How to manage dry mouth caused by Wellbutrin (bupropion)?

Managing Dry Mouth Caused by Wellbutrin (Bupropion)

For patients experiencing dry mouth from Wellbutrin (bupropion), implement a stepwise approach starting with non-pharmacological interventions such as sugar-free gum, lozenges, and increased hydration for mild symptoms, progressing to saliva substitutes for moderate symptoms, and adding pilocarpine 5 mg three to four times daily for severe symptoms. 1

Understanding Bupropion-Induced Dry Mouth

Dry mouth (xerostomia) is one of the most common side effects of bupropion, occurring significantly more frequently than with placebo 2. Clinical trials have shown that:

• Dry mouth is typically transient and often resolves without therapeutic intervention
• It can be managed by reducing the bupropion dose if necessary 2
• SNRIs and atypical antidepressants like bupropion are associated with varying degrees of dry mouth risk 3

Management Strategy Based on Severity

Mild Symptoms

• Sugar-free gum or lozenges to stimulate saliva production
• Frequent sips of water throughout the day
• Avoid caffeine, alcohol, and tobacco which can worsen dry mouth
• Use a humidifier at night

Moderate Symptoms

• Continue all non-pharmacological interventions
• Add saliva substitutes/artificial saliva products
• Consider reducing bupropion dose if clinically appropriate and in consultation with prescriber

Severe Symptoms

• Continue all previous interventions
• Consider pilocarpine 5 mg three to four times daily (a secretagogue that stimulates saliva production)
• Schedule frequent dental monitoring to prevent complications
• Evaluate if medication change is necessary 1

Important Clinical Considerations

1. Oral Health Monitoring: Poor oral health is a recognized comorbidity in people with psychiatric illness, and psychotropic-induced dry mouth is a significant risk factor 4. Regular dental check-ups are essential.

2. Medication Interactions: Be aware that the xerogenic effect increases when multiple drugs with dry mouth potential are taken concurrently 5. Review the patient's complete medication list.

3. Dosage Considerations: The standard dosage of bupropion SR (150 mg twice daily) is associated with dry mouth, but reducing to the minimum effective dose may help mitigate this side effect 2.

4. Potential Complications: Untreated severe dry mouth can lead to:

   • Increased risk of dental caries
   • Oral infections (including candidiasis)
   • Difficulty speaking, chewing, and swallowing
   • Rarely, more severe oral manifestations like aphthous ulcers 6

When to Consider Medication Changes

Consider discussing medication alternatives with the prescriber if:

• Dry mouth is severe and persistent despite management strategies
• Oral complications develop (dental caries, infections)
• Quality of life is significantly impacted

SSRIs may be associated with less severe dry mouth symptoms compared to SNRIs and atypical antidepressants like bupropion 3, but this decision must balance the efficacy of treatment for the primary condition against side effect management.