Medications That Cause Dry Mouth As an Adverse Effect in Older People

A Systematic Review and Metaanalysis

Edwin C. K. Tan, PhD; Duangjai Lexomboon, PhD; Gunilla Sandborgh-Englund, PhD; Ylva Haasum, PhD; Kristina Johnell, PhD

Disclosures

J Am Geriatr Soc. 2018;66(1):76-84. 

In This Article

Abstract and Introduction

Abstract

Objectives To assess and quantify the risk of drug-induced dry mouth as a side effect in older people.

Design Systematic review and metaanalysis.

Setting A search of the literature was undertaken using Medline, Embase, Cochrane, Web of Science, and PubMed from 1990 to 2016.

Participants Older people (aged ≥60) who participated in intervention or observational studies investigating drug use as an exposure and xerostomia or salivary gland hypofunction as adverse drug outcomes.

Measurements Two pairs of authors screened titles and abstracts of studies for relevance. Two authors independently extracted data, including study characteristics, definitions of exposure and outcome, and methodological quality. For the metaanalyses, random-effects models were used for pooling the data and I 2 statistics for exploring heterogeneity.

Results Of 1,544 potentially relevant studies, 52 were deemed eligible for inclusion in the final review and 26 in metaanalyses. The majority of studies were of moderate methodological quality. In the intervention studies, urological medications (odds ratio (OR) = 5.91, 95% confidence interval (CI) = 4.04–8.63; I2 = 62%), antidepressants (OR = 4.74, 95% CI = 2.69–8.32, I[2] = 21%), and psycholeptics (OR = 2.59, 95% CI = 1.79–3.95, I 2 = 0%) were significantly associated with dry mouth. In the observational studies, numbers of medications and several medication classes were significantly associated with xerostomia and salivary gland hypofunction.

Conclusion Medication use was significantly associated with xerostomia and salivary gland hypofunction in older adults. The risk of dry mouth was greatest for drugs used for urinary incontinence. Future research should develop a risk score for medication-induced dry mouth to assist with prescribing and medication management.

Introduction

Older adults are high users of medications. It is estimated that 40% of community-dwelling and 75% of institutionalized older adults take 5 or more medications, with approximately 10% of older adults taking 10 or more.[1] This high burden of comorbidity and polypharmacy put older adults at risk of adverse drug events.

Dry mouth is one of the most common adverse effects of medication use in older adults.[2,3] This includes salivary gland hypofunction (objectively measured decrease in salivation) and xerostomia (subjective feeling of dry mouth). It has been shown that the prevalence of hyposalivation increases with the number of medications used,[2] but few studies have investigated the severity of medication-induced dry mouth and associated sequelae.[3] Adverse effects of salivary gland hypofunction include dental caries, dysgeusia, oral mucosal soreness, and oral candidiasis.[4] The process of chewing and swallowing may also be affected, and this can affect the nutritional status of older people.

Drug-induced dry mouth has been attributed to a range of mechanisms. Although anticholinergic effects underlie the majority of cases, other mechanisms include sympathomimetic effects, topical effects of inhaled medications, dehydration, vasoconstriction in salivary glands, alterations in electrolyte and fluid balance, and changes in saliva composition.[5]

There is strong evidence that certain drug classes cause dry mouth. A previous systematic review identified particular drug groups that induce salivary gland hypofunction and xerostomia, including those affecting the alimentary, cardiovascular, genitourinary, nervous, and respiratory systems.[4] Examples of drug classes that induce dry mouth include antidepressants, antipsychotics, anticholinergics, antihypertensives, antihistamines, and sedatives,[4,6] but there is a lack of reviews focusing on elderly adults, even though they are at greater risk of drug-induced dry mouth. Additionally, although certain drugs have been found to be associated with dry mouth, few studies have tried to quantify the risk.

Objective

The aim of this study was to systematically review the literature to assess and quantify the risk of drug-induced dry mouth as a side effect in individuals aged 60 and older.

Comments

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