A Cochrane review [Abstract] 1 included 3 studies with a total of 298 subjects. Pilocarpine hydrochloride was more effective than placebo, and at least as effective as artificial saliva in those participants that responded. The response rate was 42 to 51%. The time to response was up to 12 weeks. The side effect rate was high, and side effects were the main reason for withdrawal (6% to 15% patients taking 5 mg three times daily). The side effects were usually the result of generalised parasympathomimetic stimulation (e.g. sweating, headaches, urinary frequency, vasodilatation).
Another systematic review 2 included 20 studies with a total of 1 732 subjects. The effect of several different interventions on radiotherapy-induced xerostomia and hyposalivation was studied. Meta-analysis included 6 studies, and found that both cevimeline and systemic pilocarpine reduced xerostomia symptoms and increased salivary flow compared to placebo.
Comment: The quality of evidence is downgraded by study limitations (incomplete outcome data), and by imprecise results (limited study size for each comparison).
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