Pilocarpine for the treatment of refractory dry mouth (xerostomia) associated with botulinum toxin type B

A woman with spastic hemiparesis from a stroke was injected with botulinum toxin type B (BoNTB) at a dose of 10,000 U. Although this had the desired effect of a reduction in her spasticity, she also developed severe dry mouth, which became refractory to local remedies such as moist towels, lip balms, and throat lozenges. She was then given pilocarpine (a muscarinic agonist) at a dose of 5 mg, three times a day, to which she responded well. This report describes another treatment option in rare cases of severe dry mouth after administration of BoNTB.