Efficacy and safety of pilocarpine for radiation-induced xerostomia in patients with head and neck cancer

Cheng, Caiqi; Xu, Hao; Liu, Ling; Wang, Ruinan; Liu, Yuting; Li, Jing; Zhou, Xikun

doi:10.1016/j.adaj.2015.09.014

Cited by 39 publications

(34 citation statements)

References 24 publications

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“…However, prior studies have shown that there is a gap between the objective measures of salivary flow and the patients’ subjective reports of xerostomia, with the objective response being greater than the subjective response . The feeling of wetness may be influenced by factors other than the flow from the major salivary glands, and might reflect the functioning of the minor salivary glands, such as those close to the oral cavity during head and neck irradiation …”

Section: Discussionmentioning

confidence: 99%

“…Pilocarpine impels M1 and M3 receptors, producing stimulation of exocrine glands in humans, which produces diaphoresis, salivation, lacrimation, and gastric and pancreatic secretion. Pilocarpine is an alkaloid found in the leaves of two of the jaborandi plants, namely Pilocarpus microphyllus and Pilocarpus jaborandi . Many studies have demonstrated the utility of pilocarpine for the treatment of xerostomia secondary to radiation therapy, SS, or graft‐versus‐host disease and for opioid‐induced oral dryness .…”

mentioning

confidence: 99%

“…The usual recommended dosage is 2·5–10 mg administered orally three or four times daily. The sialogenic effect is observed 30 min after intake and pilocarpine has a terminal half‐life of 9 h . Mouth rinsing with pilocarpine solutions at concentrations of 1–2% has been demonstrated to induce a significant objective and subjective dose‐dependent increase in salivary flow …”

mentioning

confidence: 99%

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Pilocarpine and artificial saliva for the treatment of xerostomia and xerophthalmia in Sjögren syndrome: a double-blind randomized controlled trial

2018

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Pilocarpine and artificial saliva for the treatment of xerostomia and xerophthalmia in Sjögren syndrome: a double-blind randomized controlled trial

2018

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“…Subcutaneous amifostine was thought to be more convenient and less toxic, but efficacy and patient compliance have been no better when compared with intravenous use [24]. Pilocarpine and bethanechol both have muscarinic side effects, including sweating, nausea, dizziness, urinary frequency, and asthenia [25]. Other treatments such as acupuncture, electrical nerve stimulation, hyperbaric oxygen therapy, salivary substitutes, or salivary stimulants such as chewing gum, ascorbic acid (vitamin C), and malic acid might also be useful, but the effects are controversial [26–28].…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Traditional Chinese Medicine in Xerostomia and Quality of Life during Radiotherapy for Head and Neck Cancer: A Prospective Pilot Study

Hsu

Yang

Tsang

et al. 2016

Evidence-Based Complementary and Alternative Medicine

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Xerostomia is one of the most common acute and late complications of radiotherapy for head and neck cancer, and it affects quality of life. We conducted a prospective study to evaluate the efficacy of traditional Chinese medicine (TCM) in toxicities and quality of life during radiotherapy. Head and neck cancer patients who were scheduled for radiotherapy were checked for inclusion/exclusion criteria before enrollment. Patients in the study group (inpatients) were hospitalized in a Chinese medicine ward and received concomitant TCM intervention during radiotherapy, while those in the control group (outpatients) received only conventional cancer treatments at the Western outpatient department. The primary end point was amelioration of postradiotherapy side effects. The secondary end points were quality of life during the cancer therapy and occurrence of adverse events following the TCM treatments. Thirty inpatients and 50 outpatients completed the study. Compared to the control group, those in the TCM group had decreased severity of xerostomia. There was no treatment-related impairment of renal or hepatic function among TCM group. Although better outcomes of social contact, dyspnea, physical and emotional function, and financial problems were found in the TCM group, we need further confirmation about the impact of hospitalization itself on these results.

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“…In post-RT patients who have already developed xerostomia, the use of pilocarpine can also be recommended for the improvement of xerostomia [30] (Table 1). According to the results of two randomized placebo-controlled trials, approximately 50% of treated patients will benefit from reactive use of oral pilocarpine; yet, in placebo groups the response rates were in the range of 25% [31,32].…”

Section: Xerostomiamentioning

confidence: 99%

Treatment of late sequelae after radiotherapy for head and neck cancer

Strojan

Hutcheson

Eisbruch

et al. 2017

Cancer Treatment Reviews

242

171

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Radiotherapy (RT) is used to treat approximately 80% of patients with cancer of the head and neck. Despite enormous advances in RT planning and delivery, a significant number of patients will experience radiation-associated toxicities, especially those treated with concurrent systemic agents. Many effective management options are available for acute RT-associated toxicities, but treatment options are much more limited and of variable benefit among patients who develop late sequelae after RT. The adverse impact of developing late tissue damage in irradiated patients may range from bothersome symptoms that negatively affect their quality of life to severe life-threatening complications. In the region of the head and neck, among the most problematic late effects are impaired function of the salivary glands and swallowing apparatus. Other tissues and structures in the region may be at risk, depending mainly on the location of the irradiated tumor relative to the mandible and hearing apparatus. Here, we review the available evidence on the use of different therapeutic strategies to alleviate common late sequelae of RT in head and neck cancer patients, with a focus on the critical assessment of the treatment options for xerostomia, dysphagia, mandibular osteoradionecrosis, trismus, and hearing loss.

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Efficacy and safety of pilocarpine for radiation-induced xerostomia in patients with head and neck cancer

Cited by 39 publications

References 24 publications

Pilocarpine and artificial saliva for the treatment of xerostomia and xerophthalmia in Sjögren syndrome: a double-blind randomized controlled trial

Pilocarpine and artificial saliva for the treatment of xerostomia and xerophthalmia in Sjögren syndrome: a double-blind randomized controlled trial

Efficacy of Traditional Chinese Medicine in Xerostomia and Quality of Life during Radiotherapy for Head and Neck Cancer: A Prospective Pilot Study

Treatment of late sequelae after radiotherapy for head and neck cancer

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