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
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