Will Wellbutrin (bupropion) affect someone with decreased salivation (hyposalivation)?

Wellbutrin Can Worsen Decreased Salivation

Wellbutrin (bupropion) can worsen symptoms in someone with decreased salivation (hyposalivation) as dry mouth is a common side effect of this medication. According to FDA drug information, dry mouth is reported in a significant percentage of patients taking bupropion, with rates of 2-6% depending on the formulation and dosage 1.

Mechanism of Bupropion's Effect on Salivation

Bupropion works as a dopamine and norepinephrine reuptake inhibitor 2. While not primarily an anticholinergic medication, it has properties that can affect salivary function:

• Inhibits reuptake of dopamine and norepinephrine, which can indirectly affect salivary gland function
• Has mild anticholinergic effects that can reduce salivary secretion
• The sustained-release formulation has specifically been documented to cause dry mouth at higher rates than placebo 3

Prevalence and Severity of Dry Mouth with Bupropion

The incidence of dry mouth with bupropion varies by formulation:

• In sustained-release formulations: 6% at 300 mg/day and 5% at 400 mg/day (compared to 2% with placebo) 1
• In clinical trials for smoking cessation, dry mouth was one of the most common side effects that persisted beyond the initial adaptation period 3

Clinical Implications for Patients with Pre-existing Hyposalivation

For patients already experiencing decreased salivation:

1. Worsened oral health outcomes:

   • Increased risk of dental caries
   • Higher likelihood of oral infections
   • Potential for worsening oral pain
   • Difficulty with speaking and swallowing 4

2. Impact on quality of life:

   • Discomfort may be more pronounced than in patients with normal baseline salivation
   • May affect medication adherence
   • Can contribute to nutritional issues if severe 5

Management Options

If Wellbutrin is clinically indicated despite hyposalivation:

1. Dose adjustment:

   • Consider starting at the lowest effective dose
   • Titrate slowly while monitoring salivary symptoms

2. Hydration strategies:

   • Frequent sips of water
   • Sugar-free gum or lozenges to stimulate remaining salivary function
   • Alcohol-free mouth rinses

3. Salivary substitutes:

   • Artificial saliva products
   • Oral lubricants

4. Preventive dental care:

   • More frequent dental visits
   • Fluoride treatments
   • Careful oral hygiene

5. Consider alternatives:

   • If hyposalivation becomes severe, discuss alternative medications with fewer xerogenic effects

Special Considerations

Patients with certain conditions may be at higher risk for complications:

• Sjögren's syndrome
• History of head and neck radiation
• Elderly patients (who often have naturally reduced salivary flow)
• Those taking other medications with anticholinergic properties 6

Monitoring Recommendations

For patients with pre-existing hyposalivation who start Wellbutrin:

• Assess baseline salivary flow if possible
• Follow up within 2-4 weeks to evaluate for worsening symptoms
• Consider dental referral for preventive strategies
• Monitor for oral infections and dental caries

The decision to use Wellbutrin in patients with hyposalivation should carefully weigh the potential benefits against the risk of worsening dry mouth symptoms and their consequences on oral health and quality of life.