- 期刊
- OpenAccess
Effect of Pilocarpine on Xerostomia and Interdialytic Weight Gain in Hemodialyzed Patients
毛果芸香鹼對血液透析患者口乾和體重增加的治療效果
並列摘要
Hemodialysis (HD) patients had lower salivary flow rates than those of healthy subjects. However, it is unclear whether xerostomia & associated symptoms in HD patients, including: dry mouth, oral discomfort, difficulty in speaking, sleeping, chewing, swallowing, and wearing dentures, correlate with decreased salivary flow rates. Oral pilocarpine can significantly increase salivary flow rates and relived symptoms of xerostomia in patients with Sjogren’s syndrome or patients receiving irradiation therapy for head & neck cancer. We try to evaluate the effects of oral pilocarpine on salivary flow rates, dry mouth, thirst & interdialytic weight gain (IDWG) in HD patients. Firstly, we studied the effect of ten drops of 1% pilocarpine solution (i.e. pilocarpine 5 mg) on salivary flow rates in 9 HD patients. The-min unstimulated whole saliva (flow rate, ml/min) was collected at 0,30th, 60th & 90th min after oral pilocarpine. Secondly, we evaluated the correlation between symptoms of xerostomia and IDWG by 100 mm visual analog scale (VAS) in 43 HD patients. Thirdly, we assessed the efficacy & safety of pilocarpine treatment by a seven ( 2 + 3 +2) – week randomized, single-blind, placebo-controlled, crossover study of oral pilocarpine in 84 HD patients. Symptoms of xerostomia were measured by a VAS, a 3-point verbal rating scale (VRS) and IDWG at baseline, 1st hr, 3rd & 6th HD sessions after oral pilocarpine. Salivary flow rates significantly increased (p＜ 0.03) at 30th, 60th & 90th min after oral pilocarpine There were significant correlations between xerostomia and associated symptoms. But there was no correlation between symptoms of xerostomia and mean IDWG (P ＞ 0.05). In crossover study, (1) using VRS. HD patients ha more improvement of xerostomia at 1st hour, 3rd and 6th HD sessions after pilocarpine compared to placebo; (2)using VAS, HD patients had more improvement of xerostomia at 3rd and 6th HD sessions after pilocarpine compared to placebo, (3) about changes of VAS, HD patients had a significantly decreased mean scores of xerostomia at 3rd and 6th HD sessions after pilocarpine; (4) both IDWG on alternative HD day (placebo: 3.62 kg vs. pilocarpine: 3.38 kg, p=0.013) and mean interdialytic weight gains within two weeks of HD (placebo: 3.83 kg vs. pilocarpine: 3.66 kg, p =0.013) significantly decreased after pilocarpine. The primary adverse drug events (ADE) related to oral pilocarpine were sweating & vomiting, but there were no serious ADE. In conclusion, oral pilocarpine can significantly increase salivary flow rates and relieve symptoms of xerostomia in HD patients, without any serious ADE. Although IDWG statistically significantly decreased after pilocarpine, but there was no clinical significance. Therefore, xerostomia (i.e. decreased salivary flow rates) might be not a major dipsogenic factor and also not responsible for IDWG in HD patients.