# Dry mouth (xerostomia) - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - 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 - Verified date: 2026-09 ## 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) ## Treatment metadata - Pilocarpine — 5 mg — oral.solid - Find the cause, protect the teeth, replace the saliva (What works here) ## Complete treatment card ```text DRY MOUTH (XEROSTOMIA) 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 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) (2026-09) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (8) - A sensation of oral dryness is the core complaint - Burning or soreness of the mouth may be reported - Taste can be diminished or altered - Patients often carry a water bottle to sip while swallowing - Dry foods such as crackers become difficult to swallow - Saliva can feel thickened - Acidic or spicy foods may become uncomfortable to eat - Appetite loss and weight loss can accompany the dryness [poor appetite · weight loss] SIGNS - what you find (6) - The tongue and lips may appear fissured - Atrophy of the filiform papillae may be seen on the tongue [atrophy] - The oral mucosa can look red and parched - A gloved finger can stick to the oral mucosa on palpation - The floor of the mouth may show an obvious lack of saliva - Dry eyes and parotid gland swelling may precede oral symptoms when Sjogren syndrome is the cause TESTS (5) - Salivary hyposalivation is defined by output below 0.5 to 0.7 mL/min stimulated, or below 0.1 mL/min unstimulated - Sialography can identify salivary stones or masses, and 3D MR sialography shows promise after radiation exposure - When an underlying systemic disease - sarcoidosis, amyloidosis, or a gland mass - is suspected, gland biopsy may be warranted - Secondary Sjogren syndrome can show a raised ESR, anemia, leukopenia, or rheumatoid factor and autoantibodies on labs - A lip biopsy in Sjogren syndrome usually shows focal lymphocytes infiltrating the minor salivary glands IF NOT THIS - what else fits (11) - Primary Sjogren syndrome is on the differential - Idiopathic sicca syndrome is on the differential - Other autoimmune diseases are on the differential - Drug-induced sicca syndrome is on the differential - Sarcoidosis is on the differential - Granulomatosis with polyangiitis is on the differential - IgG4-related disease is on the differential - Chronic hepatitis C or HIV is on the differential - Graft-versus-host disease is on the differential - End-stage renal disease is on the differential - Prior head and neck radiation therapy is on the differential Source StatPearls "Xerostomia" - disease-level clinical article Status traced to the source above Rx: The only drug with a stated dose - and it cannot be dispensed here | What primary care can actually deliver in Egypt THE ONLY DRUG WITH A STATED DOSE - AND IT CANNOT BE DISPENSED HERE 1. PILOCARPINE [1st line] Adult 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 - trial of up to 3 months, then continued only if it helped Peds 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. Choice Alternatives from the same article, none of them obtainable in Egypt: "The cevimeline dose is 30 mg 3 times a day", also FDA-approved and also absent from the register; topical physostigmine, where "A gel containing 1.8 mg of physostigmine may provide relief for about 2 hours"; malic acid, which the article says has shown some benefit where the dry mouth is drug-induced; and anethole trithionate. Because none of these can be dispensed here, the practical treatment is the row below - and stopping the drug that caused it. 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 Why 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. Caution 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. Egypt no Egyptian brand matched - prescribe by generic name WHAT PRIMARY CARE CAN ACTUALLY DELIVER IN EGYPT 2. FIND THE CAUSE, PROTECT THE TEETH, REPLACE THE SALIVA (WHAT WORKS HERE)[2nd line] Adult 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. - Assess, then decide Peds 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. 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 Why 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. Caution 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. Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)