Cevimeline

Cevimeline Brand Name– Evoxac

What is Cevimeline

Cevimeline is a quinuclidine derivative of acetylcholine and acts as a cholinergic agonist.

Cevimeline improves the symptoms of dry mouth (xerostomia) in patients with Sjogren’s syndrome.

Prior to the approval of cevimeline, pilocarpine was the only other agent approved for this indication; however, significant advantages of cevimeline over pilocarpine have yet to be determined.

In studies comparing cevimeline at various dosages per day, there was no difference between the 180 mg/day and 90 mg/day dosages; however, the 90 mg/day dosage was preferred by patients over the 45 mg/day dosage. An increase in salivary flow was reported at all dosages.

Animal studies suggest potential usefulness of cevimeline in patients with xerostomia secondary to radiation therapy of the head or neck area.

As a cholinergic agonist, cevimeline is in Phase III trials to study its usefulness as an adjunct in the treatment of Alzheimer’s disease.

The FDA approved cevimeline in January 2000.

Indications

• xerostomia

For the treatment of xerostomia associated with Sjogren’s syndrome

Side Effects

1. abdominal pain
2. acne vulgaris
3. agitation
4. alopecia
5. amenorrhea
6. anemia
7. angina
8. anorexia
9. anxiety
10. appetite stimulation
11. arthralgia
12. arthropathy
13. asthenia
14. atopic dermatitis
15. AV block
16. back pain
17. blepharitis
18. bradycardia
19. bronchospasm
20. bullous rash
21. candidiasis
22. cataracts
23. chest pain (unspecified)
24. cholecystitis
25. cholelithiasis
26. coma
27. confusion
28. conjunctivitis
29. constipation
30. contact dermatitis
31. cough
32. cystitis
33. dehydration
34. dental caries
35. dental pain
36. depression
37. diabetes mellitus
38. diarrhea
39. diplopia
40. dysarthria
41. dysgeusia
42. dyskinesia
43. dysmenorrhea
44. dysphagia
45. dysphonia
46. dyspnea
47. dysuria
48. edema
49. elevated hepatic enzymes
50. emotional lability
51. eosinophilia
52. epididymitis
53. epistaxis
54. eructation
55. esophagitis
56. fatigue
57. fever
58. flatulence
59. furunculosis
60. gastritis
61. gastroesophageal reflux
62. GI bleeding
63. gingivitis
64. glossitis
65. goiter
66. hallucinations
67. headache
68. hearing loss
69. hematoma
70. hematuria
71. hemoptysis
72. hemorrhoids
73. hepatitis
74. hiccups
75. hot flashes
76. hypercalcemia
77. hypercholesterolemia
78. hyperglycemia
79. hyperhidrosis
80. hyperkeratosis
81. hyperkinesis
82. hyperlipidemia
83. hypersalivation
84. hypertension
85. hypertonia
86. hypertriglyceridemia
87. hyperuricemia
88. hypoesthesia
89. hypoglycemia
90. hypokalemia
91. hyponatremia
92. hyporeflexia
93. hypotension
94. hypothyroidism
95. ileus
96. infection
97. insomnia
98. keratitis
99. keratoconjunctivitis
100. lacrimation
101. laryngitis
102. leukocytosis
103. leukopenia
104. leukorrhea
105. lymphadenopathy
106. malaise
107. mania
108. mastalgia
109. melena
110. menorrhagia
111. migraine
112. muscle cramps
113. myalgia
114. myasthenia
115. mydriasis
116. myocardial infarction
117. myopia
118. nail discoloration
119. nausea
120. nephrolithiasis
121. neuropathic pain
122. nocturia
123. ocular hemorrhage
124. ocular hypertension
125. ocular infection
126. ocular pain
127. osteoporosis
128. otalgia
129. pallor
130. palpitations
131. paresthesias
132. parosmia
133. peptic ulcer
134. pericarditis
135. peripheral edema
136. phlebitis
137. photopsia
138. photosensitivity
139. pleural effusion
140. polydipsia
141. proteinuria
142. pruritus
143. pulmonary embolism
144. pulmonary fibrosis
145. purpura
146. pyuria
147. rhinitis
148. seborrhea
149. sinus tachycardia
150. sinusitis
151. skin discoloration
152. skin ulcer
153. ST-T wave changes
154. stomatitis
155. supraventricular tachycardia (SVT)
156. syncope
157. synovitis
158. tenesmus
159. thrombocytopenia
160. thromboembolism
161. thrombotic thrombocytopenic purpura (TTP)
162. tinnitus
163. tongue discoloration
164. tremor
165. urinary incontinence
166. urticaria
167. vaginal bleeding
168. vaginitis
169. vasculitis
170. vertigo
171. visual impairment
172. vomiting
173. weight gain
174. weight loss
175. xerophthalmia
176. xerosis
177. xerostomia

Monitoring Parameters

• laboratory monitoring not necessary

Contraindications

• angina
• asthma
• breast-feeding
• bronchitis
• cardiac arrhythmias
• cardiac disease
• children
• cholelithiasis
• chronic obstructive pulmonary disease (COPD)
• driving or operating machinery
• geriatric
• glaucoma
• iritis
• myocardial infarction
• nephrolithiasis
• pregnancy

Interactions

• Abiraterone
• Acebutolol
• Acetaminophen; Propoxyphene
• Ambenonium Chloride
• Amiodarone
• Amlodipine; Celecoxib
• Amoxapine
• Amoxicillin; Clarithromycin; Lansoprazole
• Amoxicillin; Clarithromycin; Omeprazole
• Anticholinergics
• Apalutamide
• Aprepitant, Fosaprepitant
• Artemether; Lumefantrine
• Atazanavir; Cobicistat
• Atenolol
• Atenolol; Chlorthalidone
• Atropine
• Atropine; Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
• Atropine; Difenoxin
• Atropine; Diphenoxylate
• Atropine; Edrophonium
• Atropine; Hyoscyamine; Phenobarbital; Scopolamine
• Barbiturates
• Belladonna Alkaloids; Ergotamine; Phenobarbital
• Belladonna; Opium
• Bendroflumethiazide; Nadolol
• Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
• Benztropine
• Beta-blockers
• Betaxolol
• Bethanechol
• Bisoprolol
• Bisoprolol; Hydrochlorothiazide, HCTZ
• Boceprevir
• Bosentan
• Brimonidine; Timolol
• Bupropion
• Bupropion; Naltrexone
• Carbamazepine
• Carteolol
• Carvedilol
• Celecoxib
• Ceritinib
• Chlordiazepoxide; Clidinium
• Chlorpromazine
• Cholinesterase inhibitors
• Cimetidine
• Cinacalcet
• Ciprofloxacin
• Clarithromycin
• Clobazam
• Cobicistat
• Codeine; Phenylephrine; Promethazine
• Codeine; Promethazine
• Conivaptan
• Dacomitinib
• Darunavir; Cobicistat
• Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide
• Delavirdine
• Dextromethorphan; Promethazine
• Dextromethorphan; Quinidine
• Dicyclomine
• Diltiazem
• Disopyramide
• Donepezil
• Donepezil; Memantine
• Dorzolamide; Timolol
• Dronedarone
• Edrophonium
• Efavirenz
• Efavirenz; Emtricitabine; Tenofovir
• Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate
• Elbasvir; Grazoprevir
• Eliglustat
• Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide
• Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate
• Erythromycin
• Erythromycin; Sulfisoxazole
• Esmolol
• Fedratinib
• Flavoxate
• Fluconazole
• Galantamine
• Glycopyrrolate
• Glycopyrrolate; Formoterol
• Guanidine
• Haloperidol
• Homatropine; Hydrocodone
• Hydantoins
• Hydrochlorothiazide, HCTZ; Metoprolol
• Hydrochlorothiazide, HCTZ; Propranolol
• Hyoscyamine
• Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate
• Idelalisib
• Imatinib
• Indacaterol; Glycopyrrolate
• Isavuconazonium
• Isoniazid, INH; Pyrazinamide, PZA; Rifampin
• Isoniazid, INH; Rifampin
• Itraconazole
• Ketoconazole
• Labetalol
• Lefamulin
• Letermovir
• Levobetaxolol
• Levobunolol
• Lumacaftor; Ivacaftor
• Maprotiline
• Mepenzolate
• Meperidine; Promethazine
• Methenamine; Sodium Acid Phosphate; Methylene Blue; Hyoscyamine
• Methscopolamine
• Metoprolol
• Mirabegron
• Mitotane
• Nadolol
• Nebivolol
• Nebivolol; Valsartan
• Nefazodone
• Neostigmine
• Nevirapine
• Nilotinib
• Omeprazole; Amoxicillin; Rifabutin
• Oritavancin
• Oxybutynin
• Palbociclib
• Pazopanib
• Peginterferon Alfa-2b
• Penbutolol
• Perphenazine
• Perphenazine; Amitriptyline
• Phenylephrine; Promethazine
• Physostigmine
• Pilocarpine
• Pindolol
• Posaconazole
• Pralidoxime
• Promethazine
• Propafenone
• Propantheline
• Propoxyphene
• Propranolol
• Protease inhibitors
• Pyridostigmine
• Quinidine
• Quinine
• Ribociclib
• Ribociclib; Letrozole
• Rifabutin
• Rifampin
• Rivastigmine
• Rolapitant
• Rufinamide
• Scopolamine
• Selective serotonin reuptake inhibitors
• Simeprevir
• Sotalol
• Tacrine
• Telaprevir
• Telithromycin
• Telotristat Ethyl
• Terbinafine
• Thioridazine
• Timolol
• Trandolapril; Verapamil
• Tricyclic antidepressants
• Trihexyphenidyl
• Trospium
• Tucatinib
• Vemurafenib
• Venlafaxine
• Verapamil
• Voriconazole