Saliva plays an important role in oral health. It provides lubrication to help with chewing and swallowing, supports our sense of taste, kills germs, prevents bad breath, and protects tooth enamel. Dry mouth (xerostomia) occurs when the salivary glands in the mouth don’t make the normal amount of saliva, or there is a change to the quality of saliva. Oral dryness is not only uncomfortable but can also lead to poor dental health and problems like mouth sores that can cause severe pain.

Dry mouth is a common symptom that affects up to 20% of the American population. It can occur as a result of something as simple as sleeping with your mouth open. Dry mouth can also occur after treatments like radiation therapy or as a symptom of medical conditions like Sjogren’s syndrome, HIV/AIDS, hypertension, diabetes, lymphoma, and hepatitis C.

In addition, dry mouth can be a side effect of drug treatment. In fact, observational studies investigating drug effects have shown that several medication classes and more than 1,100 different medications produce dry mouth as one of the adverse drug outcomes.

Please continue reading to learn about some of the medications that cause dry mouth. We will also give you some tips on treating drug-induced dry mouth.

Which class of drugs causes dry mouth as a side effect?
Anticholinergics

These medications are used to treat conditions such as overactive bladder and urinary incontinence. Besides urological medications for bladder control, anticholinergics are also used to treat conditions like asthma, irritable bowel syndrome, and Parkinson’s disease. These drugs work by preventing involuntary muscle movements, but they can also reduce the salivary flow rate in the mouth as an adverse effect. Examples of anticholinergic drugs include atropine (Atropen), fesoterodine (Toviaz), and benztropine mesylate (Cogentin).

Antihistamines

These medications with anticholinergic effects are used to treat allergy symptoms. This effect is believed to be the cause of the medication-induced dry mouth associated with antihistamines. Examples include cetirizine (Zyrtec), loratadine (Claritin), and fexofenadine (Allegra).

Decongestants

This group of medicines reduces the amount of mucus made by the body and can also affect salivary flow rates causing dry mouth symptoms. Examples of common decongestants available over the counter include oxymetazoline (Afrin, Vicks Sinex) and pseudoephedrine (Sudafed).

Analgesics

Both over-the-counter analgesics (painkillers) like ibuprofen and acetaminophen and stronger prescription medications like opioid pain pills (hydrocodone, codeine, morphine) can affect how much saliva is made in the mouth. This effect is exerted through the autonomic nervous system. Opioid pain medications alone also cause dry mouth due to their anticholinergic effects.

Anti-Acne Medications

Isotretinoin (Accutane) is a prescription medication that is used to treat severe acne. Dry mouth is a common side effect of isotretinoin.

Acid Reflux Medications

Proton pump inhibitors, used to treat gastroesophageal reflux disease (GERD), can cause dry mouth as an adverse effect. Examples of proton pump inhibitors include omeprazole (Prilosec), esomeprazole (Nexium), lansoprazole (Prevacid), and rabeprazole (Aciphex).

Blood Pressure and Heart Medications

Many classes of medications prescribed to treat high blood pressure and irregular heart rhythm can cause dry mouth. Examples include angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, calcium channel blockers, and anti-arrhythmic drugs.

Bronchodilators

These medications are available in the form of inhalers or nebulizers and are prescribed for asthma or lung diseases. They help to open up the airways but can also have an effect on saliva production by salivary glands, leading to dry mouth. Examples of commonly prescribed bronchodilators include Proventil HFA, Ventolin HFA, ProAir HFA (albuterol) and Advair Diskus (fluticasone propionate-salmeterol).

Diuretics

Diuretics or water pills increase urination and reduce the amount of water and salt in the body. This dehydrating effect of diuretics can lead to dry mouth. Examples include furosemide (Lasix), bumetanide (Bumex), and ethacrynic acid (Edecrin).

Antidepressants

Medications used to treat depression can affect saliva production and cause dry mouth due to their anticholinergic effects. Examples include tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), and monoamine oxidase inhibitors (MAOIs).

Benzodiazepines

Benzodiazepines are prescribed to treat insomnia, anxiety, and seizures. They can cause mild dry mouth in some people. Examples include diazepam (Valium), alprazolam (Xanax), and temazepam (Restoril).

Antipsychotics

Antipsychotics are used to treat psychiatric disorders like bipolar disorder and schizophrenia. With different levels of anticholinergic effects, this drug class can cause dry mouth. Examples include risperidone (Risperdal), quetiapine (Seroquel), and trifluoperazine (Stelazine).

Alzheimer’s Disease Medications

Dry mouth is more common in elderly patients, especially those taking medications to treat Alzheimer’s disease. Older adults on donepezil (Aricept), galantamine (Razadyne), and rivastigmine (Exelon) may experience oral dryness.

Stimulants

Salivary gland hypofunction is a known side effect of stimulant medications used to treat conditions like attention deficit hyperactivity disorder (ADHD) and narcolepsy. Examples include dextroamphetamine/amphetamine (Adderall), dextroamphetamine (Dexedrine), and methylphenidate (Concerta).

Frequently Asked Questions

Which high blood pressure medications cause dry mouth?

Several classes of drugs used to lower blood pressure can cause dry mouth, such as:

ACE inhibitors like lisinopril (Prinivil) and benazepril (Lotensin)
Beta-blockers like atenolol (Tenormin) and metoprolol (Lopressor)
Calcium channel blockers like amlodipine (Norvasc) and diltiazem (Cardizem)
Antiarrhythmic drugs like disopyramide (Norpace)

What medication causes a very dry mouth?

Some of the common medications that can cause dry mouth include tricyclic antidepressants, antihypertensives, antihistamines, decongestants, and opioid pain medications.

What are the best treatments for drug-induced dry mouth?

Here are some of the measures that can help increase saliva flow in medication-induced dry mouth:

Chew sugar-free gum
Stay well hydrated
Suck on ice chips, sugarless hard candy, or sugarless chewing gum
Use a humidifier
Limit caffeine intake
Stop tobacco use
Use a mouthwash containing xylitol
Use saliva substitutes like Biotene Mouthwash, Aquoral, and Caphosol
Try herbal remedies like ginger, marshmallow root, and nopal cactus
Talk to your healthcare provider about medication management for dry mouth, i.e., whether you can switch to other medications that don’t cause severe dry mouth
Take a prescription medication for dry mouth, such as pilocarpine (Salagen) or cevimeline (Evoxac)

In addition to treating dry mouth with home remedies and/or prescription medications, it is important to schedule regular visits with your dentist. This will ensure dry mouth is not causing problems like dental caries (tooth decay).

Also, if your dry mouth doesn’t get better after stopping or changing medications and using the above-mentioned home remedies, schedule an appointment with your healthcare provider. Dry mouth can be a sign of an underlying health condition that needs to be treated.

References:

https://www.aaom.com/index.php%3Foption=com_content&view=article&id=107:xerostomia&catid=22:patient-condition-information&Itemid=120

Which class of drugs causes dry mouth as a side effect?Anticholinergics

Toviaz

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