School of Dental Medicine, University of Zagreb, Croatian Dental Society - Croatian Medical Association
Abstract
Kserostomija, tj. suhoća usta jest stanje uglavnom uzrokovano uzimanjem lijekova, imunološkim bolestima (Sy. Sjoegren) ili radioterapijom tumora usta i glave. Postoje mnogi ali ne dovoljno učinkoviti terapijski postupci, uključujući i uporabu agonista muskarinskih receptora pilokarpin- hidroklorida. U Hrvatskoj liječenje salivarne hipofunkcije polikarpin-hidrokloridom još nije uvedeno.
U ovome istraživanju cilj je bio ocijeniti učinak peroralne uporabe pilokarpina na male žlijezde slinovnice i ukupnu salivaciju te nadzirati moguće neželjene pojave i subjektivni odgovor bolesnika na terapiju. Bio je to jednostruko slijepi placebo pokus. Deset bolesnika s kserostomijom sudjelovalo je u pokusu. Isključeni su bolesnici sa srčanim i plućnim bolestima te oni kojima se tijekom uključenog ispitivanja 7 dana prije pokusa kemijskom stimulacijom C-vitaminom nije povećao salivarni tok. Pokus je obuhvaćao 7 uzastopnih mjerenja količine sline u vremenskim razmacima od 15 do 30 min, od vremena neposredno prije i nakon jedinstvene doze 5 mg pilokarpin- hidroklorida (5 kapi otopine, Pilokarpin 2%, Pliva, hrvatska). Sekrecija malih slinovnica mjerena je na donjoj usni i nepcu s pomoću Periotrona (Oraflow, Plainview, SAD), a ukupna salivacija mjerna je s piomoću graduiranih epruveta. Svaki je ispitanik ispunio jednostavan upitnik o subjektivnoj percepciji liječenja i o možebitnim nuspojavama. Sljedeći je tjedan procedura ponovljena, ali tada je umjesto pilokarpina upotrebljena dekspantenolna otopina (D-panthenol, Ljekarne Zagreb, Hrvatska) kao placebo.
Pilokarpin je povećao slivaciju i poboljšao simptome u svakog bolesnika. Razlike u sekreciji sline bile su statistički znatne i u usporedbi sa stanjem prije ordiniranja pilokarpina i u usporedbi s placebom (p = 0,01). Nije bilo zabilježenih nepoželjnih pojava ni nakon ordiniranja pilokarpina ni nakon placeba. Nakon poboljšanja salivacije učinak pilokarpina se vremenom smanjuje, što je zabilježeno tijekom promatranja bolesnika.
Uzimajući u obzir kontraindikacije i neželjene učinke, rezultati našeg ispitivanja upućuju da bi se pilokarpin trebao redovito upotrebljavati u liječenju kserostomije.Xerostomia, i.e. oral dryness, is mainly caused by side effects of medications, immunologic diseases, e.g. Sy. Sjoegren, and radiation treatment for oral and neck cancer. There are variable, although far from satisfactory, treatment options, including that of muscarinic receptor agonist pilocarpine-hydrochloride. Pilocarpine treatment of salivary hypofunction is not yet an established method in croatia.
The aim of this preliminary study was to assess the autcome of oral administration of pilocarpin on minor salivary glands and whole saliva production, as well as to monitor possible side effects and patients subjective responses to treatment.
Is was a single blind-placebo controlled trial. Ten patients suffering from xerostomia underwent this trial. Patients with cardiac or pulmonary diseases were excludet, as well as those that did not show any increase in salivary flow rate after administration of ascorbic acid solution (chemical stimulant) at inclusion testing one week prior to the experiment. The experiment comprised 7 repeated measurements in time intervals of 15-30 min., from the baseline up to 2 h after single oral administration of 5 mg of pilocarpine hydrochloride ( 5 drops of slution, Pilokarpin 2%, pliva, Croatia). The flow rate of minor salivary glands was measured on the lower lip and palate by means of Periotron (Oraflow Inc., Plainview, USA) and whole saliva was collected in calibrated test tubes . A simple questionnaire was filled in to record patients subjective perception of treatment. The same procedure was repeated one week later, when dexpanthenol drops (DPanthenol, Ljekarne Zagreb, Croatia) were used as placebo instead of pilocarpine.
Pilocarpine increased salivary output and gave symptomatic relief in every patient. The differences in salivary output were significant both compared to baseline and to placebo controls (p = 0,01). There were no side effects during the trial, either after administration of pilocarpine; or placebo. After increasing salivary flow rate the action of pilocarpine decrease in time, which was recordable during the observation session.
Respecting possible contraindications and side effects, according to our finding pilocarpine should be regulary used in treatment of xerostomia
