Pilocarpine for Xerostomia — MFDS Part 1 MCQ
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Correct answer: B — A patient with severe xerostomia following head and neck radiotherapy
Explanation lettering: B = shown as A · A = shown as B · E = shown as C · C = shown as E
A is correct. Pilocarpine is a cholinergic parasympathomimetic drug with predominantly muscarinic activity. It stimulates exocrine glands and is licensed to alleviate severe xerostomia caused by head and neck irradiation; it is also licensed for dry mouth and dry eyes in Sjögren's syndrome. However, uncontrolled asthma makes option B inappropriate because pilocarpine can increase bronchial smooth-muscle tone, airway resistance and secretions. It produces miosis rather than pupillary dilatation and is contraindicated when miosis is undesirable, including acute iritis, so C is incorrect. Stimulating salivation would aggravate sialorrhoea in D. Transient fasting-related dryness in E ordinarily requires hydration rather than a systemic secretagogue. Common cholinergic adverse effects include sweating, urinary frequency and increased salivation.
Reference: Norgine Pharmaceuticals Limited. Salagen 5 mg Film Coated Tablets, Summary of Product Characteristics, sections 4.1, 4.3, 4.4, 4.8 and 5.1. Revised 2025. https://www.medicines.org.uk/emc/product/1370/smpc