Do buspirone (Buspar), trazodone, tadalafil (Cialis), nifedipine, escitalopram (Lexapro), and carvedilol cause dry mouth?

Dry Mouth Risk with These Medications

Yes, several of these medications commonly cause dry mouth: Buspar (buspirone), trazodone, and Lexapro (escitalopram) are the most likely culprits, while nifedipine and carvedilol can also contribute; Cialis (tadalafil) is the least likely to cause this side effect. 1

Medications Ranked by Dry Mouth Risk

High Risk Medications

Lexapro (Escitalopram)

• SSRIs like escitalopram cause dry mouth through anticholinergic effects, with higher doses associated with greater frequency and severity 1
• This is listed among the typical side effects alongside nausea, constipation, and decreased appetite 1

Buspar (Buspirone)

• Centrally acting medications with anticholinergic properties commonly cause xerostomia 1
• The anticholinergic mechanism blocks muscarinic receptors, directly reducing salivary flow 1

Trazodone

• As an antidepressant with anticholinergic effects, trazodone commonly causes dry mouth 1, 2
• Many antidepressants decrease salivary flow through their pharmacologic mechanisms 1

Moderate Risk Medications

Carvedilol

• Beta-blockers including carvedilol can cause dry mouth through anti-adrenergic effects 1
• The effect is documented across multiple beta-blockers (atenolol, metoprolol, propranolol) 1

Nifedipine

• Calcium channel blockers like nifedipine have been associated with xerostomia in adverse event databases 3
• Cardiovascular drugs represent a significant category of medications causing dry mouth 3

Low Risk Medication

Cialis (Tadalafil)

• Not prominently listed in comprehensive xerostomia medication reviews 1, 2
• Phosphodiesterase-5 inhibitors are not a major drug class associated with dry mouth 1

Clinical Management Approach

First-Line Conservative Measures 1

• Optimize hydration by increasing water intake throughout the day and limiting caffeine consumption
• Use saliva substitutes such as moisture-preserving mouth rinses, sprays, or gels with neutral pH
• Employ salivary stimulants including sugar-free chewing gum, lozenges, or candy containing xylitol

For Persistent or Severe Symptoms 1

• Consider systemic sialagogues such as pilocarpine (5 mg orally three to four times daily) or cevimeline for patients with measurable salivary flow who fail conservative measures
• Refer to dentistry for all patients with moderate to severe dry mouth to protect against dental caries, which is a significant risk with chronic xerostomia
• Consider medication adjustment, such as reducing SSRI dose while maintaining therapeutic benefit, if symptoms are severe

Important Clinical Caveats

Avoid Premature Discontinuation 1

• The cardiovascular benefits of carvedilol and nifedipine, and the psychiatric benefits of Lexapro, Buspar, and trazodone should be weighed against the dry mouth side effect
• Do not discontinue effective therapy without considering alternatives or management strategies first

Monitor for Complications 1, 4

• Severe sicca syndrome, if left untreated, can result in dental caries and eventually tooth loss
• Regular dental check-ups are essential for patients experiencing chronic dry mouth
• Patients may also develop oral candidiasis, difficulty swallowing, and problems with denture use 4

Polypharmacy Amplification 2, 5

• The xerogenic effect increases when multiple drugs with anticholinergic properties are taken concurrently
• Elderly patients are at substantially higher risk due to multiple medications and age-related decline in salivary flow rate 1