the xerostomic patients, predominantly middle-aged and elderly persons who may have greater opportunities of systemic diseases and taking polypharmacy.…”

Section: Discussionmentioning

confidence: 99%

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

Song¹,

Park²,

Kim³

et al. 2017

Journal of Oral Medicine and Pain

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Purpose: Pilocarpine as a salivation stimulant in pill form has mostly been used to relieve oral dryness for xerostomic patients but its use may often be limited due to variable side effects from systemic absorption. Therefore, the purpose of this study was to investigate the effects of pilocarpine mouthwash on salivation according to the variable concentration and duration for healthy volunteers. Related adverse effects and subjective assessment on its effects on salivation were also examined. Methods:This study was performed as placebo-controlled, double-blind, randomized clinical trial. Thirty healthy volunteers (male=23, mean age=22.2 years) were randomly allocated to 6 groups with the different concentration of pilocarpine mouthwash (placebo, 0.1%, 0.5%, 1.0%, 1.5%, and 2.0%). The whole experiment consisted of 3 sessions according to the duration of mouthwash, i.e., 1, 3, and 5 minutes with the mean wash-out period ≥2 days between the sessions. Unstimulated whole saliva was collected before and after gargling with a mouthwash.Results: Salivation of the higher concentration groups ≥1% significantly increased than those of lower concentration group. The application period of mouthwash did not cause any changes of salivary flow rate at the higher concentrations ≥1.0%. The lower concentrations of 0.5% and 0.1% had no effects on salivation even after 5-minute mouthwash. There was no significant difference between blood pressure and pulse rate before and after use of mouthwash. Conclusions:From the results of the current study, pilocarpine mouthwash with at least 1.0% concentration more than a minute might be clinically effective in salivation without any serious side effects. Dose of mouthwash rather than duration seems to be a critical factor to salivation.

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Section: Discussionmentioning

confidence: 99%

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

Song¹,

Park²,

Kim³

et al. 2017

Journal of Oral Medicine and Pain

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“…The parasympathetic action of pilocarpine induces water and electrolyte flow in saliva. There is evidence that pilocarpine also stimulates the production of mucin and of several other salivary constituents (4,19,(27)(28)(29). Mucins are important to prevent infections and chemical or mechanical traumas to oral structures.…”

Section: Discussionmentioning

confidence: 99%

Effect of pilocarpine mouthwash on salivary flow

Bernardi

Perin

Becker

et al. 2002

Braz J Med Biol Res

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Pilocarpine is a cholinergic agonist that increases salivary flow and has been used to treat xerostomia. Oral intake is the most frequent route of administration. Adverse effects are dose-dependent and include sudoresis, facial blushing and increased urinary frequency. The objective of the present study was to evaluate the effects of topical pilocarpine solutions as mouthwashes on salivary flow and their adverse effects on healthy subjects. Forty volunteers received 10 ml 0.5, 1 and 2% pilocarpine solutions or 0.9% saline in a randomized, double-blind, placebo-controlled manner. Salivation was measured before and 45, 60 and 75 min after mouth rinsing for 1 min with 10 ml of saline or pilocarpine solutions. Vital signs were measured and ocular, gastrointestinal and cardiovascular symptoms, anxiety and flushing were estimated using visual analog scales. There was a dosedependent increase in salivation. Salivation measured after 1 and 2% pilocarpine (1.4 ± 0.36 and 2.22 ± 0.42 g, respectively) was significantly (P<0.001) higher than before (0.70 ± 0.15 and 0.64 ± 0.1 g), with a plateau between 45 and 75 min. Cardiovascular, visual, gastrointestinal and behavioral symptoms and signs were not changed by topical pilocarpine. Mouth rinsing with pilocarpine solutions at concentrations of 1 to 2% induced a significant objective and subjective dose-dependent increase in salivary flow, similar to the results reported by others studying the effect of oral 5 mg pilocarpine. The present study revealed the efficacy of pilocarpine mouthwash solutions in increasing salivary flow in healthy volunteers, with no adverse effects. Additional studies on patients with xerostomia are needed.

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“…Die Sialometrie ist das am häufigsten in Therapiestudien zur Xerostomie gewählte Zielkriterium [10,13,17,24] und wird oft zur Beurteilung der Speicheldrüsenrestfunktion nach Bestrahlung herangezogen [15,22,26]. Die in der Literatur beschriebene drastische Verminderung der Flußraten während und kurz nach Bestrahlung [26] wurde durch die vorliegende Studie bestätigt.…”

Section: Sialometrieunclassified

“…Die in der Literatur beschriebene drastische Verminderung der Flußraten während und kurz nach Bestrahlung [26] wurde durch die vorliegende Studie bestätigt. In Therapiestudien werden sialometrisch dagegen meist späte Strahlenfolgen nach spontaner Erholung des Drüsenparenchyms gemessen [10,13,17,24]. Die Flußraten im Zeitfenster der frühen Strahlenfolgen [25] fallen offensichtlich in einen nicht mehr meßbaren Bereich, so daß aus methodischen Gründen keine Diskriminierung mehr zwischen Verum und Plazebo möglich ist.…”

Section: Sialometrieunclassified

“…Ein irreversibler Funktionsverlust der Speicheldrüsen manifestiert sich ab Herddosen von über 40 Gy, und die Restfunktion nach tumortherapeutischer Bestrahlung liegt bei 5 bis 15% [15,26]. Etablierte Therapieansätze umfassen die Anwendung von Speichelersatzmitteln [20] oder Speicheldrüsenstimulanzien [10,13,17,24]. Die vielfäl-tigen Funktionen des Speichels für die physiologische Mundhöhlenökologie [6] können von Speichelersatzmitteln nicht kompensiert werden.…”

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Prospektive, doppelblinde Therapiestudie zur Prophylaxe der Radioxerostomie durch Cumarin/Troxerutin bei Patienten mit Kopf-Hals-Karzinomen

Grötz

Zepelin

Kohnen³

et al. 1999

Strahlentherapie und Onkologie

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The results give support for an advantageous effect of Venalot Depot in the treatment of radiogenic sialadenitis and mucositis. In even a small number of evaluable patients, early clinical effects of irradiation (RTOG-score) were less pronounced in the active treatment group than in the placebo group, but the sample size was too low to prove statistically also the benefit of coumarin/troxerutine with the scintigraphic method. Sialometry seems not suitable for the assessment of early radiation effects.

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Treatment of radiation side effects with oral pilocarpine

Cited by 60 publications

References 1 publication

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

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

Effect of pilocarpine mouthwash on salivary flow

Prospektive, doppelblinde Therapiestudie zur Prophylaxe der Radioxerostomie durch Cumarin/Troxerutin bei Patienten mit Kopf-Hals-Karzinomen

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