Medications That Cause Dry Mouth, and What Helps

Short answer: Medicines are the most common cause of long-lasting dry mouth in older adults. Hundreds of medicines list it as a side effect. In a review of 52 studies in people aged 60 and over, bladder medicines carried the highest risk, followed by antidepressants and medicines for sleep and anxiety, and the more medicines a person took, the more likely dry mouth became. It is worth taking seriously: saliva protects the teeth and gums, and a dry mouth can also lead to sipping all evening and more trips to the bathroom at night.

Medications that cause dry mouth

Listed roughly from the strongest evidence in older adults to the weakest:

Many of these share one action: they are anticholinergic, meaning they block a chemical messenger that also tells the salivary glands to make saliva. Our guide to oxybutynin side effects explains this in detail. Dry mouth often starts when a medicine is first prescribed or its dose is increased.

Why older adults are affected most

Older adults take more medicines, and the effects add up: two or three medicines that each dry the mouth a little can together dry it a lot. Health conditions, mouth breathing and dentures add to the problem. In the 52-study review, the number of medicines taken was itself linked to dry mouth, and the researchers advised that doctors regularly review all medicines and adjust doses or switch when dry mouth becomes a problem.

The dry mouth and night-time urination cycle

A dry mouth makes people sip, especially in the evening and at night. More fluid at night means more trips to the bathroom. Bladder medicines show this most clearly: a medicine prescribed to reduce trips to the toilet can dry the mouth enough that extra drinking partly cancels the benefit. Our guides why am I so thirsty at night? and frequent urination at night cover both sides of the cycle.

A related pattern has been studied in people with dementia. Medicines such as donepezil can cause urinary leaking as a side effect. In a 2005 study of nearly 45,000 older adults with dementia, those taking these medicines were more likely to be prescribed a bladder medicine afterward, and the two medicines work in opposite directions. Later studies have found this pattern to different degrees.

Why dry mouth matters

Saliva washes away food and bacteria and protects tooth enamel. Without enough of it, people can develop tooth decay, especially along the gum line, gum disease, thrush (a fungal infection), cracked lips, bad breath, changes in taste, trouble chewing and swallowing, and loose or sore dentures. It can also make eating less enjoyable, which matters for older adults who already eat little.

What helps

1. Ask for a medication review. Bring every medicine, including over-the-counter sleep aids, allergy pills and supplements. Ask whether a dose, timing or a medicine with less drying effect could be considered. Don’t stop or change a medicine on your own.
2. Sip water through the day, more in the morning and afternoon than at night.
3. Use sugar-free gum or lozenges, ideally with xylitol, to stimulate saliva.
4. Try a saliva substitute spray, gel or rinse from the pharmacy, especially at bedtime.
5. Run a humidifier at night and breathe through your nose if you can.
6. Limit alcohol, caffeine and tobacco, and avoid mouthwashes that contain alcohol.
7. See the dentist regularly, and ask about fluoride toothpaste or treatments.

When dry mouth is not from medicines

If dry mouth continues after a medicine review, other causes include diabetes, dehydration, mouth breathing or sleep apnea, radiation treatment to the head and neck, and Sjögren’s syndrome, an immune condition that also causes dry eyes. Our guide to excessive thirst explains how to tell a dry mouth from real thirst and which tests to ask for.

Questions about medicines and dry mouth

Does dry mouth from medication go away?

It usually lasts as long as the medicine is taken, though it may ease a little over time. It often improves within days to weeks after a medicine is changed under a doctor’s guidance.

Which bladder medicines cause the least dry mouth?

The newer bladder medicines mirabegron and vibegron work differently and cause dry mouth much less often than oxybutynin-type medicines. Whether one suits a particular person is a decision for the prescriber.

Can dry mouth cause cavities?

Yes. Without enough saliva, tooth decay can develop quickly, especially near the gums. Regular dental visits and fluoride help protect the teeth.

Independent sources

Medications that cause dry mouth as an adverse effect in older people: systematic review and meta-analysis (J Am Geriatr Soc, 2018) · A prescribing cascade involving cholinesterase inhibitors and anticholinergic drugs (Arch Intern Med, 2005)

General education; this article does not replace advice from your own doctor or pharmacist.