The Questionable Value of Salagen / Pilocarpine

I’ve been trying to reach some sort of conclusion about the value of taking Salagen (aka pilocarpine) to offset the dry mouth syndrome. Well, at least I am starting to question the value for my particular situation.

Pilocarpine (or the commercial name Salagen) is touted as being one solution to dry mouth. It is supposed to actually stimulate saliva production. Now, given that I’m down to one saliva gland because of the radiation treatment, I thought that it might be something worth trying. I was initially disappointed with my doctors because they didn’t suggest it right off the bat. I’m beginning to understand…

Salagen is supposed to be taken 3 to 4 times per day. Each pill costs approximately $1.25 Canadian. So based on a 30 day supply, and three times a day, you can expect to be spending $112.50 per month. Is it really worth it?

The saliva output has not increased enough after two months of taking the pills steadily to make eating a ‘normal’ experience again. I still need copious amounts of liquid to get through a meal. There is, however, enough saliva on a regular basis that I wouldn’t be overly concerned about the dental implications of dry mouth. But there are side effects.

In theory one is to take the pill an hour and a half before eating. Okay, well that helps with taking it regularly, I suppose. You will feel a bit sweaty within forty minutes of taking the pill; and its not a hard sweat, its one of those odd ‘nervous’ sweats that makes you feel generally uncomfortable. Mine tends to localize on my back… chilling. My nose absolutely drips! Very disconcerting to be constantly dabbing at your nose while eating… I can just imagine the discomfort this causes those I dine with. The warning with the drug is also that you will begin to urinate buckets for a brief time; true. And, to further add to the general discomfort, your stool will get loose.

The use of the drug changes the tastes of some things. I haven’t quite figured out the correlation, yet, but there is a decidedly alkaline taste associated with dark chocolate, scotch, and Swiss Chalet’s ‘special sauce’. It seems like the ‘bitter’ receptors in my taste buds are enhanced…

Also in my case, the use of the drug makes me feel that I suffer from ‘cotton mouth’; my tongue feels swollen; this contributes to the shift in taste. The drug enhances the ‘burning tongue’ feel. G. tells me that she can’t hear any difference in my speech, but it does feel odd to me, and makes me self conscious when I speak for too long. I really think I sound terrible in Spanish, murdering the oral part of the lessons G. and I are taking. This does give me some concern… I’m about to begin presenting a specialized training program at work. I can’t have my tongue failing me, nor can I restrict how I present because I’m afraid that my tongue will fail.

Here is a listing of known side effects taken from

SIDE EFFECTS: Excessive sweating (diaphoresis) is a frequent side effect of pilocarpine. Other side effects include chills, dizziness, excessive tearing, flushing, voice change, stuffy nose, tremor, increased need to urinate, visual disturbances, diarrhea, difficulty swallowing, abdominal pain, nausea, vomiting, and slow heart rate.

I hadn’t even realized that some of the swallowing issues I’ve been having lately could be attributed to the pilocarpine.

So I took a couple of days off from the Salagen, and then started back, making a conscious attempt to note the effects, good and bad.

I am not convinced that using the Salagen/pilocarpine is worth the money for my situation. Masking the flavours of food, and the concern about my tongue are starting to outweigh the benefits. Other than the swallowing issue, I can live with the other side effects.

I think I know why the doctors were not quick to prescribe it for me.

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