dry mouth can be treated with cevimeline or other muscarinics

Xerostomia (dry mouth) occurs in approximately 80% of patients undergoing radiotherapy for head and neck cancer.  Most cases are transient but permanent damage can occur with large radiation doses, especially if no parotid glands are spared (the parotid glands account for >75% of saliva production).  Complications include oral pain, dental carries, oral infections, anorexia, and difficulty talking, chewing, and swallowing.

The treatment of xerostomia is multifaceted and typically includes:

  • Removing medications (if possible) that can worsen xerostomia, such as anticholinergics and antidepressants
  • Nonpharmacologic interventions such as saline rinses, water-soluble mouth lubricants, regular dental care/surveillance, and frequent chewing (eg, sugarless gum) to mechanically stimulate salivation
  • Pharmacologic therapy using cholinergic medications (eg, pilocarpine, cevimeline) that stimulate salivary muscarinic receptors (M3) and increase saliva production; adverse effects include increased parasympathetic activity (eg, sweating, nausea/vomiting, wheezing) and are particularly troublesome with pilocarpine; cholinergic medications can also treat xerostomia in patients with Sjögren syndrome