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Artificial saliva: Drug information

Artificial saliva: Drug information
(For additional information see "Artificial saliva: Patient drug information")

For abbreviations, symbols, and age group definitions used in Lexicomp (show table)
Brand Names: US
  • Aquoral;
  • Biotene Dry Mouth Gentle [OTC];
  • Biotene Moisturizing Mouth Spray [OTC];
  • Biotene Oral Balance [OTC];
  • BocaSal;
  • Caphosol;
  • Entertainer's Secret [OTC];
  • Moi-Stir [OTC];
  • Mouth Kote [OTC];
  • NeutraSal;
  • Numoisyn;
  • Oasis;
  • SalivaMAX;
  • SalivaSure [OTC];
  • Xerostomia Relief Spray
Pharmacologic Category
  • Gastrointestinal Agent, Miscellaneous
Dosing: Adult

Note: Not all available products may be represented in dosing; also refer to manufacturer’s labeling.

Mucositis

Mucositis (due to high-dose chemotherapy or radiation therapy): Oral:

Caphosol (dispersible tablet and solution), NeutraSal: Swish and spit 4 to 10 doses daily (use for the duration of chemo- or radiation therapy).

SalivaMax: Swish and spit 2 to 10 doses daily.

Xerostomia

Xerostomia: Oral: Use as needed, or product-specific dosing:

Aquoral: Two sprays 3 to 4 times daily.

Biotene Dry Mouth Gentle oral rinse: Swish and spit 15 mL up to 3 times daily.

Biotene Oral Balance gel: Apply one-half inch length onto tongue and spread evenly; repeat as often as needed.

Biotene spray, Entertainer's Secret: Spray as often as needed.

Caphosol (dispersible tablet and solution), NeutraSal, SalivaMax: Swish and spit 2 to 10 doses daily.

Mouth Kote spray: Spray 3 to 5 times, swish for 8 to 10 seconds, then spit or swallow; use as often as needed.

Numoisyn liquid: Use 2 mL as needed.

Numoisyn lozenges: Dissolve 1 lozenge slowly; maximum 16 lozenges/day.

Oasis mouthwash: Rinse mouth with ~30 mL twice daily or as needed; do not swallow.

Oasis spray: 1 to 2 sprays as needed; maximum 60 sprays/day.

SalivaSure: Dissolve 1 lozenge slowly as needed; for severe symptoms, 1 lozenge per hour is recommended.

Xylimelts: Use as needed during the day; use 1 melt on each side of the mouth while sleeping.

Dosing: Kidney Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Hepatic Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Older Adult

Refer to adult dosing.

Dosing: Pediatric
Xerostomia

Xerostomia: Oral: Children ≥12 years of age and Adolescents: Biotene Dry Mouth Gentle oral rinse: Refer to adult dosing.

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Frequency not defined.

Central nervous system: Speech disturbance

Gastrointestinal: Dysgeusia, dysphagia, gastrointestinal disease (minor)

Contraindications

Hypersensitivity to saliva substitute or any component of the formulation; fructose intolerance (Numoisyn lozenges only)

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Gel, oral:

Biotene Oral Balance: Glycerin, water, sorbitol, xylitol, carbomer, hydroxyethylcellulose, sodium hydroxide (42 g) [alcohol-free, sugar-free]

Liquid, oral:

Biotene Dry Mouth Gentle: Water, glycerin, xylitol, sorbitol, propylene glycol, poloxamer 407, potassium sorbate, hydroxyethylcellulose, sodium phosphate, cetylpyridinium chloride, disodium phosphate (473 mL) [alcohol-free; mild mint flavor]

Numoisyn: Water, sorbitol, linseed extract, Chondrus crispus, methylparaben, sodium benzoate, potassium sorbate, dipotassium phosphate, propylparaben (300 mL)

Lozenge, oral:

Numoisyn: Sorbitol 0.3 g/lozenge, polyethylene glycol, malic acid, sodium citrate, calcium phosphate dibasic, hydrogenated cottonseed oil, citric acid, magnesium stearate, silicon dioxide (100s)

SalivaSure: Xylitol, citric acid, apple acid, sodium citrate dihydrate, sodium carboxymethylcellulose, dibasic calcium phosphate, silica colloidal, magnesium stearate, stearic acid (90s)

Powder, for reconstitution, oral:

BocaSal: Calcium chloride, sodium bicarbonate, sodium chloride, and sodium phosphates (30s)

NeutraSal: Calcium chloride, sodium bicarbonate, sodium chloride, and sodium phosphates (120s)

SalivaMAX: Calcium chloride, sodium bicarbonate, sodium chloride, and sodium phosphates (30s, 120s)

Solution, oral:

Caphosol: Dibasic sodium phosphate 0.032%, monobasic sodium phosphate 0.009%, calcium chloride 0.052%, sodium chloride 0.569%, purified water (30 mL) [packaged in two 15 mL ampuls when mixed together provide one 30 mL dose]

Entertainer's Secret: Sodium carboxymethylcellulose, aloe vera gel, glycerin (60 mL) [ethanol free; honey-apple flavor]

Solution, oral [mouthwash/gargle]:

Oasis: Water, glycerin, sorbitol, poloxamer 338, PEG-60, hydrogenated castor oil, copovidone, sodium benzoate, carboxymethylcellulose (473 mL) [ethanol free, sugar free; mild mint flavor]

Solution, oral [spray]:

Aquoral: Oxidized glycerol triesters and silicon dioxide (10 mL) [contains aspartame; citrus flavor]

Biotene Moisturizing Mouth Spray: Water, polyglycitol, propylene glycol, sunflower oil, xylitol, milk protein extract, potassium sorbate, acesulfame K, potassium thiocyanate, lysozyme, lactoferrin, lactoperoxidase (45 mL)

Moi-Stir: Water, sorbitol, sodium carboxymethylcellulose, methylparaben, propylparaben, potassium chloride, dibasic sodium phosphate, calcium chloride, magnesium chloride, sodium chloride (120 mL)

Mouth Kote: Water, xylitol, sorbitol, yerba santa, citric acid, ascorbic acid, sodium saccharin, sodium benzoate (5 mL, 60 mL, 240 mL) [ethanol free, sugar free; lemon-lime flavor]

Oasis: Glycerin, cetylpyridinium, copovidone (30 mL) [ethanol free, sugar free; contains sodium benzoate; delivers ~150 sprays, mild mint flavor]

Xerostomia Relief: Oxidized glycerol triesters and silicon dioxide (10 mL) [contains aspartame]

Generic Equivalent Available: US

No

Administration: Adult

Biotene Dry Mouth Gentle oral rinse: Rinse for 30 seconds.

Biotene Oral Balance gel: Apply on tongue and spread evenly.

Biotene spray: Spray directly into mouth; spray is safe to swallow.

Caphosol dispersible tablet: After dissolving tablet, swish thoroughly with 1/2 of mixture (25 mL) for 1 minute and spit; repeat. Avoid eating or drinking for at least 15 minutes after use.

Caphosol solution: Swish mixed solution thoroughly with 1/2 of mixture (15 mL) for 1 minute and spit; repeat. Avoid eating or drinking for at least 15 minutes after use.

Entertainer's Secret: Tilt head back and spray into throat or nostril while inhaling sharply.

Mouth Kote spray: Spray into mouth and swirl for 8 to 10 seconds; spray may be swallowed or spit out.

NeutraSal, SalivaMax: For each dose, swish 1/2 the prepared solution around the mouth for at least 1 minute and spit out; repeat with the remaining solution. Avoid eating or drinking for at least 15 minutes (NeutraSal) or 30 minutes (SalivaMax) after use.

Numoisyn liquid: Rinse in mouth before swallowing.

Numoisyn lozenges: Dissolve slowly in mouth; move lozenge around mouth for optimal effect.

Oasis mouthwash: Rinse for 30 seconds.

Oasis spray: Spray into mouth holding bottle upright; do not rinse.

SalivaSure lozenges: Allow lozenge to move around and slowly dissolve in mouth.

XyliMelts: Place tan adhesive side on the outside of a molar and/or adjoining gums, upper or lower, white side touching cheek. Hold in place 10 seconds to secure.

Administration: Pediatric

Oral: Biotene Dry Mouth Gentle oral rinse: Rinse for 30 seconds, then spit; do not swallow. May cause staining.

Use: Labeled Indications

Mucositis (due to high-dose chemotherapy or radiation therapy): Adjunct to standard oral care in relief of symptoms associated with chemotherapy or radiation therapy-induced mucositis

Xerostomia: Relief of dry mouth and throat in xerostomia or hyposalivation

Metabolism/Transport Effects

None known.

Drug Interactions

There are no known significant interactions.

Dietary Considerations

Caphosol: Dispersible tablet formulation contains sodium 1 g/50 mL dose and solution formulation contains sodium 71 mg/30 mL dose

Moi-Stir: Contains sodium: 6.47 mEq/120 mL, potassium: 1.93 mEq/120 mL, magnesium: 0.128 mEq/120 mL

Mechanism of Action

Protein or electrolyte mixtures which restore/replace saliva, lubricate, moisten, clean, and/or provide a coating on oral mucosa

Brand Names: International
International Brand Names by Country
For country code abbreviations (show table)

  • (AU) Australia: Aquoral;
  • (GB) United Kingdom: Aquoral;
  • (IE) Ireland: Aquoral;
  • (PR) Puerto Rico: Aquoral
  1. Aquoral artificial saliva protective oral spray [prescribing information]. San Antonio, TX: Mission Pharmacal Company; February 2019.
  2. Biotene Dry Mouth Gentle oral rinse [prescribing information]. Warren, NJ: GlaxoSmithKline; no date.
  3. Biotene Dry Mouth Moisturizing (glycerin, potassium sorbate, propylene glycol, sorbitol, xylitol) spray [prescribing information]. Warren, NJ: GlaxoSmithKline; received May 2022.
  4. Caphosol artificial saliva [prescribing information]. Burlington, MA: EUSA Pharma (US) LLC; October 2020.
  5. Furness S, Worthington HV, Bryan G, et al, “Interventions for the Management of Dry Mouth: Topical Therapies,” Cochrane Database Syst Rev, 2011, (12):CD008934. [PubMed 22161442]
  6. Mouth Kote [package insert]. San Rafael, CA: Parnell Pharmaceuticals, Inc; received March 2020.
  7. Narhi TO, Meurman JH, and Ainamo A, “Xerostomia and Hyposalivation: Causes, Consequences and Treatment in the Elderly,” Drugs Aging, 1999, 15(2):103-16. [PubMed 10495070]
  8. NeutraSal (calcium phosphate) rinse [prescribing information]. Rochester, NY: OraPharma Inc; January 2016.
  9. Papas AS, Clark RE, Martuscelli G, et al, “A Prospective, Randomized Trial for the Prevention of Mucositis in Patients Undergoing Hematopoietic Stem Cell Transplantation,” Bone Marrow Transplant, 2003, 31(8): 705-12. [PubMed 12692611]
  10. SalivaMax (calcium phosphate) [prescribing information]. Stafford, TX: Forward Science; November 2016.
  11. Scully C and Epstein JB, “ Oral Health Care for the Cancer Patient,” Oral Oncology, 1996, 32(5): 281-92. [PubMed 8944831]
  12. Sweeney MP and Bagg J, “The Mouth and Palliative Care,” Am J Palliat Care, 2000, 17(2):118-24. [PubMed 11406956]
  13. XyliMelts Dry Mouth (xylitol) [prescribing information]. Pleasant Prairie, WI: Quest Healthcare; received May 2022.
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