Evoxac (cevimeline)
An approved treatment for Sjögren's Syndrome.
The same compound appears under different names depending on the context. Here is how to identify Cevimeline wherever you encounter it, plus the key facts at a glance.
- Generic name
- Cevimeline
- Brand name
- Evoxac
- Development code
- SNI-2011
- Drug class
- Muscarinic agonist (M1/M3 selective)
- Manufacturer
- Cosette Pharmaceuticals (brand Evoxac); generics from several companies
- How it's taken
- Taken as a 30 mg oral capsule, 3 times daily.
An oral muscarinic agonist approved specifically for dry mouth symptoms in Sjögren's syndrome. Cevimeline is more selective than pilocarpine for the M1 and M3 receptors on salivary glands, which may result in fewer sweating and cardiovascular side effects.
Where Cevimeline fits
One of 2 FDA-approved oral secretagogues for Sjögren's dry mouth (alongside pilocarpine). The M1/M3 selectivity may offer a better side effect profile for some patients, particularly those who experience excessive sweating with pilocarpine. Both are symptomatic treatments only; disease-modifying therapies remain in clinical development.
How Cevimeline works
Cevimeline works on the same principle as pilocarpine: stimulating the remaining functional salivary and lacrimal gland cells to produce more moisture. However, cevimeline is more selective for the M1 and M3 muscarinic receptors that are most abundant on salivary glands, rather than activating all muscarinic receptor subtypes equally.
This selectivity may provide two advantages: stronger stimulation of saliva production and fewer off-target effects like sweating (which is driven primarily by M2/M3 receptors on sweat glands). Patients who experience excessive sweating with pilocarpine sometimes tolerate cevimeline better.
Like pilocarpine, cevimeline is a symptomatic treatment only. It does not address the underlying autoimmune destruction of glands and must be taken continuously to maintain its effect.
Mechanism: Selective M1 and M3 muscarinic receptor agonist that stimulates salivary and lacrimal gland secretion with greater receptor selectivity than pilocarpine
Side effects and safety
The most common side effects include excessive sweating (though often less than with pilocarpine), nausea, diarrhea, rhinitis (runny nose), and upper respiratory infections. Visual disturbances and excessive tearing can occur. Cevimeline should not be used in patients with uncontrolled asthma, narrow-angle glaucoma, or acute iritis. The label also warns that it can change heart rate and rhythm and can narrow the airways, so people with heart disease, controlled asthma, chronic bronchitis, or COPD need close medical supervision. It can blur vision, especially at night, so take care driving in the dark; people with a history of kidney stones or gallstones should use it with caution; and anyone who sweats heavily should drink extra water to avoid dehydration. Compared to pilocarpine, cevimeline may cause less sweating due to its greater M3 selectivity on salivary glands.
This is not a complete list of side effects. Talk to your doctor or pharmacist about what to expect and when to seek medical attention.
Taking Cevimeline
Taken as a 30 mg oral capsule, 3 times daily. Effects typically begin within 60-90 minutes and last approximately 4-6 hours. Should be taken with water. Food can delay absorption.
Availability and cost
Generic versions may be available at a lower cost. Ask your pharmacist.
Help paying for Evoxac
Pick your insurance to see which help fits. Drugmaker copay cards can't be used with Medicare, Medicaid or TRICARE; charity funds are the usual route there.
No drugmaker assistance program for this medicine is published on the maker's official pages.
Good to know: Cevimeline is sold as a generic by several companies (e.g. Lupin). No manufacturer program for brand Evoxac was found on an official page.
Clinical trial results
Placebo-controlled trials demonstrated that cevimeline 30 mg 3 times daily significantly improved salivary flow rate and patient-reported dry mouth symptoms compared to placebo in Sjögren's syndrome patients. The trials supported FDA approval specifically for dry mouth symptoms associated with Sjögren's syndrome.
Development history
Developed by Daiichi Sankyo (as SNI-2011), cevimeline received FDA approval in January 2000 specifically for dry mouth symptoms in Sjögren's syndrome. It was designed as a more selective alternative to pilocarpine with potentially improved tolerability. Generic versions are now available.
Explore Sjögren's Syndrome trials
Other Sjögren's Syndrome treatments
Common questions about Cevimeline
▸What is Cevimeline (Evoxac)?
An oral muscarinic agonist approved specifically for dry mouth symptoms in Sjögren's syndrome. Cevimeline is more selective than pilocarpine for the M1 and M3 receptors on salivary glands, which may result in fewer sweating and cardiovascular side effects.
▸How does Cevimeline work?
Cevimeline works on the same principle as pilocarpine: stimulating the remaining functional salivary and lacrimal gland cells to produce more moisture. However, cevimeline is more selective for the M1 and M3 muscarinic receptors that are most abundant on salivary glands, rather than activating all muscarinic receptor subtypes equally.
This selectivity may provide two advantages: stronger stimulation of saliva production and fewer off-target effects like sweating (which is driven primarily by M2/M3 receptors on sweat glands). Patients who experience excessive sweating with pilocarpine sometimes tolerate cevimeline better.
Like pilocarpine, cevimeline is a symptomatic treatment only. It does not address the underlying autoimmune destruction of glands and must be taken continuously to maintain its effect.
▸What are the side effects of Cevimeline?
The most common side effects include excessive sweating (though often less than with pilocarpine), nausea, diarrhea, rhinitis (runny nose), and upper respiratory infections. Visual disturbances and excessive tearing can occur. Cevimeline should not be used in patients with uncontrolled asthma, narrow-angle glaucoma, or acute iritis. The label also warns that it can change heart rate and rhythm and can narrow the airways, so people with heart disease, controlled asthma, chronic bronchitis, or COPD need close medical supervision. It can blur vision, especially at night, so take care driving in the dark; people with a history of kidney stones or gallstones should use it with caution; and anyone who sweats heavily should drink extra water to avoid dehydration. Compared to pilocarpine, cevimeline may cause less sweating due to its greater M3 selectivity on salivary glands.
▸How is Cevimeline taken?
Taken as a 30 mg oral capsule, 3 times daily. Effects typically begin within 60-90 minutes and last approximately 4-6 hours. Should be taken with water. Food can delay absorption.
▸Is Cevimeline FDA approved?
Yes, Cevimeline (Evoxac) is FDA approved (2000) for the treatment of Sjögren's Syndrome.
▸What is the difference between cevimeline and pilocarpine for Sjogrens?
Both stimulate saliva production. Cevimeline (Evoxac) is more selective for salivary gland receptors (M1/M3), which may cause less sweating than pilocarpine. Pilocarpine acts on a broader range of receptors. Neither modifies the underlying disease.
Sources and references
Every factual claim on this page is drawn from the public sources listed below. Click any reference to open the original document.
- U.S. Food and Drug Administration. EVOXAC (cevimeline HCl) Capsules Label. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=dac32a9b-05b8-42c2-9a29-d885a9279456
- Archives of Internal Medicine. Cevimeline for the Treatment of Xerostomia in Patients with Sjögren's Syndrome. https://pubmed.ncbi.nlm.nih.gov/11231703/