Cevimeline

( Evoxac )

Medically Reviewed by Dr. Harshi Dhingra, M.D.

Last Reviewed: Sep 19, 2023

Warnings


Cevimeline Risks, Warnings, and Complications


Cevimeline can cause serious health problems in some people. Talk to your doctor about other treatment options for dry mouth from Sjögren’s if you are at an increased risk of complications from this medicine. Some of the risks of cevimeline use include:

  • ALLERGIC REACTIONS: In a small number of people, cevimeline can cause an unusual or allergic reaction. Before starting treatment with this medicine, tell your healthcare provider if you have a history of allergy to cevimeline. Seek emergency medical help if you develop a skin rash, hives, itching, swelling, or difficulty breathing.

  • CARDIOVASCULAR DISEASE: Taking cevimeline can cause changes in cardiac conduction and heart rate. This medication should be used with caution and under medical supervision in people with heart problems, including angina (chest pain) and previous myocardial infarction (heart attack). Tell your doctor immediately if you develop changes in heart rate or blood pressure, chest pain, or an irregular heartbeat while on this medicine.

  • LUNG DISEASE: Cevimeline can increase bronchial secretions, airway resistance, and bronchial smooth muscle tone and make it harder to breathe. This medication should be used with caution in people with asthma, chronic bronchitis, and chronic obstructive pulmonary disease (COPD). Your healthcare provider may not prescribe cevimeline if you have uncontrolled asthma or COPD. 

  • EYE PROBLEMS: Taking cevimeline can cause blurred vision and difficulty with depth perception, especially at night. You may not be able to take this medication if you have certain eye conditions such as narrow angle glaucoma. Exercise caution when driving at night or performing hazardous activities in low-light conditions while on cevimeline.


Precautions Before Starting Cevimeline

Tell your doctor if you have had an allergic reaction to cevimeline, any of the active or inactive ingredients in cevimeline capsules, or any other medications. Your pharmacy can give you a list of ingredients.

Give your doctor or pharmacist a complete list of your medications, including prescription drugs, nonprescription drugs, vitamins, supplements, and herbal products such as St. John’s Wort. This can help avoid possible interactions between cevimeline and your other medicines.

Give your doctor a complete medical history. Cevimeline may not be right for people with certain health conditions, such as asthma, chronic obstructive pulmonary disease (chronic bronchitis, emphysema), acute iritis or uveitis (inflammation in the eye), narrow-angle glaucoma, chest pain, heart attack, heart disease, kidney stones, or gallstones.

Tell your doctor if you are pregnant, could be pregnant, or are planning a pregnancy. It is unclear if the drug passes into breast milk. Tell your doctor if you are breast feeding a nursing baby. 

Precautions During Use of Cevimeline

Keep all your medical and lab appointments while on cevimeline. Tell your health care professional if your symptoms do not improve or get worse.

Cevimeline can affect the sweat glands and cause increased sweating. Drink plenty of water to prevent dehydration and heat stroke, especially in hot weather or when exercising outdoors. Take measures to decrease sweating, such as exercising indoors. Talk to your doctor about what to do should you become dehydrated. 

Cevimeline can cause blurred vision and difficulties with depth perception. Drive carefully, especially at night, and exercise caution while performing hazardous activities in low-light conditions.

Tell all your healthcare providers you are on cevimeline, especially before any surgical procedures, including dental treatments.

Tell your healthcare professional if you become pregnant while on cevimeline or plan to breast feed.

Cevimeline Drug Interactions

Concomitant administration of cevimeline and certain other drugs can affect how the medicines work. Possible interactions between cevimeline and other medications can increase the risk of serious adverse events. Your doctor may change the dose of your medications, switch you to another medication, or monitor you carefully for side effects if there are known interactions between cevimeline and your other drugs. Cevimeline can have drug interactions with the following medications:

  • Medications used to treat a cardiac arrhythmia such as amiodarone (Cordarone, Pacerone) and quinidine
  • Antifungal drugs such as itraconazole (Sporanox) and ketoconazole (Nizoral)
  • Medications prescribed for high blood pressure, such as beta blockers, for example, atenolol (Tenormin), acebutolol (Sectral), bisoprolol (Zebeta), betaxolol (Kerlone), carvedilol (Coreg), metoprolol (Toprol XL, Lopressor), labetalol (Trandate), nadolol (Corgard), sotalol (Betapace), propranolol (Inderal), timolol (Blocadren), and pindolol
  • Calcium channel blockers such as verapamil (Covera, Calan, Verelan, Isoptin) and diltiazem (Cardizem, Tiazac, Dilacor, others)
  • Medications used to treat bladder problems, such as bethanechol (Urecholine)
  • Antidepressants such as bupropion (Wellbutrin, Wellbutrin XL, Wellbutrin SR, Zyban), clomipramine (Anafranil), fluoxetine (Prozac, Sarafem), duloxetine (Cymbalta), fluvoxamine, nefazodone, and paroxetine (Pexeva, Paxil, Paxil CR)
  • Cold and allergy medications such as chlorpheniramine (Teldrin Allergy, Aller-Chlor, Chlor-Trimeton, others)
  • Medications used to treat excess stomach acid (H2 blockers), such as cimetidine (Tagamet)
  • Certain antibiotics like clarithromycin (Biaxin), erythromycin (Erythrocin, E-Mycin, E.E.S.), and troleandomycin
  • Antipsychotic medications such as haloperidol (Haldol)
  • Medications prescribed for lung conditions, such as ipratropium (Atrovent)
  • Certain HIV medications such as ritonavir (Norvir), indinavir (Crixivan), and nelfinavir (Viracept) 
  • Medications prescribed for motion sickness, stomach ulcers, irritable bowel syndrome, urinary problems, Alzheimer's disease, glaucoma, myasthenia gravis, and Parkinson's disease
  • Opioid pain medications such as methadone (Dolophine)

The above list may not include all the possible drug interactions of cevimeline. Give your health care professional a complete list of all the medications you are taking, including prescription drugs, non-prescription medicines, dietary supplements, and herbal remedies. Also, tell your healthcare provider if you smoke, drink alcohol, or use recreational drugs because some of these substances can cause serious health complications when used with prescription and over-the-counter medicines.