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Experiencing body dryness, joint pain, fatigue, erectile dysfunction. On thyrox. Is cevimeline safe?

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Since the year 2000, I was experiencing 'dry mouth' and 'dry eyes' symptoms. However, these conditions were not prominently discussed with any doctor. Other pressing conditions such as weight gain, fatigue, dry skin, etc. were mentioned to a general physician and the doctor prescribed Thyrox after the TSH test. With the intake of Thyrox, my general health improved slightly.

The 'dry mouth' and 'dry eyes' problems persisted. In December 2011, there was an attack of pain in all the joints simultaneously. I rushed to an orthopedic who referred me to a rheumatologist. The rheumatologist connected the 'dry mouth', 'dry eyes' and the joint-pain, and diagnosed that I have Sjogren's Syndrome. I was put on HCQS 200 MG thrice a day. The joint-pains ceased. However, the 'dry mouth' and 'dry eyes' persist. The rheumatologist told me that the drugs that may reduce 'dry mouth' & 'dry eyes' have adverse side-effects. One side-effect he mentioned was that my off-spring might be born with some disorder. I am married male but have no issue yet.

Apart from 'dry mouth' and 'dry eyes', there is general body dryness. Lesions/skin-eruptions occur on the fingers and toes (psoriasis/eczema type). The other problems are:

1. Fatigue,
2. Irritability and agitated mind,
3. Erectile Dysfunction

I'm on Thyrox 125 MCG daily, and HCQS 200 MG thrice daily. A doctor has prescribed Cevimeline 30 MG thrice daily to alleviate 'dry mouth'. Is Cevimeline safe? Does it cause any adverse effect on my yet-to-be-conceived offspring? Also, the same doctor has said that HCQS causes fatigue. So, what is the alternative? What course of treatment should I adopt to tackle ED & Fatigue? What do I do for general dryness?

I'm 35 year old male. I am 5 feet 10 inches tall, weighing 92 kilograms. I am a vegetarian. I drink alcohol socially. I quit smoking. In the past I was a mild-to-moderate smoker with not more than 6 cigarettes in a day.
Posted Sun, 5 May 2013 in Lupus
Answered by Dr. Divya Agarwal 2 hours later
You seem to be on the right medication.

Did you ever get your XXXXXXX and anti ro and la antibodies checked?
Because that is also essential for the diagnosis of sjogrens.

The fatigue and ED are a part of this syndrome so it will get better with the disease itself.

Cevemiline is a purely symptomatic drug for dryness so it does not have any major side effects.

As such, there should not be any problem to your offspring with any of these drugs.

Hcqs is a very safe drug it generally does not cause fatigue, which as I stated is part of the disease itself.

However, local measures like artificial teardrops help.

If ED is not improving with present drugs then you can take opinion of urologist for the same.

Some other drugs like methotrexate may also be useful depending on the severity of your condition.

In addition, you should definitely be on calcium and vitamin D for overall health.

Above answer was peer-reviewed by
Follow-up: Experiencing body dryness, joint pain, fatigue, erectile dysfunction. On thyrox. Is cevimeline safe? 56 minutes later
Hi Doc,

Thanks for the quick response to my query.

1. Is Cevimeline helpful to alleviate only 'dry mouth' or is it also helpful to alleviate overall dryness including dryness in the eyes?

2. As mentioned earlier, there are skin eruptions on my fingers and toes. Does Cevimeline help control such eruptions?

3. Does Methotrexate cause side-effects on the yet-to-be-conceived offspring? You have said that Cevimeline does not cause significant side-effect. What about Methotrexate?

4. What is Pilocarpine? How helpful is it to control my conditions? What about its side-effects?
XXXXXXX and Anti RO & LA Antibodies tests were done before I was put on HCQS. My rheumatologist is very conventional and does not prescribe anything beyond HCQS for the reason that the other medications will harm my yet-to-be-conceived offspring..However, with dry mouth, dry eyes, overall dryness including skin eruptions, fatigue and ED, any sexual act for procreation is the last thing on my mind! I want relief from the symptoms, and that's my priority. The dry mouth also causes social problems as my speech becomes unclear and also causes bad breath. Even the skin eruptions are embarrassing.

Of the three - Cevimeline, Methotrexate and Pilocarpine, which is the most effective one with the least side-effects?

Can you prescribe tests whose results I can upload for a more accurate advice?

Does Sjogren's also cause low testosterone level?

And how much of calcium and vitamin-D supplement should one take in a day?

Answered by Dr. Divya Agarwal 1 hour later
Basically hydroxychloroquine and methotrexate belong to one category of drugs.
They are called DMARDs.

Hydroxychloroquine is safe when you are planning a child but methotrexate needs to be stopped 3 months before you plan a baby, so it’s not like it cannot be taken, its only that you need to stop it when you start planning.

Cevemiline and pilocarpine are drugs which work at a different level, they increase the secretions in the body and therefore reduce dryness by acting on our glands, they generally don’t have any major side effects.

Thus, skin eruptions are unlikely to be controlled by cevemeline.

Side effects of these medicines are easily controllable, and it is generally not this or that, sometimes we need to give a combination of drugs for your problems.

You should at least be taking a 500mg tab of calcium and about 800 iu of vitamin D daily.

Yes, low testosterone levels may be associated.

The specific tests are XXXXXXX ant ro and la, blood counts, ESR and CRP, Schirmer test for the eyes.

Above answer was peer-reviewed by
Follow-up: Experiencing body dryness, joint pain, fatigue, erectile dysfunction. On thyrox. Is cevimeline safe? 1 hour later

Methotrexate is ruled out for the reason that it may remotely affect my progeny. HCQS cannot be stopped. Now the question is whether Cevimeline and Pilocarpine perform similar actions or is there any difference between the two? If the two perform same/similar functions, then which one of the two is more widely prescribed by the doctors? My straight question is whether Cevimeline is better along with HCQS or Pilocarpine? What is your preference?
Answered by Dr. Divya Agarwal 6 minutes later

Thanks for the follow up.

Basically both are the same.
We use pilocarpine because cevemiline was not available.
So, it would be either Cevemiline or Pilocarpine along with HCQS.

Hope I have cleared your doubts.

Thank you.
Above answer was peer-reviewed by
Follow-up: Experiencing body dryness, joint pain, fatigue, erectile dysfunction. On thyrox. Is cevimeline safe? 45 minutes later

Two last questions -

1. Is 30 MG of Cevimiline thrice a day, that is, totally 90 MG in a day optimum for a male weighing 92 kgs?

2. Is 600 MG of HCQS in a day over a long period harmful to the eyes?

What is the brand name of Cevimeline in India? Is it Evoxac as is called in the US?
Answered by Dr. Divya Agarwal 54 minutes later

Thanks or the follow up.

Yes, the brand name and dosages are fine.

No, there are no major side effects.

Hope this clarifies.

Above answer was peer-reviewed by
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