pilocarpine
Pilocarpine (Salagen) is a cholinergic agonist that's used to help certain adults with dry mouth. It's a tablet that's taken by mouth 3 to 4 times per day. Side effects can include sweating, nausea, and runny nose. It's important to tell your provider and pharmacist about your medical history and your other medications because pilocarpine (Salagen) can sometimes worsen certain medical conditions and interact with many different medications.
What is Pilocarpine (Salagen)?
What is Pilocarpine (Salagen) used for?
Dry mouth due to radiation therapy for head and neck cancer
Dry mouth due to Sjögren's syndrome
How Pilocarpine (Salagen) works
Pilocarpine (Salagen) is a cholinergic agonist. It works by attaching to proteins in your salivary glands called acetylcholine receptors. This causes your salivary glands to make more saliva so that your mouth is less dry.
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What are the side effects of Pilocarpine (Salagen)?
Common Side Effects
- Sweating (up to 68%)
- Nausea (up to 15%)
- Chills (up to 15%)
- Runny nose (up to 14%)
- Flushing (up to 13%)
- Frequent urination (up to 12%)
- Weakness (up to 12%)
- Dizziness (up to 12%)
- Sweating (40%)
- Frequent urination (10%)
- Flushing (9%)
- Chills (4%)
Other Side Effects
- Fast heart rate
- Muscle pain
- Itching
- Rash
- Changes in vision
Source: DailyMed
The following side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor as soon as possible if any of the following side effects occur:
Symptoms of overdose
confusion
diarrhea (continuing or severe)
fainting
fast, slow, or irregular heartbeat (continuing or severe)
headache (continuing or severe)
nausea or vomiting (continuing or severe)
shortness of breath or troubled breathing
stomach cramps or pain
tiredness or weakness (continuing or severe)
trembling or shaking (continuing or severe)
trouble seeing (continuing or severe)
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
Chills
feeling of warmth or heat
flushing or redness of skin especially on face and neck
increased need to urinate
indigestion
joint pain
muscle aches and pains
passing urine more often
unusual tiredness or weakness
Sweating
Less common or rare
fast heartbeat
headache
holding more body water
swelling of face, fingers, ankles, or feet
trembling or shaking
trouble swallowing
trouble seeing
unusual weak feeling
voice change
vomiting
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Pros and cons of Pilocarpine (Salagen)
Pros
Works well to help with dry mouth
Can start to work quickly (about 20 minutes)
Available as a lower-cost, generic medication
Cons
Need to take 3 or 4 times a day
Can take several weeks to get the most benefit from the medication
Can have a lot of side effects since the medication can reach and affect many parts of your body
Pharmacist tips for Pilocarpine (Salagen)
You can take pilocarpine (Salagen) with or without food. If the medication upsets your stomach, try taking it with food to help. Lower-fat meals are generally preferred because high-fat meals can affect how well the medication is absorbed into your body.
Swallow pilocarpine (Salagen) tablets whole. Don't crush or chew the tablets.
Pilocarpine (Salagen) can cause blurry vision and make it hard to judge distance and depth, especially when it's dark. Be careful driving at night or working in low light conditions.
It's important to stay well-hydrated while you're taking pilocarpine (Salagen) since the medication can cause sweating and more urination. Drinking lots of fluids helps keep your mouth moist and also prevents dehydration from these side effects. Ask your provider about antiperspirants if sweating is a concern.
Pilocarpine (Salagen) can make you dizzy. Don't drive, operate machinery, or do anything that requires concentration until you know how this medication affects you.
It's okay to use saliva substitutes (like Biotene) with pilocarpine (Salagen), if needed.
Make sure to tell your provider and pharmacist about all the medications you're using before you start pilocarpine (Salagen). And don't start any new medications while you're taking pilocarpine (Salagen) without letting your provider or pharmacist know. Since pilocarpine (Salagen) can interact with other medications, your providers can make sure all your medications are safe to take.
Pilocarpine (Salagen) isn't recommended during pregnancy unless the benefit is greater than the risk. Studies in animals found that pilocarpine (Salagen) can harm unborn babies. While human studies haven't found a link between medication use during the first half of pregnancy and risk of harm to babies, there might be a risk of harm when it's taken near the end of pregnancy. Talk to your provider if you're pregnant or thinking of becoming pregnant.
Frequently asked questions about Pilocarpine (Salagen)
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What are the risks and warnings for Pilocarpine (Salagen)?
Pilocarpine (Salagen) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Possible worsening of medical conditions
Risk factors: Problems with brain function | Mental health problems | Eye or vision problems | Lung problems (e.g., asthma, COPD) | Heart problems (e.g., high blood pressure, heart rate problems) | Gallbladder problems | Liver problems | Kidney problems
Pilocarpine (Salagen) can cause side effects in many parts of your body. These side effects can sometimes make certain medical conditions worse. It's important to tell your provider about all the medical conditions you have or have had in the past before you start pilocarpine (Salagen). Your provider can make sure pilocarpine (Salagen) is safe for you and check for worsening symptoms of these medical conditions during your office visits.
Vision changes
Pilocarpine (Salagen) can cause blurry vision and difficulty judging distance and depth, especially when it's dark. Don't drive or do anything that requires concentration until you know how this medication affects you. Be careful driving at night or working in low light conditions, especially when you first start pilocarpine (Salagen) or when you switch to a higher dose. Let your provider know if you have trouble seeing clearly.
Dose too high
It's possible to have more or worse side effects from taking too much pilocarpine (Salagen). This can lead to various effects, including vision changes, very watery eyes, a lot of sweating, upset stomach, and tremors. Effects can also include headache, difficulty breathing, abnormal blood pressure or heart rhythm, and confusion. Stop taking pilocarpine (Salagen) if you notice any of these side effects. Talk to your provider about taking a lower dose or trying a different medication.
Pilocarpine (Salagen) dosage forms
Typical dosing for Pilocarpine (Salagen)
Dry mouth due to radiation therapy for head and neck cancer: The typical starting dose is 5 mg by mouth three times a day. The maximum amount per dose is 10 mg, and the maximum total daily dose is 30 mg per day.
Dry mouth due to Sjögren's syndrome: The typical dose is 5 mg by mouth four times a day.
Your dose might differ if you have liver problems.
Interactions between Pilocarpine (Salagen) and other drugs
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Tegafur
How much does Pilocarpine (Salagen) cost?
Pilocarpine (Salagen) contraindications
Uncontrolled asthma
When narrowing of the pupil might be harmful, such as when you have eye conditions like acute iritis or narrow-angle (angle closure) glaucoma
What are alternatives to Pilocarpine (Salagen)?
Dry mouth due to radiation therapy for head and neck cancer
Dry mouth due to Sjögren's syndrome
Dry mouth due to Sjögren's syndrome
What is the latest news about Pilocarpine (Salagen)?
Pilocarpine (Salagen) images
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References
Best studies we foundCancer.net. (2020). Dry mouth or xerostomia.
Concordia Pharmaceuticals Inc. (2022). Salagen- pilocarpine hydrochloride tablet, film coated [package insert]. DailyMed.
Gurnani, B., et al. (2023). Iritis. StatPearls.
Haleon. (n.d.). Biotène dry mouth gentle oral rinse.
Harvey, R. D. (2011). Muscarinic receptor agonists and antagonists: Effects on cardiovascular function. Handbook of Experimental Pharmacology.
Methapharm Inc. (2020). Salagen® pilocarpine hydrochloride tablets- cholinomimetic agent.
Panarese, V., et al. (2023). Pilocarpine. StatPearls.
Razeghinejad, M. R. (2018). Glaucoma medications in pregnancy. Oman Journal of Ophthalmology.
Sam, C., et al. (2023). Physiology, acetylcholine. StatPearls.
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