Treatment Options for Loss of Taste (Hypogeusia)
Zinc supplementation is the most effective first-line treatment for loss of taste (hypogeusia), particularly in patients with zinc deficiency or idiopathic taste disorders. 1
Pathophysiology and Causes
Loss of taste (hypogeusia) can result from various conditions:
- Zinc deficiency
- Chronic renal failure
- Cancer and chemotherapy
- Viral infections (including SARS-CoV-2)
- Medications
- Aging
- Neurological disorders
Treatment Algorithm
First-Line Treatment: Zinc Supplementation
- Dosage: 17-50 mg elemental zinc daily, with higher doses (68-86.7 mg/day) for severe cases or those with chronic renal failure 1
- Duration: 3-6 months
- Formulations: Zinc sulfate, gluconate, picolinate, or acetate
- Efficacy: Meta-analysis shows zinc supplementation significantly improves taste disorders compared to placebo (RR = 1.38; 95% CI: 1.16,1.64) 1
Second-Line Options
Alpha-lipoic acid
- Consider for patients who don't respond to zinc
- Particularly useful for diabetic neuropathy-related taste disorders
Pharmacological agents for appetite stimulation (if taste loss affects appetite):
- Mirtazapine: 15-30 mg daily for appetite stimulation 2
- Cyproheptadine: 2-4 mg three times daily, especially effective in pediatric patients 2
- Megestrol acetate: Most effective for appetite stimulation but carries thromboembolic risks 2
- Dexamethasone: For short-term use only (1-3 weeks) due to side effects 3
Cannabinoids (THC/Dronabinol)
- Limited evidence for effectiveness in taste disorders
- May improve chemosensory perception and pre-meal appetite in some cancer patients
- However, insufficient consistent clinical data to recommend routinely 3
Special Populations
Cancer Patients
- Zinc supplementation has shown mixed results in chemotherapy-related taste disorders 4
- Consider mirtazapine or dexamethasone (short-term) for appetite stimulation 3, 2
Cystic Fibrosis Patients
- Zinc deficiency can cause taste disorders in CF patients
- Supplementation recommended for those with signs of zinc insufficiency (growth retardation, increased infections, eye problems, anorexia) 3
- Best tolerated in divided doses 3
COVID-19 Related Taste Loss
- Zinc may help with recovery
- Taste dysfunction typically resolves within 7-14 days in most patients 3
- Consider longer treatment course if symptoms persist beyond 2 weeks
Monitoring and Follow-up
- Assess taste improvement after 4-6 weeks of treatment
- Monitor for adverse effects of zinc: nausea, abdominal pain, metallic taste
- Avoid excessive doses (>100 mg/day) which can cause copper deficiency
- Consider serum zinc levels before and during treatment in refractory cases
Non-pharmacological Approaches
- Flavor enhancement of foods (using herbs, spices, marinades)
- Food texture variation to improve sensory experience
- Oral hygiene optimization
- Avoiding smoking and alcohol
- Small, frequent, nutrient-dense meals 2
Clinical Pearls and Pitfalls
- Pearl: Zinc deficiency is a common but often overlooked cause of taste disorders
- Pearl: Improvement may take several weeks to months of consistent supplementation
- Pitfall: Excessive zinc supplementation can lead to copper deficiency
- Pitfall: Not addressing underlying causes (medications, systemic diseases) may limit treatment success
- Pitfall: Zinc supplementation may not be effective in all types of taste disorders, particularly those not related to zinc deficiency
Zinc supplementation remains the cornerstone of treatment for hypogeusia, with strong evidence supporting its use in zinc-deficient and idiopathic taste disorders. For patients who don't respond to zinc, consider alternative approaches based on the underlying cause and associated symptoms.