Sjogren’s Syndrome is not very common but I do see this diagnosis in practice periodically. This disease has two major symptoms that pharmacists should pay EXTREMELY close attention to. Placing a focus on medications that exacerbate Sjogren’s Syndrome is a critical role of the pharmacist. The disease can cause significant dry eyes and dry mouth. Those two symptoms should send off alarm bells in the heads of pharmacists across the world. You will often see these patients frequently using artificial tears and saliva substitutes to combat the symptoms of the disease.
As you can imagine, anticholinergics can exacerbate these two symptoms. Whenever I see a diagnosis of Sjogren’s Syndrome, I always go through the medication list to look for drugs that have anticholinergic activity. Commonly used oral medications with a high degree of anticholinergic activity include TCAs (pharmacology podcast review), first-generation antihistamines, anti-Parkinson’s agents (i.e. benztropine and trihexyphenidyl), urinary anticholinergics like oxybutynin and tolterodine, some antipsychotics (many first-generation agents and clozapine).
I have seen medications that exacerbate Sjogren’s Syndrome get overlooked. Inhaled anticholinergics have local effects on the mouth. While they aren’t likely to play a role in causing dry eyes, medications like ipratropium, aclidinium, glycopyrronium, tiotropium, umeclidinium, and revefenacin will certainly have the potential to contribute to dry mouth.
Medications Used to Manage Sjogren’s Syndrome
You may not have a perfect diagnosis list when working with a patient and that’s can be overcome by paying attention. There are two medications (besides artificial tears and saliva substitutes) that you have to keep an eye out for, no pun intended. When you see a patient with a prescription for Restasis, that patient will have dry eyes which should prompt you to look for anticholinergics. The other prescription order to pay attention to is pilocarpine. This can be used for the management of dry mouth and I mentioned this previously in my post on trospium (a urinary anticholinergic).
To put a nice bow on this summary of medications that exacerbate Sjogren’s Syndrome, there are two takeaway messages I want you to remember. Look for anticholinergic medications when you see this diagnosis so we aren’t making things worse for our patients. Secondly, identify medications that may treat the effects of Sjogren’s Syndrome and ensure we are doing everything we can to avoid contributing to the prescribing cascade.
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