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Cevimeline
Clinical data
Trade names	Evoxac
AHFS/Drugs.com	Monograph
MedlinePlus	a608025
Pregnancy; category	C;
Routes of; administration	By mouth (capsules)
ATC code	N07AX03 (WHO) ;
Legal status
Legal status	In general: ℞ (Prescription only);
Pharmacokinetic data
Protein binding	<20%
Identifiers
	IUPAC name (2R,2R)-2'-Methylspiro[4-azabicyclo[2.2.2]octane-2,5'-[1,3]oxathiolane];
CAS Number	107233-08-9 ;
PubChem CID	83898;
DrugBank	DB00185 ;
ChemSpider	75707 ;
UNII	K9V0CDQ56E;
KEGG	D07667 ;
ChEBI	CHEBI:3568 ;
ChEMBL	ChEMBL1201267 ;
CompTox Dashboard (EPA)	DTXSID801342027 DTXSID40274384, DTXSID801342027 ;
Chemical and physical data
Formula	C10H17NOS
Molar mass	199.31 g·mol−1
3D model (JSmol)	Interactive image;
	SMILES O1[C@H](SC[C@@]12CN3CCC2CC3)C;
	InChI InChI=1S/C10H17NOS/c1-8-12-10(7-13-8)6-11-4-2-9(10)3-5-11/h8-9H,2-7H2,1H3/t8-,10-/m1/s1 ; Key:WUTYZMFRCNBCHQ-PSASIEDQSA-N ;
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Cevimeline (trade name Evoxac) is a synthetic analog of the natural alkaloid muscarine with a particular agonistic effect on M₁ and M₃ receptors. It is used in the treatment of dry mouth and Sjögren's syndrome.

Medical uses

Cevimeline is used in the treatment of xerostomia (dry mouth)^[1]^[2] and Sjögren's syndrome.^[1] It increases the production of saliva.^[2]

Side effects

Known side effects include nausea, vomiting, diarrhea, excessive sweating, rash, headache, runny nose, cough, drowsiness, hot flashes, blurred vision, and difficulty sleeping.^[3]

Contraindications include asthma and angle closure glaucoma.^{[citation needed]}

Mechanism of action

Cevimeline is a cholinergic agonist.^[2] It has a particular effect on M₁ and M₃ receptors.^[2] By activating the M₃ receptors of the parasympathetic nervous system, cevimeline stimulates secretion by the salivary glands, thereby alleviating dry mouth.

References

^ ^a ^b Ono M, Takamura E, Shinozaki K, Tsumura T, Hamano T, Yagi Y, Tsubota K (July 2004). "Therapeutic effect of cevimeline on dry eye in patients with Sjögren's syndrome: a randomized, double-blind clinical study". American Journal of Ophthalmology. 138 (1): 6–17. doi:10.1016/j.ajo.2004.02.010. PMID 15234277.
^ ^a ^b ^c ^d Fox RI, Fox CM (2019). "Management of Sjögren's". Dubois' Lupus Erythematosus and Related Syndromes (9th ed.). Elsevier. pp. 745–758. doi:10.1016/B978-0-323-47927-1.00060-8. ISBN 978-0-323-47927-1.
^ "Cevimeline". MedicineNet. Retrieved 12 October 2007.