Oral Pilocarpine for Post-Irradiation Xerostomia in Patients with Head and Neck Cancer

Johnson, Jonas T.; Ferretti, Gerald A.; Nethery, William; Valdez, Ingrid H.; Fox, Philip C.; Ng, Dominic C. M.; Muscoplat, Charles C; Gallagher, Susan C.

doi:10.1056/nejm199308053290603

Cited by 446 publications

(282 citation statements)

References 19 publications

Supporting

Mentioning

267

Contrasting

Unclassified

Order By: Relevance

“…Similar levels of salivary increase have been previously reported in other groups of patients following head and neck irradiation and in patients suffering from Sjögren's syndrome. [19][20][21]23,24 It is noteworthy that we found a similar response to the medication under both resting and stimulated conditions, and for both major salivary glands and whole saliva. Similarly, under resting and stimulated conditions, whole saliva, parotid and SM/SL flow rates increased by 284%, 230% and 200%, and by 242%, 268% and 248%, respectively (P Ͻ 0.01).…”

Section: Discussionsupporting

confidence: 70%

“…This extensive response may be attributed to the high dose of pilocarpine hydrochloride administered, the maximal dose recommended in both animal and human studies. [17][18][19][20][21]25,26 Within 2 weeks of drug administration, the subjective xerostomic score was altered to normal. Similar levels of salivary increase have been previously reported in other groups of patients following head and neck irradiation and in patients suffering from Sjögren's syndrome.…”

Section: Discussionmentioning

confidence: 99%

“…[16][17][18] Some encouraging studies published in recent years have demonstrated the efficacy of oral pilocarpine hydrochloride in partially relieving xerostomia in post-head and neck radiotherapy patients. [19][20][21][22][23][24][25][26][27][28][29] Therefore, we investigated the efficacy of pilocarpine hydrochloride on xerostomia in cGVHD patients. The effect was evaluated by both objective parameters, including sialometric studies, measuring whole saliva and parotid and submandibular flow rates at both resting and stimulated conditions, and by subjective parameters.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Pilocarpine hydrochloride relieves xerostomia in chronic graft-versus-host disease: a sialometrical study

Nagler

1999

Bone Marrow Transplant

View full text Add to dashboard Cite

Summary:Bone marrow transplantation is considered to be the treatment of choice for various hematological and solid malignancies, as well as for bone marrow failure syndromes and some genetic diseases. Unfortunately, a great number of patients who receive allogeneic BMT suffer from graft-versus-host disease (GVHD) following the procedure. Xerostomia is considered to be one of the most annoying complications of chronic GVHD (cGVHD), and the rapidly growing number of BMT patients with prolonged survival renders GVHD-related xerostomia a major clinical problem. As pilocarpine hydrochloride has been shown to relieve xerostomia in other disease categories, we administered pilocarpine hydrochloride 30 mg/day to six cGVHD patients and measured their whole saliva, parotid and submandibular-sublingual flow rates in both resting and stimulated conditions. Mean values of flow rates of whole saliva in resting conditions at 2 weeks, 2 months and 6 months following administration of pilocarpine hydrochloride 30 mg/day were 0.71 ؎ 0.12 ml/min, 0.59 ؎ 0.07 ml/min and 0.56 ؎ 0.11 ml/min, respectively. In stimulated conditions, mean values were 1.7 ؎ 0.3 ml/min, 1.0 ؎ 0.17 ml/min and 0.94 ؎ 0.21 ml/min, respectively. The mean values of whole saliva flow rates under both conditions represented an increase of 224-284% and 134-247%, respectively (P Ͻ 0.01). The pattern and magnitude of parotid and submandibular-sublingual flow rate increases following pilocarpine hydrochloride administration were similar. Patients were followed for 6 months and demonstrated increased levels of secretion, with some reduction after the initial peak values. The medication was discontinued at 2 months and reinstated after 2 weeks in three patients. This resulted in rapid flow rate reduction followed by another profound increase. Contrary to the sialometrical analysis, the subjective scoring showed no fluctuations during the study period. We discuss these results in the context of the clinical experience of xerostomic patients in whom even a minute increase in secretion may be significant. Our results demonstrate that objective and subjective relief from xerostomia in cGVHD patients can be achieved with the routine oral administration of pilocarpine hydrochloride.

show abstract

Section: Discussionsupporting

confidence: 70%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Pilocarpine hydrochloride relieves xerostomia in chronic graft-versus-host disease: a sialometrical study

Nagler

1999

Bone Marrow Transplant

View full text Add to dashboard Cite

show abstract

“…Two placebo-controlled double-blind trials have shown the value of this alkaloid (Johnson et al, 1993;LeVeque et al, 1993). Both multicentre studies were similar in design and contained 207 and 162 patients respectively.…”

Section: Pilocarpinementioning

confidence: 99%

Treatment-induced mucositis: an old problem with new remedies

Symonds

1998

Br J Cancer

View full text Add to dashboard Cite

Summary Mucositis may be a painful, debilitating, dose-limiting side-effect of both chemotherapy and radiotherapy for which there is no widely accepted prophylaxis or effective treatment. The basis of management is pain relief, prevention of dehydration and adequate nutrition. When tested vigorously, most antiseptic mouthwashes and anti-ulcer agents are ineffective. Simple mechanical cleansing by saline is the most effective traditional measure. A variety of new agents are effective. Granulocyte macrophage colony-stimulating factor (GM-CSF) and granulocyte colony-stimulating factor (G-CSF) act outwith the haemopoeitic system and can reduce mucositis, but the best schedule, dosage and method of administration is not known or which is the best growth factor to prevent this side-effect. A placebo-controlled randomized trial of antibiotic pastilles has shown a significant reduction in mucositis and weight loss during radiotherapy for head and neck cancer. Another method to reduce radiation effects in normal tissue is to stimulate cells to divide before radiotherapy by silver nitrate or interleukin 1. These methods may be particularly effective when given along with hyperfractionated radiation treatment such as CHART.

show abstract

“…Achamos que o principal objetivo deste exame é justamente a comparação entre os resultados pré-e pós-tratamento. Pequenos aumentos da salivação costumam beneficiar substancialmente os pacientes que produziam pouca ou nenhuma saliva, enquanto aumento equivalente em pacientes com maior fluxo salivar pode não desencadear qualquer melhora 26 . Preconizamos também a realização da sialometrias previamente e após procedimentos/ tratamentos que conhecidamente promovem a hipossalivação (ex.…”

Section: Discussionunclassified

Proposta de um método prático de sialometria

Pupo

Liquidato

et al. 2002

Rev. Bras. Otorrinolaringol.

View full text Add to dashboard Cite

A proposal for a practical method of sialometry Resumo / SummaryIntrodução: A xerostomia é uma queixa subjetiva que pode ou não estar relacionada à diminuição da salivação. Deve, porém, ser sempre investigada, pois está freqüentemente associada a doenças sistêmicas, incluindo a síndrome de Sjögren. Apesar de não haver padrão universal que caracterize a hipossalivação, consideramos a sialometria importante para avaliação do tratamento, através da realização de exames seriados em um mesmo paciente. Analisando as técnicas de sialometria já descritas, optamos por adaptar e padronizar o método de Bolwig e Rafaelsen (1972) por considerá-lo o mais prático e fidedigno e visando à partir de então a sua utilização em larga escala. Objetivo: Avaliar os resultados de método submúltiplo de sialometria. Material e método: Foram avaliados 10 sujeitos, 5 sem sintomatologia de xerostomia que formam considerados compatíveis e 5 com xerostomia. Foram submetidos ao método de sialometria com algodão pré e pós estimulados. Os resultados foram comprovados. Resultados: Todos os pacientes apresentaram melhora da saliva mensurável pelo método pós-estimulado. Conclusões: O método utilizado se mostrou de fácil realização e fidedigno.

show abstract

Oral Pilocarpine for Post-Irradiation Xerostomia in Patients with Head and Neck Cancer

Abstract: Pilocarpine improved saliva production and relieved symptoms of xerostomia after irradiation for cancer of the head and neck, with minor side effects that were predominantly limited to sweating.

Cited by 446 publications

References 19 publications

Pilocarpine hydrochloride relieves xerostomia in chronic graft-versus-host disease: a sialometrical study

Pilocarpine hydrochloride relieves xerostomia in chronic graft-versus-host disease: a sialometrical study

Treatment-induced mucositis: an old problem with new remedies

Proposta de um método prático de sialometria

Contact Info

Product

Resources

About