Cevimeline alternatives: What can I take instead of cevimeline?

Compare cevimeline alternatives | Salagen | Salivasure | Biotene Oral Balance Gel | Oasis Moisturizing Mouth Spray | Plaquenil | Natural alternatives | How to switch meds

Finding a solution for your dry mouth from Sjogren’s syndrome can require a lot of patience. Xerostomia (dry mouth) is only a part of this autoimmune condition, which can include sicca symptoms (dry eyes, skin, mouth, and nasal passages) as well as disease effects on multiple organ systems. The xerostomia it causes is more than just uncomfortable; it is a major risk factor for dental and gum disease. When all of the tips and tricks for stimulating saliva flow have failed, Evoxac (cevimeline) is often called upon for relief. Unfortunately, it may not be your final answer. The brand name drug’s expense or adverse effects could dissuade you, or you may not see adequate efficacy. At this point, you want to know where you can turn. We will take you through your options here.

Related: What your saliva says about your health

What can I take in place of cevimeline?

Evoxac is a cholinergic agonist, stimulating muscarinic receptors for acetylcholine in salivary glands. The activated receptors function as part of the parasympathetic nervous system, which has branches throughout the body, including the eyes, heart, and intestinal tract. When natural acetylcholine or the drug cevimeline activates these receptors within salivary glands, the resultant salivary flow can be significant. Evoxac is not the only muscarinic agonist used for this purpose. Therefore, even if Evoxac is failing you, an alternative could still work out. If not, saliva substitutes can be reconsidered, and if you are suffering from more serious complications of Sjogren’s syndrome, immunosuppressants might be reasonable.

Top 5 cevimeline alternatives

The following are some of the most common alternatives to cevimeline.

1. Salagen

Evoxac and Salagen are the only two primary sialogogues, drugs that stimulate saliva production above baseline. They both work by mimicking acetylcholine, turning on the compound’s muscarinic receptors. The cholinergic effect throughout the body can result in benefits for those with Sjogren’s syndrome, like increased saliva and tear production.Salagen may even help with vaginal, skin, and nasal dryness. Evidence from a randomized, placebo-controlled clinical trial backs up the use of Salagen and provides the basis for why it has an official indication from the Food and Drug Administration (FDA) for xerostomia related to Sjogren’s syndrome. Evoxac has this same indication and has solid backing from a randomized, placebo-controlled, and double-blind study too. Choosing between these two effective drugs is often a matter of cost and insurance coverage. If expense is the concern driving you to contemplate changing from Evoxac, then presenting a SingleCare discount card at your local pharmacy could be an easy solution.

Side effects are another common reason to look at Salagen as an alternative to Evoxac. Cholinergic activity from either drug can lead to sweating, flushing, chills, bradycardia (slow heartbeat), low blood pressure, bronchial tube constriction, urinary frequency, nausea, and diarrhea. Which particular side effects are caused by a cholinergic agonist is typically determined by whether it has more or less affinity for M1, M2, or M3 muscarinic receptors. For example, by virtue of having less action on M2 muscarinic receptors, which are located in the heart, Evoxac might be less likely to have cardiac side effects. Evoxac may produce more nausea, while Salagen may result in more sweating. Trading one sialogogue for another may just result in trading one set of side effects for another. Nonetheless, without many alternatives, it might be worth a try unless there is a contraindication. For instance, neither Evoxac or Salagen should be used in the setting of angle-closure glaucoma or uncontrolled asthma.

2. Salivasure

Based on the scarcity of viable medications that stimulate saliva in a safe manner, you may have to rely on saliva substitutes. Salivasure lozenges dissolve on the tongue. The product relies on its key ingredients, xylitol and malic acid, to spark more saliva. Beneficial effects could extend beyond relieving the discomfort of a dry mouth. Enhanced saliva secretion can mean fewer dental caries (cavities), less gum disease, and better smelling breath. Xylitol-based products can taste appealing and not be sugary, making them better for your teeth than most candies that can get you salivating. Unfortunately, having too much xylitol from Saliasure or other products could leave you with diarrhea. This adverse effect though is much less intimidating than the list of Evoxac’s common side effects. For that reason, Salivasure or other saliva substitutes are usually tried before Evoxac or Salagen.

3. Biotene Oral Balance Gel

Biotene Oral Balance Gel combines xylitol with glycerin to help wet and coat the mouth. As a concentrated gel rather than a mouthwash, it might be a good choice at bedtime to help last overnight. Using different topical saliva substitutes at different times of day can be an effective solution. 

4. Oasis Moisturizing Mouth Spray

A quick spritz of Oasis Moisturizing Mouth Spray could prove to be helpful for you in times of need. A spray can be a convenient product to carry with you through the day. Oasis Moisturizing Mouth Spray also combines xylitol and glycerin. Xylitol can stimulate saliva flow. Glycerin is a humectant, meaning it attracts and retains moisture. This product, as well as Salivasure and Biotene Oral Balance Gel, can be obtained without a prescription, unlike Evoxac.

5. Plaquenil

Sjogren’s syndrome is an autoimmune disease. The immune system attacks different body tissues, particularly the lacrimal (tear) and salivary glands. The resultant inflammation in these glands causes them to malfunction, leaving you with dry eyes and mouth. It makes sense that suppressing the immune system could theoretically lessen the inflammation, improve the function of these glands, and help alleviate xerostomia. 

Plaquenil, a drug with established utility in treating autoimmune conditions like lupus erythematosus and rheumatoid arthritis, has been evaluated for use in Sjogren’s syndrome. Although it has shown utility in helping muscle and joint symptoms of the disease and it did reduce markers of salivary gland inflammation, proof of effectiveness is still lacking. Consequently, Plaquenil is used off-label and has no FDA indication for treatment of Sjogren’s syndrome. Taking the risk of infection that comes from suppressing the immune system may not appeal to you when efficacy has not been well established.

Natural alternatives to cevimeline

You might be better off getting back to basics on addressing your symptoms of dry mouth. Before trying another prescription or over-the-counter medication, you may want to make sure you have tried natural options for treating xerostomia. Maintaining adequate hydration by drinking plenty of water is a good start. Keeping the air more humid in your home might help too. You can also review your habits for any that might be contributing to dry mouth, such as caffeine, alcohol, and smoking. Medications are another potential cause of xerostomia to consider. The anticholinergic effects of some antidepressants, for example, can lead to this issue.If reflecting on hydration, habits, and medications did not turn up a solution, you can try to increase saliva production without formal products for treatment. Simple sugar-free gum and candy could get the job done. Even better, some sugar-free gum and candy varieties contain xylitol or malic acid which may help even more. You may have to keep trying different options to find what works best. Studies have not yet identified one approach that works best.

How to switch to a cevimeline alternative

The search for a remedy to your dry mouth should not be undertaken alone. Your healthcare provider should be notified of your concerns with Evoxac, whether they are based on cost or effectiveness. The two of you can go over your list of prescription drugs, over-the-counter medications, and supplements to see if there are potential causes of xerostomia among your therapeutic regimen. The professional can provide medical advice on whether any of the alternatives to Evoxac discussed here make sense for you. Once properly vetted by you both, you should be able to confidently make a decision on whether to continue Evoxac and what to try next.