A patient with Sjögren syndrome is prescribed CEVIMELINE. What is its expected effect?

Correct answer: A. Increased salivary secretion

• A. CORRECT. CEVIMELINE is a MUSCARINIC (M1/M3) receptor AGONIST — a cholinergic sialogogue. Stimulating M3 receptors on salivary acinar cells increases secretion, so it raises salivary flow in patients with residual functioning gland tissue. It is approved for xerostomia in Sjögren syndrome, as is PILOCARPINE.
• B. Decreased salivation would be the effect of an ANTImuscarinic (anticholinergic) drug such as atropine, glycopyrrolate, or the many antihistamines, tricyclics and antipsychotics that cause drug-induced dry mouth.
• C. It genuinely increases FLOW; it is not merely a buffering agent.
• D. Cevimeline has no direct anti-inflammatory action on the gingiva. Any periodontal benefit is indirect, through improved salivary clearance.

Note: Predictable cholinergic side effects: sweating, nausea, flushing, increased urinary frequency and visual disturbance. Contraindicated in uncontrolled ASTHMA, narrow-angle GLAUCOMA and acute IRITIS. It only works where secretory tissue survives — in end-stage glandular destruction, saliva substitutes and meticulous caries prevention are the mainstay.