Salagen
The active ingredient in Salagen is 'pilocarpine'. It stimulates specific receptors in lacrimal gland and cause increased secretion of tears. The medicinal properties of pilocarpine, including its ability to stimulate salivation, have been recognized for many centuries by the Tupi Indian tribe of northern Brazil, who named this indigenous shrub "jaborandi," or the "slobber-mouth plant."
SALAGEN tablets are currently indicated for 1) the treatment of symptoms of dry mouth from salivary gland hypofunction caused by radiotherapy for cancer of the head and neck; and 2) the treatment of symptoms of dry mouth in patients with Sjogren's syndrome.

Several studies have shown that Salagen is beneficial in dry eye patients. In one study 20 mg per day (four tablets per day) did help (Arch Intern Med.1999;159:174-181), but a higher dose of 30 mg per day was shown to be more beneficial in a different study (Arthritis Rheum. 1997;40(suppl):S202). Salagen was also reported to help in dry eye induced because of radiation therapy (Clin Oncol (R Coll Radiol) 1997;9:62-3).
The most common drug-related adverse experiences included sweating, urinary frequency, and flushing. Salagen cannot be given to patients who have iritis or to those with anatomically narrow angles (gonioscopy finding) because of the risk of precipitating acute angle closure glaucoma. Muscarinic agonists like pilocarpine have been reported to cause visual blurring which may result in decreased visual acuity, especially at night and in patients with central lens changes, and to cause impairment of depth perception. Caution should be advised while driving at night or performing hazardous activities in reduced lighting.
Given what we know so far, the use of Salagen in severe dry eyes especially in patients who have Sjogren's syndrome may be a reasonable management strategy.
Manufacturer web site

Evoxac
The active ingredient in Evoxac is 'cevimeline'. Like salagen, Evoxac stimulates secretion from the lacrimal and salivary glands. As compared with Salagen, Evoxac has a much higher affinity for lacrimal gland receptors, therefore is more effective. Cevimeline was recently approved by the Food and Drug Administration for the treatment of dry mouth in patients with Sjögren syndrome. Because of its extended 5-hour half-life, cevimeline is taken 3 times daily; it seems to have minimal adverse effects at doses of 90 mg/d and is tolerated at doses up to 180 mg/d. The monthly cost of treatment with cevimeline, at the recommended dosage for xerostomia in Sjögren syndrome, is approximately $118 (Archives of Internal Medicine 2002;162:1293-1300).
A recent study showed that cevimeline treatment for 12 weeks is associated with significant improvement of dry eye symptoms in patients with Sjögren's syndrome (Arthritis Rheum 2002;46:3:748-54). Evoxac web site

Dietary Fatty acids (Flaxseed oil) and Dry Eyes
Our diet contains two types of fat (saturated and unsaturated). Recent research has shown that oral therapy with polyunsaturated fatty acids reduces ocular surface inflammation and improves dry eye symptoms (Cornea 2003;22:97-101). In this study patients received tablets containing 28.5 mg linoleic (omega-6 fatty acid) and 15 mg gamma-linolenic acid (omega-3 fatty acid) twice daily for 45 days. Both of these are polyunsaturated fats.

Americans obtain an excess of linoleic (omega-6 fatty acid) through their consumption of beef, dairy, vegetable cooking oils, and vegetable shortenings (i.e. cookies, potato chips, snacks etc). However, the American diet is deficient in gamma-linolenic acid (omega-3 fatty acid). The two best sources of omega-3 fatty acid are fish oil and flaxseed oil.
Dietary modification advice is not straightforward. Recall that (as discussed in the macular degeneration section), increasing the intake of both types of polyunsaturated fats does not help in macular degeneration. Linolenic acid (omega-3 fatty acid) is associated with lessening of macular degeneration risk, but only among individuals with lower intake of linoleic acid (omega-6 fatty acid). So whereas dry eye studies show that pills containing omega-6 fatty acid help dry eye patients, they are not good for macular degeneration.

AgingEye Times Position: As the typical American diet already has more than enough omega-6 fatty acid, we do not think it wise to increase the intake further. In fact, we should reduce the intake of omega-6 fatty acid i.e. eat less beef etc. However it does make sense to increase omega-3 fatty acid intake i.e. eat more fish or take oral flaxseed oil supplement, if you wish.

TheraTears Nutrition is an oral Flaxseed Oil Supplement.
HydroEye is an oral prepration of black currant seed oil and cod liver oil. These provide both omega-3 & omega-6 fatty acids (HydroEye website).

Contact Us Complete the form below to contact us. If you would like a reply, please include your name and email address.