Cholinergic Agonists (Secretagogues) for Sjögren’s Disease

If self-care and saliva substitutes are not enough for your dry mouth, your doctor may suggest a cholinergic agonist. These prescription drugs help your glands make more saliva and sometimes more tears.^1,3

They are also called secretagogues, which simply means they prompt glands to release fluid. This article explains how they work, which ones are approved by the US Food and Drug Administration (FDA), and what to expect.^1,3

How do cholinergic agonists work?

Cholinergic agonists work by signaling the glands in your mouth and eyes to produce more moisture. Unlike artificial tears or saliva substitutes, which add moisture from outside, these drugs prompt your own glands to make natural saliva and tears. They are taken as pills, so they can help with dryness throughout the mouth rather than 1 spot at a time.¹

Doctors have several ways to treat dry mouth, including saliva substitutes and prescription drugs that help your glands make more saliva. Cholinergic agonists fall into that second group. They are a good fit when saliva substitutes and sipping water are not enough on their own.²

These drugs do not cure Sjögren’s or stop the disease. They ease one of its most bothersome symptoms so that eating, speaking, and swallowing feel more comfortable.

Examples

Two cholinergic agonists are FDA-approved to treat the dry mouth of Sjögren’s:³

• Pilocarpine (Salagen®) – An FDA-approved pill that increases saliva production.
• Cevimeline (Evoxac®) – An FDA-approved pill that increases saliva production.

These come as pills. You will likely need to take them consistently for a few weeks to months before you notice the full benefit.³

What to expect

These drugs work gradually. Because they prompt your glands over time, the improvement in dry mouth builds rather than appearing overnight. You will likely need to take the drug consistently for a few weeks to months before you notice the full benefit, so it helps to stick with it and give it time. Your doctor will help you decide whether one of these drugs fits your symptoms and your other health conditions.³

What are the possible side effects?

Side effects can vary depending on the specific drug you are taking. Because cholinergic agonists boost the glands throughout the body, common side effects include:¹

• Sweating – This is one of the most common effects.
• Flushing – You may feel warm or look flushed.
• Increased urination – You may need to urinate more often.
• Stomach upset – Some people have abdominal pain.

These are not all the possible side effects of cholinergic agonists. Talk to your doctor about what to expect when taking cholinergic agonists. You also should call your doctor if you have any changes that concern you when taking cholinergic agonists.

Other things to know

Before beginning treatment for Sjögren’s disease, tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you take. This includes over-the-counter drugs. Some health conditions can make these drugs a poor fit, so your full history matters.

Talk to your doctor

A cholinergic agonist is 1 option among several for dry mouth. It is not right for everyone, and it works differently for each person. Talk with your doctor about whether it makes sense for you and what to expect.