What is the best management for xerostomia in an 84-year-old male with major depressive disorder taking bupropion (Wellbutrin)?

From the Research

For an 845-year-old male with major depressive disorder experiencing dry mouth from bupropion, the best management option is to continue the medication while implementing supportive measures to alleviate the side effect, including the use of saliva substitutes such as 1% malic acid topical spray, as it has been shown to improve dry mouth compared to placebo 1. The patient should be advised to increase fluid intake, use sugar-free hard candies or gum to stimulate saliva production, avoid caffeine and alcohol which can worsen dry mouth, use alcohol-free mouthwash, and consider over-the-counter artificial saliva products if needed. Some key points to consider when managing dry mouth include:

• The importance of saliva in maintaining oral health, and the potential consequences of dry mouth, such as dental caries and fungal infections 2
• The variety of treatment alternatives available for dry mouth, including local therapies, systemic treatments, and non-conventional approaches 2
• The efficacy of different saliva substitutes in improving oral lubrication, with some products performing better than others 3
• The potential benefits of using saliva substitutes that contain carrageenan, carboxymethylcellulose, pig gastric mucin, xanthan gum, and carbomer, which have been shown to enhance oral lubrication 3 It's also important to note that the patient should not discontinue the antidepressant abruptly, as this could worsen depression symptoms and cause withdrawal effects. If dry mouth becomes severe or intolerable despite these measures, the patient should follow up with their healthcare provider to discuss possible dose adjustments or alternative medications. Bupropion works by inhibiting the reuptake of norepinephrine and dopamine, and its anticholinergic properties are responsible for the dry mouth side effect by reducing saliva production. The use of 1% malic acid topical spray has been shown to improve dry mouth compared to placebo, with patients using this treatment being 5.4 times more likely to report improvement compared to placebo 1.