Cevimeline

Cevimeline (trade name Evoxac) is a synthetic analog of the natural alkaloid muscarine with a particular agonistic effect on M1 and M3 receptors. It is used in the treatment of dry mouth and Sjögren's syndrome.

Cevimeline
Clinical data
Trade namesEvoxac
AHFS/Drugs.comMonograph
MedlinePlusa608025
Pregnancy
category
  • C
Routes of
administration		By mouth (capsules)
ATC code
Legal status
Legal status
  • In general: ℞ (Prescription only)
Pharmacokinetic data
Protein binding<20%
Identifiers
IUPAC name
  • (2R,2R)-2'-Methylspiro[4-azabicyclo[2.2.2]octane-2,5'-[1,3]oxathiolane]
CAS Number
PubChem CID
DrugBank
ChemSpider
UNII
KEGG
ChEBI
ChEMBL
CompTox Dashboard (EPA)
Chemical and physical data
FormulaC10H17NOS
Molar mass199.31 g·mol−1
3D model (JSmol)
SMILES
  • O1[C@H](SC[C@@]12CN3CCC2CC3)C
InChI
  • InChI=1S/C10H17NOS/c1-8-12-10(7-13-8)6-11-4-2-9(10)3-5-11/h8-9H,2-7H2,1H3/t8-,10-/m1/s1 Y
  • Key:WUTYZMFRCNBCHQ-PSASIEDQSA-N Y
 NY (what is this?)  (verify)

Medical uses

Cevimeline is used in the treatment of xerostomia (dry mouth),[1][2] and Sjögren's syndrome.[1] It increases the production of saliva.[2]

Side effects

Known side effects include nausea, vomiting, diarrhea, excessive sweating, rash, headache, runny nose, cough, drowsiness, hot flashes, blurred vision, and difficulty sleeping.[3]

Contraindications include asthma and angle closure glaucoma.

Mechanism of action

Cevimeline is a cholinergic agonist.[2] It has a particular effect on M1 and M3 receptors.[2] By activating the M3 receptors of the parasympathetic nervous system, cevimeline stimulates secretion by the salivary glands, thereby alleviating dry mouth.

See also
  • Pilocarpine — a similar parasympathomimetic medication for dry mouth (xerostomia)
  • Bethanechol — a similar muscarinic parasympathomimetic with longer-lasting effect

References
  1. Ono M, Takamura E, Shinozaki K, Tsumura T, Hamano T, Yagi Y, Tsubota K (July 2004). "Therapeutic effect of cevimeline on dry eye in patients with Sjögren's syndrome: a randomized, double-blind clinical study". American Journal of Ophthalmology. 138 (1): 6–17. doi:10.1016/j.ajo.2004.02.010. PMID 15234277.
  2. Fox RI, Fox CM (2019). "Management of Sjögren's". Dubois' Lupus Erythematosus and Related Syndromes (9th ed.). Elsevier. pp. 745–758. doi:10.1016/B978-0-323-47927-1.00060-8. ISBN 978-0-323-47927-1.
  3. "Cevimeline". MedicineNet. Retrieved 12 October 2007.
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