Cevimeline

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.

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 Y
PubChem CID	83898
DrugBank	DB00185 Y
ChemSpider	75707 Y
UNII	K9V0CDQ56E
KEGG	D07667 Y
ChEBI	CHEBI:3568 N
ChEMBL	ChEMBL1201267 N
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 Y Key:WUTYZMFRCNBCHQ-PSASIEDQSA-N Y
NY (what is this?)  (verify)

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.

See also

• Pilocarpine — a similar parasympathomimetic medication for dry mouth (xerostomia)
• Bethanechol — a similar muscarinic parasympathomimetic with longer-lasting effect