Last updated: November 24, 2014

Trade Names: Evoxac

Drug Class: Cholinergic agent

Preparations: 30-mg capsule

Dose: 30 mg three times daily

Indications: Dry mouth in Sjögren’s syndrome

Mechanism of Action: Stimulates muscarinic receptors to increase saliva production

Contraindications: Hypersensitivity to pilocarpine, iritis, uncontrolled asthma

Precautions: Asthma, GI ulceration, cardiovascular disease, urinary tract obstruction, gallstones

Pregnancy Risk: C

Adverse Effects
Common: Sweating, headache
Less common: Nausea, rash, flushing, tachycardia, dizziness
Rare: Arrhythmia, cytopenias, cholecystitis

Drug Interactions
Beta-blockers: Increased risk of cardiac conduction defects
Anticholinergic drugs: Decreased effect
CYP2D6 inhibitors (quinidine, fluoxetine, paroxetine, and others) and CYP3A inhibitors (erythromycin, azole antifungals, diltiazem, verapamil): Increased levels of cevimeline

Patient Instructions: Expect increased sweating. It make take several weeks for response to occur. It may decrease visual acuity, particularly for night vision.

Clinical Pharmacology: Half-life 5 hours; hepatic metabolism by CYP2D6 and CYP3A4

Cost: $$$

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