{"id":821,"date":"2012-07-01T00:00:21","date_gmt":"2012-07-01T07:00:21","guid":{"rendered":"http:\/\/rhochistj.org\/RCP_TEST\/?p=821"},"modified":"2014-02-17T18:52:55","modified_gmt":"2014-02-18T01:52:55","slug":"artificial-saliva-agents-xerostomia","status":"publish","type":"post","link":"https:\/\/rhochistj.org\/RhoChiPost\/artificial-saliva-agents-xerostomia\/","title":{"rendered":"Artificial Saliva Agents in Xerostomia"},"content":{"rendered":"

By: Neal Shah, Co-Editor-in-Chief<\/span><\/p>\n

–<\/p>\n

Xerostomia, commonly known as dry mouth, is an anti-muscarinic side effect of numerous medications. \u00a0Antidepressants, analgesics, diuretics, and antihistamines have a high propensity to cause xerostomia.1<\/sup> \u00a0Xerostomia may also result from Sjogren\u2019s syndrome, Parkinson\u2019s disease, and various chemotherapy agents.2<\/sup> \u00a0Traditionally, muscarinic agonists like pilocarpine have been used to reverse xerostomia. \u00a0Interestingly, angiotensin-converting enzyme-inhibitors (ACEi) are also reported to increase salivary production.3 \u00a0\u00a0<\/sup>There are salivary replacements available via prescription commonly referred to as artificial saliva (i.e. Caphosol\u00ae, NeutraSal\u00ae, Aquoral\u00ae, and Numoisyn\u00ae). \u00a0Over the counter \u00a0artificial saliva products include Biotene\u00ae, which also has antimicrobial properties, and SalivaSure\u00ae, which is a xylitol salivary stimulant.<\/p>\n

Caphosol\u00ae and NeutraSal\u00ae are supersaturated calcium phosphate rinses that are indicated for xerostomia caused by chemotherapy. \u00a0Patients are instructed to mix the different colored Caphosol\u00ae vials together and rinse with half the liquid for one minute, then repeat. \u00a0If swallowed, the manufacturer states there are no adverse effects, nor are there any interactions with other medications.4<\/sup> \u00a0NeutraSal\u00ae is a powder-packet dissolved in a glass of water with similar rinsing directions as Caphosol\u00ae.5<\/sup> \u00a0Aquoral\u00ae is an oral spray consisting of oxidized glyceral triesters that coats the mouth and provides extended lubrication; since it coats the lining of the mouth, this product may also help heal ulcerations. \u00a0Like Caphosol\u00ae, it does not have any side effects if swallowed nor any drug interactions reported by the manufacturer. \u00a0It is dosed as two sprays three or four times a day.6<\/sup> \u00a0Numoisyn\u00ae is a prescription salivary inducing agent, available in both tablet and liquid dosage forms. \u00a0Numoisyn\u00ae tablets primarily consist of mannitol and malic acid designed to stimulate the salivary glands to produce saliva, while the liquid resembles salivary consistency. \u00a0Both preparations are contraindicated in fructose-intolerant patients and can be used up to 16 times per day. \u00a0Like Aquoral\u00ae and Caphosol\u00ae, no drug interactions or adverse effects if swallowed are reported by the manufacturer.7<\/sup><\/p>\n

These salivary replacements provide a benefit compared to pilocarpine. \u00a0Pilocarpine (Salagen\u00ae) tablets taken orally produce systemic muscarinic agonist effects, including sweating, diarrhea, tearing, blurred vision, and excessive urination.8<\/sup> \u00a0These side effects are minimized with the introduction of pilocarpine spray, but this medication is unavailable in the United States. \u00a0For patients who wish to resolve their xerostomia without systemic effects, Caphosol\u00ae, Aquoral\u00ae or Numoisyn\u00ae are attractive, but expensive alternatives. \u00a0A one-month Caphosol\u00ae supply through a discount program and Medicare costs about $128, which may be too costly for some patients.9<\/sup> \u00a0Aquoral\u00ae, if not covered by insurance, can cost $110 for a 40mL bottle. \u00a0A 100-count of Numoisyn\u00ae lozenges can cost up to $40; and a 300 mL bottle of Numoisyn\u00ae can cost up to $65. \u00a0Artificial saliva agents thus have significant advantages and disadvantages to consider when choosing a treatment regimen for xerostomia.<\/p>\n

SOURCES:<\/strong><\/span><\/p>\n

    \n
  1. Xerostomia (Dry Mouth). Available at: http:\/\/www.uic.edu\/classes\/peri\/peri343\/xerost\/xerost1.htm<\/a>. Accessed June 24, 2012.<\/li>\n
  2. Dry Mouth (Xerostomia). Available at: http:\/\/www.nidcr.nih.gov\/oralhealth\/topics\/drymouth\/<\/a>. Accessed June 24, 2012.<\/li>\n
  3. Bossola M, Tazza L. Xerostomia in patients on chronic hemodialysis. Nat Rev Nephrol. 2012 Jan 17;8(3):176-82. doi: 10.1038\/nrneph.2011.218.<\/li>\n
  4. Caphosol [package insert]. \u00a0EUSA Pharma.<\/li>\n
  5. Neutrasal [package insert]. Available at: http:\/\/www.neutrasal.com\/<\/a>. Accessed June 24, 2012.<\/li>\n
  6. Aquoral [package insert]. Auriga Labororatories.<\/li>\n
  7. Numoisyn [package insert]. ALIGN Pharmaceuticals, LLC.<\/li>\n
  8. Pilocarpine. Available at: http:\/\/www.ncbi.nlm.nih.gov\/pubmedhealth\/PMH0000465\/<\/a>. Accessed June 24, 2012.<\/li>\n
  9. Caphosol \u00a0Exclusive Medicaid Offer. Available at: http:\/\/live.caphosol.com\/us\/PAT\/Medicare-Offer.aspx<\/a>. Accessed June 24, 2012.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

    By: Neal Shah, Co-Editor-in-Chief – Xerostomia, commonly known as dry mouth, is an anti-muscarinic side effect of numerous medications. \u00a0Antidepressants, analgesics, diuretics, and antihistamines have a high propensity to cause xerostomia.1 \u00a0Xerostomia may also result from Sjogren\u2019s syndrome, Parkinson\u2019s disease, and various chemotherapy agents.2 \u00a0Traditionally, muscarinic agonists like pilocarpine have been used to reverse xerostomia.…<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[7,4],"tags":[668,1825,343,61,15,13,2227,29,446,314,96,1763,14,1462,363,968,1625,657,737,378,187,507,149,236,321,16,1061],"class_list":["post-821","post","type-post","status-publish","format-standard","hentry","category-clinical","category-featured","tag-acid","tag-agents","tag-and","tag-calcium","tag-disease","tag-drug","tag-ebola-virus-disease","tag-editor","tag-extended","tag-for","tag-june","tag-live","tag-medication","tag-mix","tag-of","tag-one","tag-or","tag-oral","tag-phosphate","tag-powder","tag-side","tag-spray","tag-syndrome","tag-tablet","tag-tablets","tag-treatment","tag-with"],"views":2421,"_links":{"self":[{"href":"https:\/\/rhochistj.org\/RhoChiPost\/wp-json\/wp\/v2\/posts\/821","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/rhochistj.org\/RhoChiPost\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/rhochistj.org\/RhoChiPost\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/rhochistj.org\/RhoChiPost\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/rhochistj.org\/RhoChiPost\/wp-json\/wp\/v2\/comments?post=821"}],"version-history":[{"count":0,"href":"https:\/\/rhochistj.org\/RhoChiPost\/wp-json\/wp\/v2\/posts\/821\/revisions"}],"wp:attachment":[{"href":"https:\/\/rhochistj.org\/RhoChiPost\/wp-json\/wp\/v2\/media?parent=821"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/rhochistj.org\/RhoChiPost\/wp-json\/wp\/v2\/categories?post=821"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/rhochistj.org\/RhoChiPost\/wp-json\/wp\/v2\/tags?post=821"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}