10 Medication Side Effects That Can Affect Your Mouth

Have you started taking a new medication and noticed something different about your mouth? Your first instinct may 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 explain some of these side effects and which medications may cause them.

1. Dry mouth

Dry mouth is one of the most common medication side effects. Over time, dry mouth can cause uncomfortable symptoms and affect your oral health.

Medications that can cause dry mouth include:

• 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

• Antihistamines: such as loratadine (Claritin), cetirizine (Zyrtec), and diphenhydramine (Benadryl)

• Diuretics: 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

Talk with your healthcare team if you think you’re experiencing dry mouth. They can offer you treatments, like:

• Adjusting your medication

• Using ice chips or rinsing your mouth with cold water

• 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

Some medications can cause gum overgrowth (gingival enlargement). This side effect can cause pain and trouble with eating.

Medications that can cause gum overgrowth include:

• Anti-epileptic medications: such as phenytoin (Dilantin):

• Blood pressure medications: such as calcium channel blockers, like amlodipine (Norvasc)

• Immunosuppressants: such as cyclosporine (Sandimmune) and tacrolimus (Prograf)

Work with your dental team if you develop gum overgrowth. Daily dental care and regular teeth cleanings can help 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 inside your mouth. Sometimes, they look like tongue blisters or blood blisters in your mouth. 

Medications rarely cause oral ulcers, but they can happen with some medications, including:

• Amoxicillin 

• Ampicillin

• Aspirin 

• Ibuprofen (Advil, Motrin)

• Methotrexate

• Naproxen (Aleve, Naprosyn)

• Phenytoin (Dilantin) 

Cancer treatments, like chemotherapy and radiation therapy, can cause oral mucositis, which causes ulceration of the lining of your mouth. This is a common and potentially serious side effect that should be managed carefully with a cancer specialist.

4. Oral yeast infection

Yeast infections in the mouth, also known as oral thrush, can cause symptoms like:

• White patches in your mouth, including on the tongue, cheeks, throat, and roof of the mouth

• Mouth soreness or redness 

• Painful swallowing 

• Pain with eating

• Redness and cracking at the corners of your mouth

• Loss of taste

• Cotton mouth 

Inhaled steroid medications, like fluticasone (Flovent) and budesonide / formoterol (Symbicort), can sometimes cause thrush. Inhaled steroid medications are common treatments for asthma and chronic obstructive pulmonary disease (COPD).

To avoid thrush while taking these medications:

• Fully inhale each dose so the medication doesn’t stay in your mouth

• Rinse your mouth with water after taking your medication. 

Talk with your healthcare team if you develop thrush symptoms. They can prescribe antifungal treatments to help cure your symptoms.

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. 

With black hairy tongue, the tiny dots on your tongue, called papillae, can grow longer and change color. They may look brown or black. The condition is harmless and usually goes away on its own after you finish taking the antibiotic. Brushing your tongue can also help.

6. Weird taste in your mouth

Sometimes, medications can affect how you taste things. It could mean a change in how things taste, like sweet foods tasting salty. You may also lose some of your ability to taste.

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

7. Osteonecrosis of the jaw

Osteonecrosis of the jaw (ONJ), also known as dead jaw syndrome, is a condition in which parts of the jawbone start to break down. It can lead to exposed bone in the mouth and cause symptoms like pain, swelling, and drainage.

ONJ is a rare but serious side effect of certain osteoporosis medications, including: 

• Bisphosphonates: such as alendronate (Fosamax) and ibandronate (Bonvia)

• Monoclonal antibody medications: like denosumab (Prolia)

Some cancer medications, such as denosumab (Xgeva) and bevacizumab (Avastin), can also cause ONJ.

Although the risk is low, good oral hygiene and regular dental visits can help lower your risk of developing ONJ while taking these medications.

8. Burning mouth syndrome

Burning mouth syndrome is a condition that causes a burning and painful feeling in various parts of your mouth. It can last about 4 to 6 months. 

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: like levothyroxine (Synthroid)

• Anti-seizure medication: such as topiramate (Topamax)

There’s no way to prevent burning mouth syndrome while taking these medications. But talk to your healthcare team if you develop symptoms. They can suggest treatments to ease your symptoms or offer alternatives to the medication causing your symptoms.

9. Tooth decay

Medications that lower the amount of saliva in your mouth can lead to tooth decay. This is because saliva helps keep your mouth from becoming too acidic. Some medications can also cause tooth decay because of high sugar content.

In addition to the medications listed in the dry mouth section above, these medications can cause tooth decay:

• Opioid medication: such as 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

Some medications can also cause discoloration of your teeth. These include:

• Antibiotics: such as tetracyclines and ciprofloxacin (Cipro)

• Inhaled corticosteroids: such as fluticasone (Flovent)

• Antibacterial mouth rinses: such as chlorhexidine (Peridex)

• Cholesterol medication: such as cholestyramine (Prevalite)

Tooth discoloration from medication can be difficult to treat. Your dentist may recommend bleaching teeth, scraping stains, or covering the discolored areas with crowns or veneers. 

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Written by:

Austin Ulrich, PharmD, BCACP

​​Austin Ulrich, PharmD, BCACP, is a board-certified ambulatory care clinical pharmacist. Ulrich’s experience includes direct patient care in hospital and community pharmacies.

Edited by:

Patricia Pinto-Garcia, MD, MPH

Patricia Pinto-Garcia, MD, MPH, is a medical editor at GoodRx. She is a licensed, board-certified pediatrician with more than a decade of experience in academic medicine.

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