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Impact of medications on salivary flow rate in patients with xerostomia: a retrospective study by the Xeromeds Consortium

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Abstract

Objectives

This study evaluates the impact of systemic medications and polypharmacy on unstimulated (UWS) and chewing-stimulated whole saliva (SWS) flow rates in patients with xerostomia.

Material and methods

This cross-sectional multicenter study is based on data of patients referred to five oral medicine outpatient practices in Europe and USA from January 2000 and April 2014. Relevant demographic, social, medical history and current medications were collected.

Results

The study included 1144 patients, 972 (85%) females, with a mean (SD) age of 59 (14.1) years. In unmatched patients, the UWS flow rate was lower in patients taking a medication (vs. not taking a medication) from the following drug categories: opioid analgesics, anticonvulsants, antidepressants, antihypertensives, benzodiazepines, corticosteroids, diuretics, disease-modifying antirheumatic drugs (DMARDs) and hormones. There was a greater negative effect on SWS flow rate in patients taking (vs. not taking) anticonvulsants, antidepressants, benzodiazepines, corticosteroids, and DMARDs. In matched patients, both UWS (0.22 vs. 0.19 ml/min; p = 0.03) and SWS (0.97 vs. 0.85 ml/min; p = .017) flow rates were higher in patients on non-opioid analgesics (vs. not taking). The UWS flow rate was lower in patients taking antidepressants (vs. not taking) (0.16 vs. 0.22 ml/min p = .002) and higher (and within normal range) in patients taking sex hormones (vs. not taking) (0.25 vs. 0.16 ml/min; p = .005). On the other hand, SWS was lower in patients taking corticosteroid (vs. not taking) (0.76 vs. 1.07 ml/min; p = .002), and in patients taking DMARDs (vs. not taking) (0.71 vs. 0.98 ml/min; p = .021).

Finally, differences in medians of both UWS and SWS were statistically significant in patients taking 1 or more than 1 opioid analgesic (vs. not taking, p ≤ .0001 and p = .031, respectively), 1 or more than 1 anticonvulsants (vs. not taking, p = .008 and p = .007), 1 or more than 1 antidepressants (vs. not taking, p < .0001 for both), 1 or more than 1 DMARDs (vs. not taking, p = .042, and p = .003).

Conclusions

A greater negative impact on UWS and SWS flow rates was seen in patients taking more than one medication from the same drug class. Intake of antidepressants, corticosteroids and DMARDs is associated with lower whole saliva flow rates.

Clinical relevance

Salivary flow rate can be modified by some specific medications, mostly by polypharmacy.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request. Some data may not be made available because of privacy or ethical restrictions.

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Funding

Dr. Giulio Fortuna received an American Academy of Oral Medicine Research Advancement Committee Award to support this work.

Author information

Authors and Affiliations

  1. Department of Oral Medicine/Oral & Maxillofacial Surgery, Atrium Health Carolinas Medical Center, 1000 Blythe Blvd, Charlotte, NC, 28203, USA

    Giulio Fortuna, Sarah Whitmire, Kathleen Sullivan, Jenene Noll & Michael T. Brennan

  2. Department of Oral Medicine, Glasgow Dental Hospital and School, University of Glasgow, Glasgow, G2 3JZ, UK

    Giulio Fortuna

  3. Department of Oral Medicine, University of Zagreb, Zagreb, Croatia

    Ivan Alajbeg & Ana Andabak-Rogulj

  4. Section for Oral Medicine and Pathology, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Noerre Allé 20, 2200, Copenhagen N, Denmark

    Anne Marie Lynge Pedersen

  5. Department of Oral and Maxillofacial Surgery, University of Groningen and University Medical Centrum Groningen, PO Box 30.001, 9700 RB, Groningen, the Netherlands

    Arjan Vissink

  6. Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy

    Olga di Fede

  7. Department of Economics and Statistics, Federico II University of Naples, 80126, Naples, Italy

    Massimo Aria

  8. Department of Oral and Maxillofacial Surgery/Oral Pathology, Amsterdam UMC and Academic Center for Dentistry (ACTA), Amsterdam Institute for Infection and Immunity, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands

    Derk Jan Jager

  9. Department of Dentistry and Oral Health, Aarhus University, Vennelyst Boulevard 9, 8000, Aarhus C, Denmark

    Siri Beier Jensen

  10. Saliwell Ltd, Harutzim, Tel Aviv, Israel

    Andy Wolff

  11. Department of Otolaryngology/Head and Neck Surgery, Wake Forest University School of Medicine, Winston Salem, NC, USA

    Michael T. Brennan

Authors
  1. Giulio Fortuna
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  2. Sarah Whitmire
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  3. Kathleen Sullivan
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  4. Ivan Alajbeg
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  5. Ana Andabak-Rogulj
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  6. Anne Marie Lynge Pedersen
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  7. Arjan Vissink
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  8. Olga di Fede
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  9. Massimo Aria
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  10. Derk Jan Jager
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  11. Jenene Noll
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  12. Siri Beier Jensen
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  13. Andy Wolff
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  14. Michael T. Brennan
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Contributions

All authors made substantial contributions to the study conception or design, or the acquisition, analysis or interpretation of data for the work; and drafting the work or revising it critically for important intellectual content. Details regarding author contributions are as follows:

study conception or design: GF, SW, KS, IA, AAR, AMLP, AV, OF, MA, DJJ, JN, SBJ, AW, MTB; acquisition of data: GF, SW, IA, AAR, AMLP, AV, OF, DJJ, JN, SBJ, AW, MTB; analysis or interpretation of data: GF, KS, IA, AAR, AMLP, AV, OF, MA, DJJ, SBJ, AW, MTB; drafting the work: GF, KS, MA, AW, MTB; editing/revising the work: GF, SW, KS, IA, AAR, AMLP, AV, OF, MA, DJJ, JN, SBJ, AW, MTB. All authors gave final approval of the version to be published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

Corresponding author

Correspondence to Michael T. Brennan.

Ethics declarations

Ethics approval and consent to participate

Appropriate Ethics Board approval was obtained for patients assessed in the present study. The study was conducted in accordance with the principles of the Declaration of Helsinki. Informed consent was obtained from all participants.

Conflict of interest

All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organization for the submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

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Fortuna, G., Whitmire, S., Sullivan, K. et al. Impact of medications on salivary flow rate in patients with xerostomia: a retrospective study by the Xeromeds Consortium. Clin Oral Invest 27, 235–248 (2023). https://doi.org/10.1007/s00784-022-04717-1

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  • DOI: https://doi.org/10.1007/s00784-022-04717-1

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