Salagen


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pilocarpine (oral)†

(pye-loe-kar-peen) ,

Salagen

(trade name)

Classification

Therapeutic: none assigned
Pharmacologic: cholinergics
Pregnancy Category: C
†For ophthalmic use of pilocarpine, see

Indications

Management of xerostomia, which may occur as a consequence of radiation therapy for cancer of the head and neck.Treatment of dry mouth in patients with Sjögren’s syndrome.

Action

Stimulates cholinergic receptors, resulting in primarily muscarinic action, including stimulation of exocrine glands.
Other effects include:
  • Increased sweating, gastric secretions,
  • Increased bronchial secretions,
  • Increased tone and motility of the urinary tract, gallbladder, and biliary duct smooth muscle.

Therapeutic effects

Increased salivary gland secretion.

Pharmacokinetics

Absorption: Well absorbed after oral administration.
Distribution: Unknown.
Metabolism and Excretion: Inactivated at neuronal synapses and in plasma. Some unchanged pilocarpine and metabolites are excreted in urine.
Half-life: After 5-mg dose for 2 days—0.8 hr; after 10-mg dose for 2 days—1.3 hr.

Time/action profile

ROUTEONSETPEAKDURATION
PO20 min1 hr3–5 hr

Contraindications/Precautions

Contraindicated in: Hypersensitivity;Uncontrolled asthma;Angle-closure glaucoma;Iritis.
Use Cautiously in: History of pulmonary disease (asthma, bronchitis, or chronic obstructive pulmonary disease);Biliary tract disease or cholelithiasis;Cardiovascular disease;Retinal disease;Nephrolithiasis;History of psychiatric or cognitive disorders; Obstetric / Lactation / Pediatric: Safety not established.

Adverse Reactions/Side Effects

Central nervous system

  • dizziness
  • headache
  • weakness

Ear, Eye, Nose, Throat

  • amblyopia
  • epistaxis
  • rhinitis

Cardiovascular

  • edema
  • hypertension
  • tachycardia

Gastrointestinal

  • nausea (most frequent)
  • vomiting (most frequent)
  • dyspepsia
  • dysphagia

Genitourinary

  • urinary frequency

Dermatologic

  • flushing (most frequent)
  • sweating (most frequent)

Neurologic

  • tremors

Miscellaneous

  • chills
  • voice change

Interactions

Drug-Drug interaction

Concurrent use of anticholinergics will ↓ the effectiveness of pilocarpine.Concurrent use of bethanechol or ophthalmiccholinergics may result in ↑ cholinergic effects.Concurrent use with beta blockers may ↑ the risk of adverse cardiovascular reactions (conduction disturbances).

Route/Dosage

Head and Neck Cancer Patients
Oral (Adults) 5 mg three times daily initially, then titrated to need/response, usual range 15–30 mg/day (no single should exceed 10 mg).
Patients with Sjögren’s Syndrome
Oral (Adults) 5 mg four times daily.

Availability

Tablets: 5 mg, 7.5 mg

Nursing implications

Nursing assessment

  • Assess oral mucosa for dryness and ulceration periodically during therapy.

Potential Nursing Diagnoses

Impairedoral mucous membrane (Indications)

Implementation

  • Do not confuse Salagen (pilocarpine) with selegiline.
  • Oral: Use lowest dose that is tolerated and effective for maintenance.

Patient/Family Teaching

  • Instruct patient to take medication as directed.
  • Caution patient that pilocarpine may cause visual changes, especially at night; avoid driving or other activities requiring alertness until effects of medication are known.
  • Advise patient to drink adequate daily fluids (1500–2000 mL/day), especially if sweating occurs. Less than adequate fluid intake may lead to dehydration.

Evaluation/Desired Outcomes

  • Increased salivary gland secretion in patients with xerostomia.
  • Decrease in dry mouth in patients with Sjögren’s syndrome. Full effects in cancer patients may not be seen for up to 12 wk or 6 wk in patients with Sjögren’s syndrome.

Salagen®

ENT A pilocarpine used for dry mouth of Sjögren syndrome and RT for head & neck CA. See Pilocarpine.

Salagen

A brand name for PILOCARPINE.