What medications cause xerostomia (dry mouth)?

Medications That Cause Dry Mouth (Xerostomia)

Medications with anticholinergic properties are the most common cause of dry mouth, as they interrupt neural stimulation of saliva secretion by blocking muscarinic receptors in the salivary glands. 1, 2

Common Medication Classes That Cause Dry Mouth

Anticholinergic Medications

• Centrally acting anticholinergic drugs such as scopolamine and atropine block muscarinic receptors, causing blurring of vision, dry mouth, dilated pupils, urinary retention, and sedation 3
• Atropine directly causes dry mouth as one of its primary adverse effects by blocking muscarinic receptors 4
• Anticholinergics used for motion sickness (like scopolamine) commonly cause xerostomia 3

Antidepressants

• Sertraline and other SSRIs cause dry mouth in 14% of patients compared to 8% on placebo 5
• Tricyclic antidepressants have significant anticholinergic effects, making them common causes of xerostomia 6
• Bupropion (found in combination medications like naltrexone/bupropion) causes dry mouth as a common side effect 3

Muscle Relaxants

• Cyclobenzaprine has significant anticholinergic effects, with dry mouth being one of its most common adverse reactions 6
• It is structurally related to tricyclic antidepressants and has both peripheral and central anticholinergic activity 6

Sympathomimetic Agents

• Stimulant medications like phentermine cause dry mouth in a significant percentage of users 3
• Lisdexamfetamine (Vyvanse) commonly causes dry mouth as a side effect 7

Other Common Medications

• Beta-blockers (atenolol, metoprolol, propranolol) can cause dry mouth 3
• Diuretics may contribute to dry mouth through dehydration 8
• Opioids commonly cause dry mouth as one of their adverse effects 6
• Anti-obesity medications like phentermine/topiramate and naltrexone/bupropion list dry mouth as a common side effect 3

Mechanisms of Medication-Induced Dry Mouth

• Most medications cause dry mouth through anticholinergic activity against the M3 muscarinic receptor in salivary glands 2
• Some medications affect serotonin and noradrenaline uptake, which can impact salivary function 2
• Sympathomimetic agents can reduce salivary flow through adrenergic effects 2
• Dehydration from diuretics can contribute to reduced salivary flow 8

Risk Factors for Medication-Induced Dry Mouth

• Polypharmacy significantly increases the risk of xerostomia, especially in elderly patients 9
• The elderly are more susceptible to medication-induced dry mouth due to age-related changes in pharmacokinetics 8
• Patients taking multiple medications with anticholinergic properties have cumulative risk 1
• Dehydration can exacerbate medication-induced dry mouth 8

Clinical Implications

• Chronic dry mouth can lead to dental caries, periodontal disease, oral infections, and diminished quality of life 1
• Dry mouth can affect denture retention, mastication, and swallowing in elderly patients 8
• Xerostomia can lead to dysgeusia (taste disturbance), glossodynia (tongue pain), and halitosis 8
• Patients with medication-induced dry mouth should be referred to a dentist for preventive care 8

Management Strategies

• Optimize hydration by increasing water intake throughout the day and limiting caffeine consumption 7
• Use saliva substitutes such as moisture-preserving mouth rinses, sprays, or gels with neutral pH 7
• Employ salivary stimulants including sugar-free chewing gum, lozenges, or candy containing xylitol 7, 8
• For severe cases, systemic sialagogues such as pilocarpine may be considered 7, 8
• When possible, consider medication alternatives with fewer anticholinergic properties 1