CEVIMELINE HYDROCHLORIDE

CEVIMELINE HYDROCHLORIDe
(cev-i-may'leen)
Evoxac
Classifications: cholinergic agonist; cholinergic enhancer;
Therapeutic: cholinergic enhancer
Pregnancy Category: C

Availability

30 mg capsules

Action

Cholinergic agent that binds to muscarinic receptors.

Therapeutic Effect

Increases secretion of exocrine glands, such as salivary and sweat glands. It relieves severe dry mouth.

Uses

Treatment of dry mouth in patients with Sjögren's syndrome.

Contraindications

Hypersensitivity to cevimeline; uncontrolled asthma; acute iritis; narrow-angle glaucoma; lactation.

Cautious Use

Controlled asthma; chronic bronchitis, COPD; cardiac disease, cardiac arrhythmias, myocardial infarction; history of nephrolithiasis or cholelithiasis; elderly; pregnancy (category C); older adults. Safety and effectiveness in children are not established.

Route & Dosage

Dry Mouth
Adult: PO 30 mg t.i.d.

Administration

Oral

Give without regard to food.
Store refrigerated at 2°–8° C (35.6°–46.4° F) with occasional fluctuations between 15°–30° C (59°–86° F).

Adverse Effects (≥1%)

Body as a Whole: Excessive sweating, headache, back pain, dizziness, fatigue, pain, hot flushes, rigors, tremor, hypertonia, myalgia, fever, eye pain, ear ache, flu-like symptoms. CNS: Insomnia, anxiety, vertigo, depression, hyporeflexia. CV: Peripheral edema, chest pain. GI: Nausea, diarrhea, excessive salivation, dyspepsia, abdominal pain, coughing, vomiting, constipation, anorexia, dry mouth, hiccup. Respiratory: Rhinitis, sinusitis, upper respiratory tract infection, pharyngitis, bronchitis. Skin: Rash, conjunctivitis, pruritus. Special Senses: Abnormal vision. Urogenital: Urinary tract infection.

Interactions

Drug: beta-adrenergic agonists may cause conduction disturbances; parasympathomimetic drugs may have additive effects.

Pharmacokinetics

Absorption: Rapidly absorbed. Peak: 1.5–2 h. Distribution: <20% protein bound. Metabolism: In liver by CYP2D6 and 3A3/4. Elimination: Primarily in urine. Half-Life: 5 h.

Nursing Implications

Assessment & Drug Effects

Monitor for S&S of increased airway resistance, especially in patient with asthma, bronchitis, emphysema, or COPD.
Monitor cardiac status, especially in those with known cardiac disease or dysfunction.
Monitor fluid status, especially in those at risk for dehydration.
Lab tests: Routine blood chemistry during long-term therapy.
Report S&S of excess cholinergic activity (e.g., diaphoresis, frequent urge to urinate, nausea and/or diarrhea).

Patient & Family Education

Do not drive or engage in potentially hazardous activities until response to drug is known.
Consult physician if confusion, dizziness, or faintness occur.
Report diminished night vision or depth perception.
Drink fluids liberally (2000–3000 mL/d) in the event of excessive sweating when it occurs.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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