Can ivabradine, levocetirizine, or montelukast cause a metallic taste?

Metallic Taste and the Three Medications in Question

Among ivabradine, levocetirizine, and montelukast, none are established causes of metallic taste based on available guideline evidence, though ivabradine has the most documented adverse effects overall.

Ivabradine

• Ivabradine does not cause metallic taste according to the American College of Cardiology/American Heart Association/Heart Rhythm Society guidelines, which document its side effect profile extensively 1
• The primary visual side effect is phosphenes (enhanced brightness in visual field), occurring in only 3% of patients in the SHIFT trial, and this effect is typically transient 1
• The drug demonstrates an excellent safety profile in large randomized controlled trials for heart failure and inappropriate sinus tachycardia 1

Levocetirizine

• Levocetirizine is not associated with metallic taste in the available evidence 2
• The primary concern with antihistamines like levocetirizine is somnolence, which can negatively impact quality of life 2
• When combined with montelukast in bilayer formulations, stability is maintained without reports of taste-related adverse effects 2

Montelukast

• Montelukast does not cause metallic taste based on the available guideline and research evidence 2
• The drug is alkaline-stable and when formulated with levocetirizine, demonstrates good stability profiles without documented taste disturbances 2

Medications That DO Cause Metallic Taste (For Context)

To provide perspective on what medications actually cause this side effect:

• Ethionamide (anti-tuberculosis drug) commonly causes profound metallic taste along with gastrointestinal disturbance and hypothyroidism 1
• Eszopiclone and zopiclone (sleep medications) cause bitter/metallic taste in 7-26% of patients, representing their most common adverse effect 3
• Clarithromycin causes metallic taste as one of its most common gastrointestinal toxicities in a dose-dependent manner 3
• Oral ribavirin causes metallic taste, though most adverse effects occur after prolonged use 1

Clinical Approach

If a patient reports metallic taste while taking any of these three medications, investigate alternative causes:

• Review all concurrent medications, particularly antibiotics (clarithromycin), sleep aids (eszopiclone), and anti-tuberculosis drugs (ethionamide) 3
• Evaluate for metal hypersensitivity to dental or orthopedic implants (nickel, aluminum, vanadium, titanium), which affects 10-15% of the population 3
• Consider age-related changes in taste, particularly in older adults with altered salivary flow and multiple medications 3
• Assess for renal dysfunction and oral health issues 4