title: A Guide to Medications Inducing Salivary Gland Dysfunction, Xerostomia, and Subjective Sialorrhea: A Systematic Review Sponsored by the World Workshop on Oral Medicine VI.
abstract: BACKGROUND
  Medication-induced salivary gland dysfunction (MISGD), xerostomia (sensation of oral dryness), and subjective sialorrhea cause significant morbidity and impair quality of life. However, no evidence-based lists of the medications that cause these disorders exist.
  
  
  OBJECTIVE
  Our objective was to compile a list of medications affecting salivary gland function and inducing xerostomia or subjective sialorrhea.
  
  
  METHODS
  Electronic databases were searched for relevant articles published until June 2013. Of 3867 screened records, 269 had an acceptable degree of relevance, quality of methodology, and strength of evidence. We found 56 chemical substances with a higher level of evidence and 50 with a moderate level of evidence of causing the above-mentioned disorders. At the first level of the Anatomical Therapeutic Chemical (ATC) classification system, 9 of 14 anatomical groups were represented, mainly the alimentary, cardiovascular, genitourinary, nervous, and respiratory systems. Management strategies include substitution or discontinuation of medications whenever possible, oral or systemic therapy with sialogogues, administration of saliva substitutes, and use of electro-stimulating devices.
  
  
  CONCLUSIONS
  While xerostomia was a commonly reported outcome, objectively measured salivary flow rate was rarely reported. Moreover, xerostomia was mostly assessed as an adverse effect rather than the primary outcome of medication use. This study may not include some medications that could cause xerostomia when administered in conjunction with others or for which xerostomia as an adverse reaction has not been reported in the literature or was not detected in our search.
  
  
  CONCLUSIONS
  We compiled a comprehensive list of medications with documented effects on salivary gland function or symptoms that may assist practitioners in assessing patients who complain of dry mouth while taking medications. The list may also prove useful in helping practitioners anticipate adverse effects and consider alternative medications.
authors.affiliation: Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel. awolff@zahav.net.il.|Saliwell Ltd, 65 Hatamar St, 60917, Harutzim, Israel. awolff@zahav.net.il.
authors.forename: Andy
authors.initials: A
authors.lastname: Wolff
authors.affiliation: Department of Oral Medicine and Radiology, DAPMRV Dental College, Bangalore, India.
authors.forename: Revan Kumar
authors.initials: RK
authors.lastname: Joshi
authors.affiliation: Department of Pharmacology, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Göteborg, Sweden.
authors.forename: Jörgen
authors.initials: J
authors.lastname: Ekström
authors.affiliation: The Hebrew University, Jerusalem, Israel.
authors.forename: Doron
authors.initials: D
authors.lastname: Aframian
authors.affiliation: Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Anne Marie Lynge
authors.initials: AM
authors.lastname: Pedersen
authors.affiliation: Mucosal and Salivary Biology Division, Dental Institute, King's College London, London, UK.
authors.forename: Gordon
authors.initials: G
authors.lastname: Proctor
authors.affiliation: Department of Oral Biology, University of Nebraska Medical Center (UNMC) College of Dentistry, Lincoln, NE, USA.
authors.forename: Nagamani
authors.initials: N
authors.lastname: Narayana
authors.affiliation: Division of Oral Medicine and Dentistry, Department of Oral Medicine Infection and Immunity, Brigham and Women's Hospital, Harvard School of Dental Medicine, Boston, MA, USA.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Villa
authors.affiliation: McGill University, Faculty of Dentistry, Montreal, QC, Canada.
authors.forename: Ying Wai
authors.initials: YW
authors.lastname: Sia
authors.affiliation: Faculty of Dental Medicine, University of Medicine, Tirana, Albania.|Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway.
authors.forename: Ardita
authors.initials: A
authors.lastname: Aliko
authors.affiliation: New York University, New York, NY, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: McGowan
authors.affiliation: New York University, New York, NY, USA.
authors.forename: Alexander Ross
authors.initials: AR
authors.lastname: Kerr
authors.affiliation: Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.|Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark.
authors.forename: Siri Beier
authors.initials: SB
authors.lastname: Jensen
authors.affiliation: Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Arjan
authors.initials: A
authors.lastname: Vissink
authors.affiliation: Department of Oral Biology, University of Manitoba, Winnipeg, MB, Canada.
authors.forename: Colin
authors.initials: C
authors.lastname: Dawes
mesh_terms: D064420:Drug-Related Side Effects and Adverse Reactions; D006801:Humans; D019242:Oral Medicine; D012469:Salivary Glands / Q000187:drug effects* / Q000503:physiopathology*; D012798:Sialorrhea / Q000139:chemically induced*; D014987:Xerostomia / Q000139:chemically induced*