Dry mouth is common among older people, affecting between 20% and 30% of those over 65. There are two aspects to the condition. Salivary gland hypofunction (SGH) is the state of having low salivary flow, while xerostomia refers to the subjective sensation of dry mouth.
Physical and Functional Impacts | Psychosocial Impacts |
---|---|
Difficulty eating/swallowing | Symptoms of dry mouth |
More tooth decay | Compromised quality of life |
Problems with dentures | Halitosis |
Infections—salivary glands, mucosa | Poor sleep |
Compromised taste sensation | Distress |
Medication Type | Mechanism of Action | ||||
---|---|---|---|---|---|
Gastrointestinal agents e.g., Hyoscine, hyoscyamine, belladonna alkaloids, atropine |
Block muscarinic receptors | ||||
Antiemetics e.g., prochlorperazine, |
Block dopamine D2, serotonin types 2–4, histamine type 1 and acetylcholine receptors | ||||
Appetite suppressants/stimulants e.g., Phentermine, sibutramine |
Inhibit CNS uptake of norepinephrine, serotonin and dopamine | ||||
Cardiovascular agents e.g., Atenolol, metoprolol, prazosin, clonidine |
Block α | 1 | - and β | 2 | -adrenergic receptors |
Urological e.g., Oxybutynin, propantheline, darifenacin, solifenacin, tolterodine, mirabegron |
Block muscarinic receptors and α | 1 | -adrenergic receptors | ||
Muscle relaxants Cyclobenzaprine, orphenadrine |
Act as α | 1 | -adrenergic receptor agonists, and H2 histamine blockers | ||
Analgesics e.g., Opioids, tramadol, gabapentin, pregabalin. |
Block noradrenaline reuptake in the CNS and so inhibit the salivary reflex arc | ||||
Anticonvulsants e.g., Carbamazepine |
Act centrally to reduce neurotransmitter release | ||||
Sedatives—benzodiazepines & Z-drugs e.g., Zolpidem, zopiclone |
Enhance GABA effect in CNS, reduce the salivary secretory reflex, and block muscarinic, α | 1 | - and β | 2 | -adrenergic receptors |
Antipsychotics e.g., Olanzapine, clozapine, amisulpiride |
Block neurotransmitter uptake (various) | ||||
Antidepressants e.g., Tricyclics (e.g., amitriptyline), SSRIs and SNRIs |
Anticholinergic; increase serototinn and noradrenaline at the synaptic cleft. | ||||
Bronchodilators e.g., Ipratropium, tiotropium, salbutamol, salmeterol, eformoterol, umeclidinium |
2 types: β agonists and antimuscarininc, Block muscarinic receptors M1 and M3, | ||||
Antihistamines- sedating only e.g., Diphenhydramine, doxylamine, chlorpheniramine, promethazine |
Central inhibitory action on histamine type 1 and muscarinic receptors | ||||
CNS Stimulants e.g., Caffeine, pseudoephedrine, amphetamines |
α | 1 | and α | 2 | agonists. |