{
  "schema_version": 1,
  "kind": "condition",
  "id": "dry-mouth",
  "name": "Dry mouth (xerostomia)",
  "category": "chronic",
  "sources": "Xerostomia - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK545287/ · Egyptian drug register (data/egyptian-drugs.csv): no oral pilocarpine or licensed saliva-stimulating medicine is marketed in Egypt",
  "review_status": "reviewed",
  "verified_against": "Xerostomia - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK545287/, Treatment / Management (pilocarpine 5-10 mg three times daily; cevimeline 30 mg three times daily) · Egyptian drug register (no oral pilocarpine; no cevimeline; no physostigmine)",
  "verified_date": "2026-09",
  "treatments": [
    {
      "id": 640,
      "generic": "Pilocarpine",
      "line": 1,
      "is_adjunct": false,
      "form": "oral.solid",
      "strength_mg": 5.0,
      "adult_dose": "5 to 10 mg three times a day by mouth. Try it for up to 3 months to judge whether it works. NOT MARKETED IN EGYPT in any oral form - see the cautions",
      "adult_duration": "trial of up to 3 months, then continued only if it helped",
      "dose_source": "Xerostomia - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK545287/, Treatment / Management - verbatim: \"Pilocarpine is given orally with a normal dose of 5 to 10 mg 3 times a day.\" and \"Either agent is tried for up to 3 months to ascertain efficacy.\" Availability from the Egyptian drug register",
      "rationale": "A sialogogue - it acts on muscarinic receptors and stimulates the salivary glands to secrete. The article: \"The sialogogue drugs pilocarpine and cevimeline are FDA-approved medications for managing xerostomia.\" It is the only drug treatment for dry mouth with a stated dose, and the amount is recorded here so that a physician who obtains it - or sees a patient already taking it - knows what the dose should be. Everything a Cairo prescription can actually deliver is on the row below.",
      "cautions": [
        "NOT AVAILABLE IN EGYPT. The register carries pilocarpine only as eye drops (ISOPTO CARPINE, OCUCARPINE, ORCHICARPINE) and in hair lotions - there is no oral tablet, and cevimeline and physostigmine have no entry at all. Do not write for oral pilocarpine expecting it to be dispensed. Eye drops are not a substitute and must not be swallowed.",
        "It only works if there is gland left to stimulate. The article: \"These medications require some residual salivary gland function to be effective as they stimulate the patent gland to secrete saliva.\" After destructive head-and-neck radiotherapy there may be nothing to stimulate.",
        "The predictable effects are cholinergic. The article names sweating, nausea and rhinitis as the most prevalent adverse effects of pilocarpine. Sweating is the one that stops patients taking it.",
        "RED FLAG - A muscarinic agonist is the wrong drug in uncontrolled asthma, in significant chronic obstructive pulmonary disease, and in narrow-angle glaucoma, because it can provoke bronchospasm and raise the risk in an already narrow angle. Take care in cardiovascular disease, where the cholinergic effect on heart rate matters."
      ],
      "peds_mgkg_low": null,
      "peds_mgkg_high": null,
      "peds_max_mg": null,
      "peds_basis": null,
      "peds_unit": null,
      "peds_note": "The article states no paediatric dose. Dry mouth in a child is nearly always a drug effect, mouth-breathing or dehydration - find the cause rather than prescribing for the symptom.",
      "peds_min_weight_kg": null,
      "peds_max_weight_kg": null,
      "peds_age_min_months": null,
      "peds_age_max_months": null,
      "peds_age_bands": null,
      "peds_doses": null,
      "brands": [],
      "condition_id": "dry-mouth"
    },
    {
      "id": 641,
      "generic": "Find the cause, protect the teeth, replace the saliva (What works here)",
      "line": 2,
      "is_adjunct": false,
      "form": null,
      "strength_mg": null,
      "adult_dose": "Dry mouth is a side effect or a symptom, almost never a disease in itself. Read the drug list first - anticholinergics, tricyclic antidepressants, antihistamines, diuretics and opioids are the usual culprits - then check for diabetes, dehydration, mouth-breathing, Sjogren's syndrome and previous head-and-neck radiotherapy. Frequent sips of water, sugar-free gum and fluoride toothpaste achieve more than anything available on prescription here.",
      "adult_duration": "Assess, then decide",
      "dose_source": "No dose - non-drug management and the causes to look for, from Xerostomia - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK545287/, Treatment / Management. Availability of the drug treatments from the Egyptian drug register",
      "rationale": "No licensed saliva-stimulating medicine is marketed in Egypt - pilocarpine is registered only as eye drops and hair lotions - so a drug row here would promise something a Cairo pharmacy cannot dispense. The saliva substitutes that are sold (Artificial Saliva oral spray, around 8 EGP) are appliances rather than licensed medicines, carry no labelled dose, and are used as often as comfort requires.",
      "cautions": [
        "If a causative drug can be stopped, reduced or swapped, that single change usually does more than everything else combined. Read the drug list first: anticholinergics, tricyclic antidepressants, antihistamines, diuretics and opioids are the usual culprits.",
        "A dry mouth loses its protection against decay. Dental review, fluoride toothpaste and not sipping sugary drinks all day matter more here than any medicine - and this is the part that prevents permanent damage.",
        "What to advise, and when. Frequent sips of water, sugar-free chewing gum to stimulate what gland function remains, and a saliva substitute or oral moisturiser; the article notes these are \"helpful for special times, like during a flight or bedtime\" - which is when the mouth dries most.",
        "Dry mouth with dry eyes, or with joint pain or parotid swelling, suggests Sjogren's syndrome - check anti-Ro and anti-La antibodies and refer.",
        "Persistent dry mouth with oral thrush is common - the saliva that normally keeps candida in check is gone. Treat the thrush and the dryness separately; the oral candidiasis card carries the antifungal dose.",
        "RED FLAG - Complications include oral candidiasis, periodontitis, accelerated dental caries, and impaired oral intake leading to poor nutrition. None of these is trivial and all of them are preventable."
      ],
      "peds_mgkg_low": null,
      "peds_mgkg_high": null,
      "peds_max_mg": null,
      "peds_basis": null,
      "peds_unit": null,
      "peds_note": "Same approach in a child: mouth-breathing, dehydration and medication are the usual causes. A persistently dry mouth in a child is not normal and is worth a cause being found.",
      "peds_min_weight_kg": null,
      "peds_max_weight_kg": null,
      "peds_age_min_months": null,
      "peds_age_max_months": null,
      "peds_age_bands": null,
      "peds_doses": null,
      "brands": [],
      "condition_id": "dry-mouth"
    }
  ]
}