Pilocarpine for Radiotherapy-Induced Dry Mouth and Dry Eyes: A Review of Clinical Effectiveness, Cost-Effectiveness, and Guidelines

Key Message

Two systematic reviews (one with meta-analysis), were identified regarding the effectiveness of pilocarpine for the treatment of dry mouth caused by radiotherapy of the head or neck. 

The identified literature was at high risk of bias and revealed conclusions that were based on studies of limited quality. One study found no difference between a pilocarpine mouthwash and saliva substitutes, while another study found more patients responded favourably to 5 mg pilocarpine lozenges over tablets, lozenges of a lower strength, and inactive lozenges.

One evidence-based guideline was identified regarding the use of pilocarpine for dry mouth caused by radiotherapy of the head or neck. It recommends that pilocarpine be offered, if available.

No evidence regarding the cost-effectiveness of pilocarpine for the treatment of dry mouth caused by radiotherapy of the head or neck was identified. Furthermore, no evidence regarding the clinical effectiveness and cost-effectiveness of pilocarpine for the treatment of dry eyes caused by radiotherapy of the head or neck was identified.

The limitations of the included studies, such as the high risk of bias of the primary studies included in the systematic review and the low-quality evidence upon which guideline recommendations were based, should be considered when interpreting the results.