Does cymbalta give you dry mouth? (5+ steps)

In this article, we will discuss Cymbalta causing dry mouth, what research says about it, factors contributing to dry mouth, and tips and remedies to manage and alleviate dry mouth.

Does Cymbalta give you dry mouth?

Yes, Cymbalta can give you dry mouth (xerostomia). It is a very common side effect listed with this medication. 1 in 10 patients happens to experience this side effect. It can vary in severity and frequency from person to person. It is usually not serious and improves within a few weeks of starting Cymbalta or even earlier.

Dry mouth is a result of less salivation and is not a side effect that can be overlooked for a prolonged period as it can result in a progressive decline in oral health. Saliva is essential for maintaining oral health and regulating the oral microbiome (1). 

It is significant for normal speech, chewing, taste, bolus formation, and swallowing. It protects the inside of the mouth from pathogens and acids.

Thus, dry mouth contributes to dental caries, changes speech patterns, and affects dietary preferences as well as the nutritional status of an individual. A person suffering from dry mouth faces vitamin deficiencies and caloric insufficiency because once the flow and volume of salivation are reduced, chewing and swallowing become a huge problem. People also suffer from frequent oral infections (2).

Patients with dry mouth may also complain about dry throat, lips, oral soreness, and altered taste.

Cymbalta is the brand name for the drug duloxetine, which belongs to the class of selective serotonin and norepinephrine reuptake inhibitors. It raises the levels of 2 chemicals, serotonin and norepinephrine in the brain, allowing for better control and regulation of mood and pain. It is prescribed for the treatment of depression, anxiety, and chronic pain.

How does Cymbalta cause dry mouth?

Not much research has been conducted on how Cymbalta causes dry mouth. Some authors have hypothesized that the medication affects the cholinergic pathway.

A possible mechanism would be that the salivary glands secrete saliva due to nerve signaling to and from the brain. A chemical named acetylcholine released by the brain acts on the salivary glands promoting saliva secretion. Many medications including duloxetine affect this pathway by preventing acetylcholine from acting on the gland (3). 

The amount of acetylcholine can also be reduced due to an increase in the amount of another chemical in the brain named dopamine caused by Cymbalta (4). The amount of dopamine and acetylcholine in the brain is interdependent. If the amount of dopamine increases for some reason, the amount of acetylcholine proportionally decreases affecting salivary secretion.

Although duloxetine has a very low anticholinergic side effect profile, it does cause dry mouth. So, a small amount of the drug must work on the glands causing a decrease in salivation. 

What does research suggest?

A study reported a case of a 54-year-old woman presenting with amnesia (loss of memory), apathy, and mental stress. Her serum anticholinergic activity was high without any physical illnesses or medications. She was initially set on a course of donepezil, a medication that works to increase the level of acetylcholine and helps with amnesia.

Her clinical symptoms were partially resolved; she was still feeling depressive and this symptom was resolved with the addition of duloxetine to the treatment plan. The anticholinergic activity was reduced with the combined effect of donepezil and duloxetine. The case study showed that depression was intrinsically associated with anticholinergic activity and it is a known fact that so are the medications treating it (5). 

A study showed that medications having anticholinergic activity including Cymbalta, showed a significant association with lower salivary rates resulting in dry mouth. The anticholinergic activity was further lowered by increased intake of medication and polypharmacy (taking 5 or more medications) (6).

Lots of patients have reported their experiences:

A patient reported “For me, dry mouth due to 60 mg Cymbalta was pretty severe the first couple of months, but after that it became tolerable. It is bad during mornings, but still tolerable.” The patient noted that if dry mouth is intolerable for the first few months, it will not get better later as well. Every patient gets affected differently with Cymbalta.

Another patient said “I was switched from 30 to 60 mg of Cymbalta and experienced dryness only on one side of the tongue”. A 51-year-old patient on Cymbalta for 15 years said “The drug is notorious for causing dry mouth. It also dries up the esophagus as well as the colon”. For 1 of the patients, Cymbalta caused many cavities and broken teeth.

Cymbalta causes dry mouth in most patients, however, the severity, the duration, and the differences with the switching of dosage differ from patient to patient.

What factors contribute to dry mouth in patients on Cymbalta?

 Following are some of the common confounding factors that affect the symptoms of dry mouth (6, 7):

• Age: Decreased salivary flow rates, dehydration, increased dementia, and diminished biting force affect salivation and may cause dry mouth.
• Sex: Females are reported to be on a higher total number of medications, reduced saliva secretion, oral health issues, and dryness.
• Genetic variations: People with defective genetic variants of liver enzymes responsible for metabolizing medicines are more prone to dry mouth.
• Dehydration
• Lack of oral hygiene
• Consumption of sweet confectionery, sugar-containing gums, cariogenic/acidic beverages
• Polypharmacy: Several medications other than Cymbalta cause dry mouth. Taking multiple medications along with Cymbalta can increase the intensity of the side effects (7).

What steps to take to prevent/reduce dry mouth?

The following steps can be taken before starting Cymbalta:

• Get as much information as possible from your healthcare provider about the side effect.
• Get a dental check-up and treatment of any active dental disease such as cavities.
• Take instructions in oral hygiene and follow them.
• Provide a complete medical history, the entire list of medications, or any herbs that you might be taking.

The following steps to be taken to reduce dry mouth:

• Drink plenty of water. Sip water at regular intervals. One can also take Aloe vera juice.
• Suck on ice chips.
• Chew sugar-free gum containing xylitol (enhances salivary flow) or suck on sugarless hard candy (8).
• Use saliva-based substitutes for temporary relief. If not the commercial product, you can spray a mixture of equal parts of water and glycerin in the mouth at regular intervals (9).

The following steps to be taken for oral hygiene and care:

• Avoid tobacco, alcohol, and caffeinated beverages as they can make your mouth drier.
• Avoid acidic beverages such as fruit juices, sodas, soft drinks, sports drinks, and wine.
• Brush your teeth twice a day and floss daily as dry mouth can increase the risk of getting caries.
• Examine your mouth daily for red or white patches, ulcers, or tooth decay.
• Use fluoride rinses, a high-strength fluoride toothpaste, or a casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) cream to promote remineralization and prevent caries.
• Have fluoride-based sealants applied to fissures and rough margins of teeth from the dentist to prevent caries.
• Use an anti-bacterial dental varnish containing 1% chlorhexidine and 1% thymol to prevent caries.
• Use a bicarbonate mouthwash on waking and during the day to provide symptomatic relief. Avoid alcohol-based mouthwashes.

If dry mouth is persistent and bothersome despite the above measures taken, consult your doctor to either reduce your dose or switch your medication.

What medicines to take to treat dry mouth?

If all measures to counteract dry mouth fail, doctors can prescribe medicines to treat dry mouth. There are 2 medicines on the market to treat this condition. Regulatory agencies approve both for the treatment of dry mouth.

1. Cevimeline: It is an orally taken cholinergic drug that increases salivary secretion and provides relief to patients. Care should be taken to take this drug with Cymbalta as both of them affect vision.
2. Pilocarpine: It is another cholinergic drug that stimulates the secretion of saliva.

In my opinion, Cymbalta causes dry mouth in the majority of the patients. If Cymbalta is efficacious in treating your primary concern whether it may be depression, anxiety, or pain, then do not choose to switch your medication. Do not abruptly stop Cymbalta if you find dry mouth troublesome as it may cause withdrawal symptoms. 

One must weigh the benefits and the risks associated with a medication and if the benefit outweighs the risks, preventive and reductive measures should be taken to minimize the risk.

References