What is your approach to managing sicca symptoms in patients not responding or not tolerating conservative measures, pilocarpine, and cevimeline?

This question is part of a collaboration with RheumMadness and is specifically in reference to: CD40L inhibitor for Sjogren's

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Rheumatology · Uniformed Services University of the Health Sciences (USUHS)

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Try lower doses of pilocarpine with just 1/4 tablet at a time. Very slowly go up on the dose as tolerated. The patient's job is to find the maximum tolerated dose. I recommend this pill splitter:
Mix capsule of cevimeline in water, just drink a tiny bit at a time tid and go up on dose as tolerated...

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