Recently I have been having my patients with severe dry mouth utilize a prescription that relieves their symptoms and restores some of the balance to the oral cavity that saliva provides. Pilocarpine is a cholinergic medication and is commonly given to patients with severe dry mouth. Many patients have dry mouth that is not significantly helped with topical solutions like Biotene or AOvantage, or they have to use these products so often that it becomes a challenge. Recently our GCAmerica rep came in for a lunch and learn and mentioned using Pilocarpine in a lollipop for this group of patients. I was intrigued enough to do the research. Compounding pharmacies can fabricate a lollipop that contains pilocarpine in either a 5mg or 2mg dose, they also can add Xyltiol as a caries preventive and flavoring agents.
Patients are instructed to suck on the lollipop for 3-20 seconds as needed up to 5 times per day. The length of time they use the lollipop and number of times per day is easy for them to discern based on the feeling of saliva in their mouths. The medication increases salivary flow for about 3-5 hours. The pharmacy dispenses the lollipop in a plastic pill holder with a hole in the lid that supports the stick and allows the pop to be used over and over again until it is gone while being kept clean. Pilocarpine can also be given as a pill and is available in 5 and 10mg formulations, but I was amazed at how much more patients like the lollipop then having to swallow a pill. When I did my research I was amazed at the variety of instructions I came across, from 3-30 seconds in the mouth, and 3 times per day to every 2 hours and even use as needed.
I am fortunate enough to have a compounding pharmacy right down the street so I called and spoke to the lead pharmacist. He explained that unlike a pill the dose will be variable with the lollipop, however it will take a lower dose to get the same oral effect versus a systemic application, and this accounts for the variable instructions. The most common side effect will be too much salivary flow and the patient will use this to reduce the length of time the pop is in their mouths or the number of uses per day. Pilocarpine can also cause increased sweating, but the pharmacist explained this should be uncommon at the does of the lollipops. He also shared that although it is available in many flavors, Root Beer seems to cover the flavor of the Pilocarpine the best, and he strongly recommends the formula with Xylitol.
It has been great to have one more thing to offer our patients to help them be comfortable and keep their mouths healthy.
Thanks Lee I will try this. I think my hygienists will love it as well.
Is there a pharmacy that you can recommend? I have not worked with a compounding pharmacy in my area.
I use a local compounding pharmacy called Potter’s House Apothecary, however if you do not have one locally use a mail order compounding pharmacy. Two examples are Steven’s Pharmacy and Apex Compounding Pharmacy, both have great websites where you can submit prescriptions.
Seems like a great idea. I have too many patents with severe dry mouth. root caries are a huge problem. Any concerns with getting too much of the pilocarpine?
Steve,
It’s hard to get too much with the lollipop. The first sign a patient needs to cut back is excessive salivation, and then they can do fewer seconds or fewer times per day. The next most common sign of too much is excessive sweating, and again I tell my patients to look for this and cut back accordingly. I use this when the dry mouth is severe, the current treatments are ineffective, and when caries is still an ongoing issue.
Does the 2mg or 5mg dose mean that is the total amount in the whole lollipop or that is how much they should get each time they suck the lollipop?