Written by Austin Ulrich, PharmD, BCACP | Reviewed by Joshua Murdock, PharmD, BCBBS Updated on July 14, 2022
Key takeaways:
- Many medications can cause mouth-related side effects, from certain antibiotics to blood pressure and seizure medications.
- Some mouth-related side effects, like thrush or burning mouth syndrome, might need treatment. Others, like having a weird taste in your mouth or black hairy tongue, tend to resolve on their own.
- If you think your mouth-related issue is a side effect of a medication, talk with your healthcare provider. They can help you find the best way to manage it.
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Have you started taking a new medication and noticed something different about your mouth? Your first instinct might be to ignore it, but changes to your mouth can affect your overall health.
Many popular medications can cause mouth-related side effects, from dry mouth to black hairy tongue and burning mouth syndrome. Here, we’ll talk about some of those side effects and the medications that cause them.
1. Dry mouth
Dry mouth is one of the most common medication side effects out there. It usually happens because your mouth doesn’t have or make enough saliva, and it can also affect the tongue.
These are some of the main medication culprits:
- Anticholinergic medications for overactive bladder: such as oxybutynin and tolterodine (Detrol, Detrol LA)
- Selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants: such as sertraline (Zoloft) and amitriptyline
- Some antihistamine medications: such as loratadine (Claritin), cetirizine (Zyrtec), and diphenhydramine (Benadryl)
- Diuretics, or water pills: such as furosemide (Lasix)
- Muscle relaxants: such as tizanidine (Zanaflex)
- Attention-deficit hyperactivity disorder (ADHD) medications: such as dextroamphetamine/amphetamine salts (Adderall)
- Opioids: such as oxycodone
If you think you’re having dry mouth as a side effect from a medication, you should talk with your healthcare provider. They can give you some recommendations for managing it, such as:
- Stopping the medication causing it (when possible)
- Using ice chips or cold water rinses in your mouth
- Avoiding foods that are dry, salty, or acidic
- Staying hydrated by drinking plenty of water
- Using a saliva substitute to relieve dry mouth symptoms
2. Gum overgrowth
Overgrowth of your gums (gingival enlargement) can happen for several reasons, but it’s often the result of poor oral hygiene or a side effect of a medication. It can cause trouble with eating and pain due to swelling and inflammation.
Gum overgrowth can be seen with medications that include:
- Phenytoin (Dilantin): an anti-seizure medication
- Calcium channel blockers like amlodipine (Norvasc): used to treat high blood pressure
- Cyclosporine (Sandimmune) and tacrolimus (Prograf): immunosuppressants used by people who have received an organ transplant
Preventing gum overgrowth starts with having good oral hygiene. Daily dental care and regular teeth cleanings are critical — especially if you have gum overgrowth — to prevent bacteria and plaque from building up. In some cases, surgical removal of the excess tissue may be needed.
3. Oral ulcers
Oral ulcers are painful sores that appear on the inside of your mouth. Sometimes, they look like tongue blisters or blood blisters in your mouth.
Medications rarely cause oral ulcers, but it can happen with these:
- Methotrexate: an immunosuppressant used to treat many autoimmune disorders, like rheumatoid arthritis and psoriasis
- Non-steroidal anti-inflammatory drugs (NSAIDs): such as ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), and aspirin
- Antibiotics: such as amoxicillin and ampicillin
- Anti-seizure medications: such as phenytoin (Dilantin)
On a related note, many cancer medications (especially forms of chemotherapy and radiation) can cause oral mucositis, or ulceration of the lining of the mouth. This is a common and potentially serious side effect that should be managed carefully with a cancer specialist.
4. Oral yeast infection, or thrush
Yeast infections in the mouth, also known as oral thrush, can cause symptoms like:
- White patches in the mouth (including tongue, cheeks, throat, and roof of mouth)
- Soreness or redness in the mouth
- Pain while swallowing or eating
- Redness and cracking at the corners of the mouth
- Loss of taste
- Sensation of cotton in the mouth
In some cases, oral yeast infections can be caused by inhaled steroid medications for asthma and chronic obstructive pulmonary disease (COPD) — like fluticasone (Flovent) and budesonide/formoterol (Symbicort) — and other steroid-based inhalers. This can happen if the medication is deposited primarily in your mouth instead of being inhaled into your lungs.
To help avoid this problem, remember to fully inhale when taking one of these medications and thoroughly rinse your mouth after each dose. If you end up developing thrush, your healthcare provider may prescribe you an antifungal medication.
5. Black hairy tongue
Certain antibiotics can cause a condition called black hairy tongue by changing the balance of different bacteria that naturally live in your mouth. Other causes include smoking, frequent coffee or black tea consumption, and poor oral hygiene.
With black hairy tongue, you’ll see the tiny dots on your tongue, known as papillae, get longer and turn a different color, typically brown or black. The condition is harmless and usually goes away on its own after you finish taking the antibiotic that is causing it. Brushing your tongue can also help.
6. Weird taste in your mouth
Changes in people’s sense of taste can result from many things, like aging and certain infections that affect the ability to smell. But sometimes medications can affect how people taste things, too.
What kind of changes are we talking about? It could mean a change in how things taste (like experiencing sweet foods as salty) or losing some of your ability to taste all together.
Many medications can cause a weird taste in your mouth, including:
- Certain antibiotics: including some penicillins and cephalosporins
- Neurologic medications: like migraine treatments and stimulant ADHD medications
- Heart medications: like angiotensin-converting enzyme (ACE) inhibitors or diuretics
- Thyroid medications: such as methimazole (Tapazole) or levothyroxine (Synthroid)
- Antidepressants and other mood medications: such as sertraline (Zoloft) and amitriptyline
Sometimes, you can tolerate a weird taste if it can be masked by putting something else in your mouth (like food or gum). Other times, it may be bothersome and require a change in medication. Always check with your healthcare provider before changing any of the medications you take.
7. Osteonecrosis of the jaw
If you are taking or considering taking an osteoporosis medication, you and your provider may have discussed this very rare but serious health condition.
Osteonecrosis of the jaw (ONJ), also known as dead jaw syndrome, is a condition where parts of the jaw bone start to break down. It can lead to exposed bone in the mouth and cause symptoms like pain, swelling, and drainage.
Dental extractions and mouth infections are possible causes of ONJ, but it can also be a rare side effect of certain medications, including:
- Bisphosphonates for osteoporosis: such as alendronate (Fosamax) and ibandronate (Bonvia)
- A monoclonal antibody medication for osteoporosis: denosumab (Prolia)
- Some cancer medications: such as denosumab (Xgeva) and bevacizumab (Avastin)
Although the risk is low, if you’re taking one of these medications, good oral hygiene and regular dental visits are encouraged to help lower the chances of developing this condition.
8. Burning mouth syndrome
If you have pain in your mouth but don’t have an ulcer or a sore, you could be experiencing burning mouth syndrome. Burning mouth syndrome is a condition that lasts about 4 to 6 months and causes a burning pain in various areas of your mouth.
While there’s not always a clear cause, some medications that have been linked to burning mouth syndrome are:
- ACE inhibitors and angiotensin II receptor blockers (ARBs) : such as enalapril (Vasotec) and candesartan (Atacand)
- Antiretrovirals and efavirenz-containing medications: such as efavirenz (Sustiva)
- Thyroid medication: levothyroxine (Synthroid)
- Anti-seizure medication: topiramate (Topamax)
Treating burning mouth syndrome, which may require medication or behavioral treatments, should be done under the care of your healthcare provider.
9. Tooth decay
Tooth decay can happen when your teeth are exposed to acidic or dry conditions over a long period of time. Medications that lower the amount of saliva in your mouth (dry mouth) carry a risk of causing tooth decay. This is because saliva helps maintain a less acidic environment in your mouth. Some medications can also cause tooth decay because of high sugar content.
In addition to those listed in the dry mouth section above, these medications can cause tooth decay:
- Opioid medication: buprenorphine (Subutex)
- Children’s syrup-based medications: such as Children’s Tylenol
- Antacids: such as Tums (calcium carbonate)
- Antifungal medications: such as nystatin oral suspension
10. Tooth discoloration
Tooth discoloration can be caused by various things, like poor dental hygiene, tobacco use, and low tooth enamel. It can also be caused by certain medications, including:
- Antibiotics: such as tetracyclines and ciprofloxacin (Cipro)
- Inhaled corticosteroids: such as fluticasone (Flovent)
- Antibacterial mouth rinse: chlorhexidine (Peridex)
- Cholesterol medication: cholestyramine (Prevalite)
Tooth discoloration from medication can be difficult to treat, but it is possible. Your dentist may recommend bleaching teeth, scraping stains, or covering the discolored areas with crowns or veneers.
The bottom line
There are many medications that can cause mouth problems. Sometimes, these side effects don’t cause any long-term issues and resolve on their own. But others require intervention from your healthcare provider. It’s important not to stop or change your medication without talking with a healthcare provider. Your provider will help you determine if you’re having medication-related mouth issues and recommend a treatment to ease your symptoms, if needed.
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