And It's About Time There Was Some Support For Cushing's!
The following offers practical hints from several sources for coping with treatment side effects that may affect your eating. These suggestions have helped other patients manage eating problems that can be frustrating to handle.
Try all the ideas to find what works best for you. Share your needs and concerns with your family and friends, particularly those who prepare meals for you. Let them know that you appreciate their support as you work to take control of eating problems.
Transsphenoidal surgery, chemotherapy and radiation therapy in the head or neck area can reduce the flow of saliva and often cause dry mouth. When this happens, foods are harder to chew and swallow. Dry mouth also can change the way foods taste.
The suggestions below may be helpful in dealing with dry mouth. Also try some of the ideas for dealing with a sore mouth or throat, which can make foods easier to swallow.
Pilocarpine is one such preparation. The FDA has granted marketing approval for an oral preparation of pilocarpine hydrochloride (Salagen/MGI Pharma) for treatment of radiation-induced xerostomia (dry mouth) in patients with cancer of the head and neck. The product is the first pharmacologic treatment for dry mouth. Pilocarpine, which has been used for over a century to treat glaucoma, was first isolated from the leaves of the South American plants Pilocarpus jaborandi and Pilocarpus microphyllus in 1875.
An estimated 40,000 cancers of the head and neck are diagnosed each year in the United States, and most of the patients undergo radiation therapy. The radiation can cause permanent damage to the salivary glands, with a major effect on the patient's quality of life. Direct effects can include difficulty in talking, eating, and sleeping; rapid tooth decay; and increased risk of periodontal disease and oral infections. Indirect effects can include nutritional deficiencies, weight loss, and altered social habits.
Pilocarpine is a cholinergic parasympathomimetic agent with a broad range of pharmacologic effects. It increases secretion by the exocrine glands and can affect the sweat, salivary, lacrimal, gastric, pancreatic, and intestinal glands and the mucosal cells of the respiratory tract. The most common side effect with Salagen treatment has been moderate sweating. Other side effects have included nausea, runny nose, chills, flushing, urinary frequency, dizziness, and fatigue. Salagen use is contraindicated in uncontrolled asthma, known hypersensitivity to pilocarpine, and when miosis (contraction of the pupil) is undesirable, in acute iritis and narrow-angle glaucoma.
Patients with cardiovascular disease should receive pilocarpine only under close supervision. Concomitant administration of beta-adrenergic antagonists could result in conduction disturbances.
Two pivotal studies have demonstrated the usefulness of Salagen in improving salivary function in patients with radiation-induced xerostomia. The first study involved 207 patients who had received radiation therapy for head and neck cancers. The patients received 5 or 10 mg pilocarpine or placebo by mouth three times a day for 12 weeks. Oral dryness improved in 44% of the 5- mg pilocarpine group, compared with 25% of the placebo group. Overall improvement occurred in 54% of the 5-mg group, compared with 25% in the placebo group. The 10-mg pilocarpine group also showed significantly greater improvement than the placebo group.
The second study a total of 162 patients received placebo or 2.5-mg pilocarpine tablets for 4 weeks, followed by 5-mg tablets for 4weeks and then 10-mg tablets for 4 weeks. Patients were permitted to adjust their individual doses for best effect (up to increase therapeutic effect, down to reduce side effects). Overall assessments showed significantly greater improvement with pilocarpine than with placebo. Active treatment also produced less need for artificial saliva, hard candy, water, and other "oral comfort agents." All the drug dosages were found to be safe, and there were no serious treatment-related adverse events.
Salagen is available as 5-mg film-coated tablets. The recommended dosage is 5 mg three times a day, titrated up to 10 mg three times a day if the lower dosage is not effective. However, the lowest effective dosage should be used to avoid or minimize side effects.
Dry mouth (xerostomia) can result in oral discomfort and can have serious consequences. If you feel you have this symptom, please contact our office for assistance.