Salivary stimulation by prolonged release of pilocarpine in Sjögren’s syndrome.

Jesús Rodríguez-Pulido, Gloria Martínez-Sandoval, Norma Rodríguez-Franco, María Chapa-Arizpe, Janett Riega-Torres, Mario Garza-Elizondo

Abstract


Introduction: Prolonged drug delivery in the oral cavity offers many advantages, such as reducing adverse effects. Pilocarpine is an FDA-approved parasympathomimetic drug for the treatment of glandular hypofunction; however, its adverse effects limit its use. Objective: To evaluate the stimulation of salivary flow by the use of pilocarpine-releasing films, as well as their effects on the symptoms of xerostomia and adverse effects in patients with Sjögren's syndrome (SS). Materials and methods: Hy­droxypropylmethylcellulose (Methocel K4MCR) films were prepared in 1% acetic acid and pilocarpine was added under magnetic stirring. The pH and thickness, as well as diffusion uniformity and kinetics of drug release per cm2 were evaluated by spectrophotometry. The films were tested sublingually in 40 patients with Sjögren's syndrome for a period of two weeks. Changes in their salivary flow were evaluated by analyzing samples of total saliva. Additionally, patients were screened for symptoms of xerostomia and adverse effects. Results: The films had a pH of 2.91±0.035, a thickness of 0.06866±0.00152 μm, and a diffusion uniformity of 91% per cm2. Use of the films resulted in an increase in salivary flow in both primary and secondary Sjögren's syndrome, but this increase was only significant in primary SS.  Conclusion: Films showed optimal physicochemical properties for their administration, and proved effective in stimulating salivary flow without causing adverse effects during their administration.


Keywords


Hyposalivation; Sjögren's syndrome; Pilocarpine; Hydroxypropylmethylcellulose; Xerostomia.

References


Yoshimoto K, Fujimoto T, Itaya-Hironaka A, Miyaoka T, Sakuramoto-Tsuchida S, Yamauchi A, Takeda M, Kasai T, Nakagawara K, Nonomura A, Takasawa S. Involvement of autoimmunity to REG, a regeneration factor, in patients with primary Sjögren’s syndrome. Clin Exp Immunol. 2013;174(1):1–9.

Maślińska M, Przygodzka M, Kwiatkowska B, Sikorska-Siudek K. Sjögren’s syndrome: still not fully understood disease. Rheumatol Int. 2015;35(2):233–41.

Mathews DP, Kokich VG. Accelerating tooth movement: the case against corticotomy-induced orthodontics. Am J Orthod Dentofacial Orthop. 2013;144(1):5–13.

Triana S, Rodríguez J, Garza B, Martínez G, Rodrígue N. Relación entre Periodontitis y Artritis Reumatoide. Revisión de Literatura. Odontol Actual. 2016; 13(160):44-7.

Patel R, Shahane A. The epidemiology of Sjögren’s syndrome. Clin Epidemiol. 2014;30(6):247–55.

Goldblatt F, O’Neill SG. Clinical aspects of autoimmune rheumatic diseases. Lancet. 2013;382(9894):797–808.

González S, Sung H, Sepúlveda D, González M, Molina C. Oral manifestations and their treatment in Sjögren’s syndrome. Oral Dis. 2014;20(2):153–61.

Rodríguez J, Martínez G, Rodríguez N, Chapa M, Solis J. Dental perspective on Sjögren’s syndrome: literature review. J Oral Res. 2015;4(3):211–22.

Tanigawa T, Yamashita J, Sato T, Shinohara A, Shibata R, Ueda H, Sasaki H. Efficacy and safety of pilocarpine mouthwash in elderly patients with xerostomia. Spec Care Dentist. 2015;35(4):164–9.

Silva G, Fontinele L, de Souza J, Mendes R, Cunha L. Technological Development And Evaluation On Sialagogue Activity Of A Spray-Like Liquid Formulation Of Pilocarpine. Afr J Pharm Pharmacol. 214;8(35):868–74.

Khosravani N, Birkhed D, Ekström J. The cholinesterase inhibitor physostigmine for the local treatment of dry mouth: a randomized study. Eur J Oral Sci. 2009;117(3):209–17.

Noaiseh G, Baker JF, Vivino FB. Comparison of the discontinuation rates and side-effect profiles of pilocarpine and cevimeline for xerostomia in primary Sjögren’s syndrome. Clin Exp Rheumatol. 2014;32(4):575–7.

Gibson J, Halliday JA, Ewert K, Robertson S. A controlled release pilocarpine buccal insert in the treatment of Sjögren’s syndrome. Br Dent J. 2007;202(7):E17–discussion 404-5.

Perioli L, Ambrogi V, Angelici F, Ricci M, Giovagnoli S, Capuccella M, Rossi C. Development of mucoadhesive patches for buccal administration of ibuprofen. J Control Release. 2004;99(1):73–82.

Rodríguez J, Sánchez R, Garza M, Nakagoshi M, Solis J, Arévalo K, Garza E. Salivary stimulation by prolonged release of pilocarpine using films in diabetic rats. J Oral Res. 2015;4(2):103–8.

Rodríguez J, Sánchez R, Garza M, Nakagoshi M, Solís J, Arévalo K, Garza E. Physicochemical and antimicrobial evaluation of chitosan and hydroxypropyl methylcellulose films for prolonged release of pilocarpine. J Oral Res. 2015;4(1):25–31.

Cavallari C, Fini A, Ospitali F. Mucoadhesive multiparticulate patch for the intrabuccal controlled delivery of lidocaine. Eur J Pharm Biopharm. 2013;83(3):405–14.

Lockhart PB, Fox PC, Gentry AC, Acharya R, Norton HJ. Pilot study of controlled-release pilocarpine in normal subjects. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1996;82(5):517–24.


Full Text: PDF

Refbacks

  • There are currently no refbacks.




Creative Commons License
This work is licensed under a Creative Commons Attribution 3.0 License.

Corresponding: Facultad de Odontología, Universidad de Concepción, Chile. Roosevelt 1550, Concepción, Chile. Phone +56-41-2204232 - Fax +56-41-2243311- Mailbox 160-C, Concepción, Chile. E-mail journal@joralres.com.