engleski

Absence of Long term Effects of Pilocarpine in Patients with Xerostomia

Pilocarpine, a muscarinic cholinergic agonist, has been shown to improve symptoms of oral drynes and to increase salivary output in patients with xerostomia. The aim of this study was to assess and compare the short-term and long-term effects of orally administered pilocarpine-hydrochloride (PHC) on minor salivary glands and whole saliva production in patients with decreased salivary flow. Eighteen patients with xerostomia (12 with drug-induced xerostomia, 6 with diagnosed Sjögren's syndrome) were included in two consecutive single blind placebo controlled experiments. Experiment 1 comprised 7 repeated labial and palatal minor salivary glands flow measurements (in time intervals of 15-30 min.) and 5 repeated measurements of whole saliva (every 30 min.), from the baseline up to 2 h after single oral administration of 5 mg of PHC. Experiment 2 was designed to evaluate a possible presence of long-term effect of PHC on salivary flow rate. In this experiment, patients were instructed to take 5 mg of PHC, 3 times a day for 5 weeks. Minor salivary gland measurements were performed on weekly basis and whole saliva was measured on the baseline and at the end of 5-weeks treatment. In both experiments the flow rate of minor salivary glands was measured on lower lip and palate by means of Periotron&#8482; 8000 and whole saliva was collected in calibrated test tubes. Dexpanthenol drops were used as placebo. Immediate (short term) effect of pilocarpine on minor salivary glands and on whole saliva production was compared with its effects after prolonged administration on the same group of subjects with xerostomia. Experiment 1 showed that PHC increased salivary output in every patient. The differences were statistically significant, both compared to baseline and to placebo controls (p<0, 05). After increasing salivary flow rate, the action of PHC decreased with time, which was recorded during the observation session. Results of experiment 2 showed that orally administered PHC does not produce long-term increase of salivary flow rate. Conclusion: The treatment with PHC is effectively supportive, but not curative because there is no residual effect in salivary gland stimulation once the drug is discontinued and eliminated.

pilocarpine; xerostomia; periotron; Sjogren's syndrome

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