Cevimeline (Oral)

Cevimeline stimulates certain nerves to make more saliva, making it more comfortable and easier to swallow and speak.

Overview

Cevimeline (Evoxac) increases saliva and sweat gland secretions in the body.

It helps treat dry mouth symptoms in people suffering from Sjogren's syndrome. In Sjogren's syndrome, your immune system upsets the glands that produce saliva and tears. It can also attack the joints, blood vessels, kidneys, lungs, nerves, and digestive organs.

  • Cevimeline is in a category of medications known as cholinergic agonists.
  • Evoxac is available in capsule form. It's normally taken thrice a day.
  • Common Cevimeline side effects include nausea, sweating, and runny nose.

Conditions treated

  • Dry mouth

Type of medicine

  • Cholinergic agonist

Side effects

Apart from its desirable effects, Cevimeline can bring about several undesirable effects. While not all of the following effects can happen, if some occur they may require medical attention.

See your doctor straight away if you feel any of these effects while using Cevimeline.

Less common:

  • Itching
  • Fast heartbeat
  • Difficult breathing
  • Blurred vision
  • Bloody/cloudy urine
  • Cough
  • Chest pain
  • Dizziness
  • Cracks in skin
  • Burning, painful, or difficult urination
  • Dry/itching eyes
  • Lower back pain
  • Earache
  • Itching of genital, vaginal, or other area of skin
  • Feeling of continuous movement of surroundings or self
  • Scaling of skin
  • Redness/pain in the eye
  • Skin rash
  • Shortness of breath
  • Buzzing/ringing in the ears
  • Redness or soreness of skin
  • Tense muscles
  • Stiffness of muscles
  • Swelling of lower legs, feet, ankles, or hands
  • Swelling on one side of the jaw and face, with/without pain
  • Ulcers, sores, or white marks on lips, inside of mouth, or tongue

Rare:

  • Chest pain (angina)
  • Swelling of tongue or gums
  • Fainting/lightheadedness when standing up suddenly

Symptoms of overdose

Get emergency medical attention as soon as you can if any of these symptoms of overdose happen while taking Cevimeline:

  • Chest pain
  • Loss of vision or blurred vision
  • Cold, clammy skin
  • Disturbed color vision
  • Continuous and severe diarrhea
  • Difficult/labored breathing
  • Faintness, lightheadedness, or dizziness when standing up suddenly
  • Fast, weak pulse
  • Fast, slow, pounding, or irregular heartbeat
  • Headache
  • Nausea
  • Mental confusion
  • Pounding in ears
  • Sweating
  • Tearing of eyes
  • Shortness of breath
  • Stomach cramps/pain
  • Shaking/trembling of feet or hands

Some Evoxac side effects may happen that normally don't need treatment. They may disappear during treatment while you adapt to Evoxac. Moreover, your healthcare giver may recommend ways to reduce or prevent some of the effects. Consult your healthcare giver if any of these effects are troublesome, persist or you need more information about them.

More common:

  • Nausea
  • Runny/stuffy nose
  • Excessive sweating

Less common:

  • Abdominal pain
  • Constipation
  • Belching
  • Bloating/swelling of face, lower legs, feet, or hands
  • Joint pain or bone pain
  • Bloody nose
  • Change in vision
  • Itching, burning, or dry feeling in the eye
  • Chills
  • Mucus producing cough
  • Diarrhea
  • Dry mouth
  • Decreased touch sensation
  • Depression
  • Eye pain
  • Fever
  • Heartburn
  • Feeling of warmth in the neck, face, arms, and sometimes chest
  • Hiccups
  • Itching
  • Injury
  • Loss of appetite
  • Leg cramps
  • Migraine headache
  • Mood/mental changes
  • Muscle stiffness, aches, or pain
  • Tightness in chest
  • Rapid weight gain
  • Swelling and pain in the inner lining of the eye, eyelid, or eye
  • Pain on one side of the jaw and face
  • Redness, pain, or swelling of joints
  • Postoperative pain
  • Shortness of breath
  • Tooth pain or disorders
  • Vomiting
  • Trembling/shaking of feet or hands
  • Troubled sleeping
  • Unusual bleeding/bruising
  • Watering of mouth
  • Unusual tiredness/weakness
  • Weight loss

Rare:

  • Puffiness or swelling of face
  • Abnormal crying
  • Deep, purple, dark bruise
  • Temperature sensation changes

Dosage

  • Take Cevimeline orally with or without meals, usually thrice a day or as ordered by your physician.
  • Your Cevimeline dosage will depend on your response to treatment and medical problem.
  • Use Cevimeline on a regular basis to fully benefit from it. Be sure to take the medication at the same intervals each day.
  • You can continue to use saliva alternatives or drink water as needed for mouth moisture. This will help your kidneys work properly, as well as prevent dehydration.
  • You may begin to feel some improvement in one or two weeks. However, it can take up to six weeks to enjoy the full benefit. If your condition gets worse or persists, tell your doctor.
  • Overdose symptoms can include headache, confusion, vision problems, tremors, sweating, vomiting, diarrhea, irregular heartbeat, and shortness of breath.
  • Take the missed Cevimeline dose as soon as possible. Don't take the missed dose if it's around time for another dose. Don't take extra medication to offset a missed dose.

Interactions

The effects of certain medications may change if you use them together with other medications or herbal products. This may increase your chances of experiencing severe side effects or could make your medications not work properly. The following drug interactions may happen, but don't always occur. Your healthcare professional can prevent or control interactions by close observation or changing how you take your medications.

To help your healthcare professionals provide you with the best medical care, make sure to tell them about all the medication products you use before commencing treatment with Cevimeline. While using Cevimeline, don't change, stop, or adjust the dose of any other drugs you're taking without your doctor's permission.

Before using Cevimeline, notify your physician if you're taking any of these medications:

  • Cimetidine (Tagamet)
  • Amiodarone (Pacerone, Cordarone)
  • Metronidazole (Protostat, Flagyl)
  • Cyclosporine (Sandimmune, Gengraf, Neoral)
  • Antibiotics like Ciprofloxacin (Cipro), Azithromycin (Zithromax), Ketoconazole (Nizoral),

Itraconazole (Sporanox), Erythromycin (Erythrocin, E-Mycin, Ery-Tab, E.E.S), and Clarithromycin (Biaxin)
Antidepressants such as Sertraline (Zoloft), Escitalopram (Lexapro), Citalopram (Celexa), Paroxetine (Paxil), Fluvoxamine (Luvox), and Fluoxetine (Prozac, Sarafem)
Asthma medications such as Terbutaline (Brethaire, Brethine), Albuterol (Proventil, Ventolin, etc.), Bitolterol (Tornalate), Epinephrine (Asthmahaler, Primatene mist inhaler, Bronkaid), Isoetharine (Bronkosol, Bronkometer), Pirbuterol (Maxair), Salmeterol (Serevent), and Metaproterenol (Alupent, Metaprel)
Blood pressure or blood medications like Acebutolol (Sectral), Diltiazem (Cardizem, Dilacor, Tiazac), Nadolol (Corgard), Timolol (Blocadren), Carvedilol (Coreg), Labetalol (Trandate, Normodyne), Metoprolol (Toprol, Lopressor), Atenolol (Tenormin), Verapamil (Covera, Verelan, Calan, Isoptin), Sotalol (Betapace), Propranolol (Inderal, InnoPran), etc.
HIV/AIDS medication such as Delavirdine (Rescriptor), Amprenavir (Agenerase), Nevirapine (Viramune), Saquinavir (Invirase, Fortovase), Indinavir (Crixivan), Ritonavir (Norvir), and Nelfinavir (Viracept)

These are not all the possible Cevimeline interactions. List all the medication products you take and share the list with your healthcare provider to reduce your risk for severe side effects.

Warnings

Before taking Cevimeline:

Tell your healthcare professionals if you have Cevimeline allergies, or allergies to any other drugs.

Tell your pharmacist as well as your doctor what other medications (prescription and nonprescription), nutritional supplements, and vitamins you're using or plan to use. Make sure to state any of these:

  • Amiodarone (Cordarone, Pacerone)
  • Methodone (Dolophine)
  • Nefazodone
  • Paroxetine (Paxil CR, Paxil, Pexeva)
  • Troleandomycin
  • Quinidine
  • Bupropion (Wellington XL, Wellbutrin SR, Wellbutrin, Zyban)
  • Bethanechol (Urecholine)
  • Chlorpheniramine (Teldrin allergy, Aller-Chlor, Chlor Trimeton, etc.)
  • Cimetidine (Tagamet)
  • Clomipramine (Anafranil)
  • Clarithromycin (Biaxin)
  • Duloxetine (Cymbalta)
  • Fluoxetine (Sarafem, Prozac)
  • Erythromycin (E.E.S, E-Mycin, Erythrocin)
  • Fluvoxamine
  • Ipratropium (Atrovent)
  • Haloperidol (Haldol)
  • Antifungal medicines:
  • Itraconazole (Sporanox)
  • Ketoconazole (Nizoral)
  • Beta blockers:
  • Atenolol (Tenormin)
  • Acebutolol (Sectral)
  • Labetalol (Trandate)
  • Betaxolol (Kerlone)
  • Carvedilol (Coreg)
  • Pindolol
  • Timolol (Blocadren
  • Metoprolol (Toprol XL, Lopressor)
  • Bisoprolol (in Ziac, Zebeta)
  • Nadolol (Corgard)
  • Propranolol (Inderal)
  • Solatol (Betapace)
  • Calcium channel blockers:
  • Diltiazem (Tiazac, Dilacor, Cardizem, etc.)
  • Verapamil (Covera, Calan, Verelan, Isoptin)
  • Certain HIV medications:
  • Ritonavir (Norvir)
  • Nelfinavir (Viracept)
  • Indinavir (Crixivan)
  • Medications for glaucoma, Alzheimer's disease, Parkinson's disease, urinary problems, ulcers, Myastenia Gravis, or irritable bowel syndrome

Many other medicines could also interact with Evoxac, so make sure to notify your healthcare provider about the medicines you take, even those not on this list.

If you'll be using Cevimeline for quite a while, it's vitally important that you be checked by your doctor at regular intervals for signs of you getting too much of the medicine.

Report to your doctor any herbal medicines you're using, especially St John's wort.

Tell your healthcare giver if you have glaucoma (an eye condition), asthma, and acute iritis/uveitis (irritation and swelling inside your eye). Your doctor may order you to not use Cevimeline.

Tell your healthcare provider if you've ever suffered or have a heart attack or chest pain, COPD (a set of lung conditions that includes emphysema and bronchitis), chronic bronchitis, gallstones, kidney stones, or heart disease.

Tell your physician if you're having a baby, want to get pregnant, or breastfeeding. Call your doctor if you conceive while using Cevimeline.

During pregnancy, Cevimeline should be taken only when it's really necessary. Be sure to discuss its benefits and risks with your healthcare professional.

If you're undergoing surgery, for example, dental surgery, notify your dentist or doctor that you're using Cevimeline.

You need to know that Cevimeline can cause vision changes, especially when there isn't enough light or at night. Use the medicine cautiously when doing risky activities in decreased lighting or driving at night.

Alcohol or marijuana may cause more dizziness if taken with Cevimeline. Limit your intake of alcoholic drinks while using Cevimeline. If you're using marijuana, consult your doctor.

You need to know that Cevimeline can make you sweat profusely, which may cause dehydration. Make sure to take lots of water and consult your doctor about preventing dehydration while using Cevimeline.

If your symptoms don't ease within days or they get worse, please see your doctor at once.

Storage

  • Keep Cevimeline at room temperature in a sealed container.
  • Keep Cevimeline away from direct light, heat, and moisture.
  • Keep Cevimeline from freezing.
  • Keep Cevimeline away from children.
  • Don't keep expired medication or one that you no longer use.
  • Ask your healthcare giver how to discard any medication you don't use.

Summary

Don't use Cevimeline (Evoxac) if you have allergies to it, or if you have uncontrolled or untreated glaucoma, asthma, cholelithiasis (gallstones), heart disease, nephrolithiasis (kidney stones), other pulmonary disease, or an eye problem known as iritis or uveitis.

If you'll be taking Evoxac for quite a while, it's vitally important to be checked by your doctor regularly for signs of taking too much Evoxac.

If your symptoms don't get better within days or they deteriorate, please see your doctor immediately.

Don't share Cevimeline with other people. Keep all your regular lab and medical appointments so your doctor can check your progress or look for side effects. For more information, consult your doctor.

Some of Cevimeline side effects may impair your eyesight, especially at night. Take care if you drive or carry out any activity that needs you to see clearly.

Avoid getting dehydrated/overheated in hot weather and during exercise. Cevimeline can make you sweat a lot, and you can more easily become dehydrated while taking this medicine. Follow your doctor's orders for the amount and type of fluids you should take.

Consult your physician before you eat grapefruit and drink its juice while using Cevimeline.

Cevimeline can also be taken for other purposes, so ask for more information from your pharmacist as well as doctor.