Buccal drug delivery technologies for patient-centred treatment of radiation-induced xerostomia (dry mouth).
Level 5 - mechanism / opinion, no new human data
Narrative review of drug delivery technologies without primary clinical trial data or systematic review methodology.
PubMed 29425763 · doi:10.1016/j.ijpharm.2018.02.004
What was done
The authors conducted a critical review of local buccal drug delivery systems—including orally disintegrating tablets (ODTs), oral disintegrating films, medicated chewing gums, and implantable drug delivery devices—for administering saliva-stimulating cholinergic agents (such as pilocarpine, cevimeline, and bethanechol) to treat radiation-induced xerostomia in head and neck cancer patients.
What was found
The abstract reports no primary experimental or clinical trial numbers. It highlights that radiation induces dry mouth in nearly 100% of head and neck cancer patients and that systemic cholinergic agents cause adverse effects including sweating, excessive lacrimation, and gastrointestinal distress. The review identifies ODTs engineered to release drug rapidly in residual saliva volumes of 0.05–0.1 mL as the most promising patient-friendly platform for stimulating local minor salivary glands without systemic exposure.
Why it matters
It defines the formulation and physiological requirements needed to deliver cholinergic stimulants locally to the oral mucosa, addressing a major therapeutic gap in managing post-radiation dry mouth.
Limits
The abstract describes a narrative review and concept proposal; no new human pharmacokinetic, pharmacodynamic, or randomized comparative clinical data are presented. Specific performance parameters in clinical practice remain to be empirically tested.
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- contradicts There are no pharmacological drugs that duplicate the neurotransmitter acetylcholine.