ClinCalc Pro
Menu
Calculators Drugs Pathways AI Dx Donate Get the App
Muscarinic Agonist — Dry Mouth / Sjögren's Pregnancy: Avoid — cholinergic effects may increase uterine tone; limited safety data

Pilocarpine

Brand names: Salagen, Pilocarpine HCl

Adult dose

Dose: 5 mg
Route: Oral
Frequency: Three times daily with meals; may increase to four times daily if tolerated
Max: 30 mg/day
Oral muscarinic agonist for xerostomia (dry mouth) in Sjögren's syndrome or radiation-induced dry mouth (post-head and neck radiotherapy). Stimulates residual salivary gland function. Onset 30–60 minutes; peak effect 1–2 hours.

Paediatric dose

Dose: Seek specialist opinion mg/kg
Route: Oral
Frequency: Three times daily
Max: Not established in children
Not licensed in children — seek specialist ENT/rheumatology opinion

Dose adjustments

Renal

Use with caution in renal impairment

Hepatic

Use with caution in hepatic impairment — reduced metabolism may increase systemic cholinergic effects

Paediatric weight-based calculator

Not licensed in children — seek specialist ENT/rheumatology opinion

Clinical pearls

  • Non-selective muscarinic (M3 > M1) agonist — stimulates exocrine glands including salivary, lacrimal, and sweat glands
  • Sjögren's syndrome: pilocarpine improves saliva and tear production; cevimeline (M3-selective) is an alternative with fewer side effects
  • Radiation-induced xerostomia: pilocarpine 5 mg TDS shown to significantly improve saliva production in randomised trials (Fox et al.)
  • Sweating is the most common limiting side effect — reduces adherence; warn patients that this is expected
  • Eye drops (pilocarpine 1–4%) used for glaucoma and mydriasis reversal — different indication from oral tablets

Contraindications

  • Uncontrolled asthma or COPD (bronchospasm risk)
  • Angle-closure glaucoma
  • Active peptic ulcer
  • Severe cardiovascular disease
  • Pregnancy

Side effects

  • Sweating (most common — ~40%)
  • Flushing
  • Urinary frequency
  • Nausea
  • Rhinorrhoea
  • Diarrhoea
  • Bradycardia (cholinergic effects)
  • Visual disturbance (miosis)

Interactions

  • Beta-blockers — bradycardia risk
  • Anticholinergic drugs — reduced efficacy (antagonistic)
  • Calcium channel blockers — additive cardiac effects

Monitoring

  • Saliva production and symptom relief
  • Cardiovascular effects (heart rate, blood pressure)
  • Sweating and anticholinergic side effects

Reference: BNFc; BNF 90; Fox et al. (1996) NEJM Pilocarpine for Sjögren's; BSAC/BSR Sjögren's Syndrome Guidelines 2017. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

Calculators
Pathways