Can Nurofen Cold and Flu Cause Dry Mouth?
Yes, Nurofen Cold and Flu can cause dry mouth, primarily due to its pseudoephedrine component, which has anticholinergic properties that reduce saliva secretion.
Mechanism and Evidence
The dry mouth side effect comes specifically from the pseudoephedrine component of this combination product, not from the ibuprofen:
First-generation antihistamines and decongestants with anticholinergic properties are well-documented causes of dry mouth by interrupting neural stimulation of saliva secretion and reducing saliva flow 1, 2.
Pseudoephedrine, while primarily an α-adrenergic agonist causing vasoconstriction, also exhibits anticholinergic effects that can lead to xerostomia (dry mouth) 1, 3.
The anticholinergic effect on salivary glands is among the most sensitive target organ responses to these medications, with hyposalivation resulting in the subjective sensation of dry mouth 2.
Clinical Significance
Dry mouth from pseudoephedrine is generally mild and self-limiting:
In controlled studies of pseudoephedrine, dry mouth was reported as a common side effect but was well-tolerated and did not lead to study discontinuation 1.
The FDA label for ibuprofen lists "dry eyes and mouth" as a recognized adverse reaction, though this occurs in less than 3% of patients 4.
When pseudoephedrine was studied in pediatric populations (ages 6-11), the medication was generally safe with multiple dosing for up to 7 days 5.
Important Clinical Considerations
The dry mouth effect is temporary and resolves with discontinuation:
Anticholinergic medications interrupt neural stimulation of saliva secretion, but this effect is reversible when the medication is stopped 2.
Short-term use (3-7 days) for acute cold symptoms minimizes the risk of significant oral health complications from reduced saliva flow 1.
Patients at higher risk for problematic dry mouth include:
Those taking multiple medications with anticholinergic properties concurrently, as the xerogenic effect increases with polypharmacy 6, 2.
Elderly patients who are more susceptible to anticholinergic side effects and may already have reduced salivary function 6.
Patients with pre-existing salivary gland dysfunction or those taking other medications that reduce saliva production 2.
Management Strategies
If dry mouth becomes bothersome:
Consider switching to alternative decongestants such as intranasal corticosteroids or topical nasal decongestants (limited to ≤3 days), which do not cause systemic anticholinergic effects 1, 3.
Use the medication only as needed rather than on a scheduled basis to minimize cumulative anticholinergic exposure 1.
Maintain good oral hydration and consider saliva substitutes if dry mouth persists during treatment 2.
Common Pitfalls to Avoid
Do not combine Nurofen Cold and Flu with other anticholinergic medications (such as first-generation antihistamines like diphenhydramine) as this significantly increases the risk and severity of dry mouth 6, 2.
Avoid prolonged use beyond 7 days, as extended anticholinergic exposure can lead to dental caries, intraoral infections, and diminished oral health-related quality of life 2.
Be aware that the ibuprofen component can also rarely cause dry mouth (reported in <3% of patients), though this is much less common than with the pseudoephedrine component 4.