Xerogenic Medications

Of the 200 classifications of medications that are most prescribed annually, those that are most commonly associated with xerostomia are tricyclic antidepressants, antipsychotics, atropinics, beta blockers and antihistamines.14 Therefore, it is logical to conclude xerostomia is commonly found as an adverse side effect in patients under medical care for hypertensive, psychiatric, and urinary problems.

Tricyclic Antidepressants

Tricyclic antidepressants were the most commonly prescribed antidepressants until Selective Serotonin Reuptake Inhibitors (SSRI’s) were introduced. Doctors still use tricyclic antidepressants, particularly with patients who have not benefited from SSRI’s. Special note: The elderly taking tricyclic antidepressants metabolize them more slowly and are more susceptible to all side effects of the medication.15

In addition to dry mouth, adverse side effects include: constipation, dizziness, lethargy, sweating, weight gain, nausea, tremors, confusion (especially in the elderly), tachycardia, and skin rash (or other allergic reactions).

Table 1. Generic/Brand Names of Drugs
Generic NameBrand Name
ImipramineTofranil
AmitriptylineElavil, Endep
ClomipramineAnafranil
DoxepinSinequan, Adapin
DesipramineNorpramin
NortriptylinePamelor
ProtriptylineVivactil
TrimipramineSurmontil

Antipsychotics

Antipsychotics are medications used to treat unrealistic ideas, delusions, and hallucinations that can manifest during depression. There are two types, atypical and traditional:

  • Atypical antipsychotics include: Olanzapine and Risperidone.
    • Atypical antipsychotic drugs are the newest type of antipsychotics and are used to treat psychosis. Adverse side effects are reported to be easier to tolerate than previous medications; however, they may cause weight gain and a higher susceptibility to diabetes.
  • Typical antipsychotics include: Haloperidol and Chlorpromazine.
    • Traditional antipsychotic drugs were developed in the 1950’s, however, unpleasant effects (which can be severe) leave them to be used with caution today.15

Atropinics

Atropine is known for its ability to arrest the secretion of sweat, mucus, and saliva. Atropinic medications are anticholinergic drugs used primarily to dry up bodily secretions, dilate the bronchi, and prevent excessive cardiac slowing during anesthesia, and to dilate the pupil of the eye.16 Another benefit of atropine is its ability to provide relief from spasms of the gastrointestinal tract, bladder, and biliary tract, helpful in providing relief to people suffering from colitis, spastic bladder, diverticulitis, infant colic, renal and biliary colic, peptic ulcer, and irritable bowel syndrome (IBS). Atropine is often used as a treatment for Parkinson’s disease to treat rigidity, tremor, excessive salivation, and sweating. In addition, atropine is used as an antidote for organophosphate insecticide poisoning and nerve gas.17

Adverse side effects include: ventricular fibrillation, supraventricular or ventricular tachycardia, nausea, blurred vision, loss of balance, dilated pupils, and photophobia. In the elderly, atropinic drugs can cause hallucinations, excitability, and confusion.

Beta Blockers

Beta-adrenergic blocking agents (beta blockers) are a group of medications that have been shown to reduce a person’s risk of a second heart attack. Beta blockers are used to treat a variety of cardiac conditions (including angina and arrhythmias). Examples of beta blockers include: atenolol, bisoprolol, metoprolol, nadolol, pindolol, propranolol, and timolol.18 In addition to their anti-hypertensive properties, beta blockers are commonly prescribed to treat glaucoma and the frequency of migraines.19

Common side effects include: sexual difficulty, dizziness, drowsiness, and insomnia. Less common side effects include anxiety, constipation, or diarrhea, increased sensitivity to sunlight, loss of appetite, numbness of the extremities, upset stomach, or stuffy nose.18

Antihistamines and Other Less Commonly Prescribed Xerogenic Drugs

Antihistamines are often prescribed to treat symptoms of hay fever and other specific allergies. Sometimes antihistamines are combined with decongestants to help shrink the swollen lining of the ear, nose, and sinuses. Antihistamines are taken seasonally, when a patient is bothered by allergic symptoms, or sometimes they are taken every day to prevent symptoms all throughout the year or during an allergy season. There are antihistamine preparations that cause drowsiness and others that are non-sedating. There are many over-the-counter antihistamines and antihistamine/decongestant combinations on the market today. Some of these medications require a prescription, and there is a variation in an individual’s response to these drugs.

Table 2. Common Antihistamines
AlavertClarinex
AllegraClaritin
Aller-ChlorContac
AtaraxDexchlor
BanophenDimetapp
BendrylDiphenhist
BromphenDormarex
CalmDramamine
ChlorateTavist
Chlor-TrimetonZyrtec

Asthmatics oftentimes take inhaled corticosteroids, powerful anti-inflammatory drugs used to reduce lung inflammation. Inhaled steroids are generally considered safe and effective but have side effects including throat irritation, hoarseness, and dry mouth. Rinsing the mouth after each treatment along with use of a spacer can minimize these side effects.

In addition to tricyclic antidepressants, antipsychotics, atropinics, beta blockers and antihistamines, other less commonly prescribed xerogenic drugs include: analgesics (centrally acting), angiotensin-converting enzyme inhibitors, anorexiants, antacids, antiacne agents, antiallergy agents, antianxiety agents, anticholinergic/antispasmodic agents, anticonvulsants, antidepressants, antinausea agents, antiparkinsonism agents, antipsychotics, bronchodilators, calcium channel blockers, decongestants, diuretics, muscle relaxants, narcotic analgesics, nonsteroidal anti-inflammatory drugs, sedatives, and smoking-cessation agents, antidiarrheal agents, antidysrhythmics, and antihypertensives.20