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a cholinergic agonist used as the hydrochloride salt in the treatment of xerostomia associated with Sjögren's syndrome; administered orally.
Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. © 2003 by Saunders, an imprint of Elsevier, Inc. All rights reserved.


(se-vim-e-leen) ,


(trade name)


Therapeutic: xerostomia therapy adjuncts
Pharmacologic: cholinergics
Pregnancy Category: UK


Treatment of the symptoms of dry mouth associated with Sjögren's syndrome.


Direct cholinergic (muscarinic) effects result on increased secretion of exocrine glands including salivary and sweat glands, and increased smooth muscle tone in the gastrointestinal and urinary tracts.

Therapeutic effects

Improved symptoms of dry mouth in patients with Sjögren's syndrome.


Absorption: Rapidly absorbed following oral administration.
Distribution: Extensively bound to tissues.
Metabolism and Excretion: genetic implication Mostly metabolized by the liver (CYP2D6 and CYP3A3/4 isoenzymes) (the CYP2D6 enzyme system exhibits genetic polymorphism; ~7% of population may be poor metabolizers and may have significantly ↑ cevimeline concentrations and an ↑ risk of adverse effects); 16% excreted unchanged in urine.
Half-life: 5 hr.

Time/action profile (blood levels)

POunknown1.5–2 hrunknown


Contraindicated in: Hypersensitivity; When miosis is undesirable (acute iritis, angle-closure glaucoma); Lactation: Discontinue or bottle feed.
Use Cautiously in: Cardiovascular disease including angina pectoris or history of MI; Pulmonary disease including asthma, chronic bronchitis, or chronic obstructive pulmonary disease; Nephrolithiasis or cholelithiasis; Geriatric: May be more sensitive to toxicity; Obstetric: Use only if potential benefit justifies potential risk to the fetus; Pediatric: Safety not established.

Adverse Reactions/Side Effects

Central nervous system

  • coughing

Ear, Eye, Nose, Throat

  • rhinitis (most frequent)
  • visual disturbances


  • nausea (most frequent)
  • diarrhea
  • excessive salivation


  • excessive sweating (most frequent)
  • hot flashes


Drug-Drug interaction

Concurrent beta blocker therapy may ↑ the risk of cardiac conduction disturbances.Additive parasympathetic and muscarinic effects may occur with drugs that have parasympathetic or muscarinic properties.Drugs that inhibit CYP2D6 and CYP3A3/4 liver enzymes may inhibit the metabolism of cevimeline and ↑ its effects and risk of toxicity.St. John's wort may ↑ the metabolism of cevimeline and ↓ its levels.Angel's trumpet, jimson weed, and scopolia may antagonize cholinergic effects.


Oral (Adults) 30 mg 3 times daily.

Availability (generic available)

Capsules: 30 mg

Nursing implications

Nursing assessment

  • Assess patient for dry mouth prior to and periodically during therapy.
  • Lab Test Considerations: May cause ↑ GGT, AST, and ALT.

Potential Nursing Diagnoses

Impairedoral mucous membrane, altered (Indications)
Deficient knowledge, related to medication regimen (Patient/Family Teaching)


  • Oral: Administer 30 mg three times daily.

Patient/Family Teaching

  • Instruct patient to take cevimeline as directed.
  • May cause visual disturbances, especially at night, that could impair ability to drive safely.
  • Advise patient to drink extra water if sweating excessively. May cause dehydration.
  • Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and consult health care professional before taking any new medications.
  • Advise female patients to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

Evaluation/Desired Outcomes

  • Decrease in dry mouth in patients with Sjögren's disease.
Drug Guide, © 2015 Farlex and Partners
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References in periodicals archive ?
M2 EQUITYBITES-June 12, 2014-ACETO announces availibility of generic Evoxac Capsules for treating dry mouth in Sjogren's Syndrome
The company added that the Cevimeline Hydrochloride Capsules, 30 mg strength, is the the generic version of Daiichi Sankyo's Evoxac Capsules.
M2 PHARMA-June 12, 2014-ACETO announces availibility of generic Evoxac Capsules for treating dry mouth in Sjogren's Syndrome
** Pilocarpine (Salagen) and cevimeline (Evoxac) tablets may be used to increase salivary flow.
Medications such as Salagen and Evoxac may improve saliva production, and eyedrops containing cyclosporine A (Restasis) may improve tear production.
Finally, prescription drugs such as pilocarpine hydrochloride (Salagen: MGI Pharma) and cevimaline hydrochloride (Evoxac: Daichii Pharmaceutical) actually stimulate the salivary glands to increase production and may be effective.
Two prescription salivary substitute medications--pilocarpine (Salagen) and cevimeline (Evoxac)--can be an effective adjunct to lifestyle modifications, but many patients are deterred by their side effects, which include flushing, sweating, and headaches.
Lubricating agents: Salagen[R] by prescription (Evoxac's patent is pending), ice water, ice cubes, sugar-free popsicles, salivary substitutes (Oral Balance GaF[R], Moistir[R], UniMist[R], or MouthKote[R], others), sugarless gum and/or lozenges.
Medications such as Salagen and Evoxac may improve saliva production, and Restasis eye drops may improve tear production.