Drugs Taste Bad

Feb 8, 2017

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

My dog Sheldon should run for the leadership of the Conservative Party of Canada. He is way cuter than Kevin O'Leary. Unlike Kellie Leitch, Sheldon is very inclusive. Sheldon loves everyone. He might be susceptible to bribes, though. A handful of Milk Bones and a belly rub will pretty much get Sheldon to follow you anywhere. The main reason Sheldon should run for the leadership of the Conservatives is Sheldon hates taxes. As a dog, it is not that Sheldon pays taxes, but this time of year, Doris goes back to work at the accounting firm MNP. That means Sheldon is alone in the house for a good chunk of the day. Sheldon hates tax season.

Doctors hate pharmacists and I don't blame them. Let me tell you why. Recently, a lady called and said her new inhaler caused every side effect on the patient info sheet we gave her. After chatting for a little while, she admitted that she only conclusively had one of the side, and wasn't sure if the inhaler really caused some of the other symptoms she was having. And after chatting a while longer, she admitted she could walk up the stairs better now with the inhaler than before she started it. Eventually we got to a compromise. Instead of throwing out the new inhaler, she would put up with the side effect for a few weeks, until her next doctor's appointment. By that point we could see if the side effect got better on its own and her and her doctor could decide together if the benefit of walking up the stairs more easily was worth the side effect.

This is why the doctors hate pharmacists like me. We got lucky on the lady who actually called me to discuss side effects. There are patients who will have a problem, see their doctor, get a diagnosis and a treatment, fill the prescription at the pharmacy, take their medication home and then throw it out before they take their first dose because of the pharmacy patient information leaflet. I'm telling you this because I'd like to discuss some more unusual side effects of medications. I think they are interesting, but please don't stop taking your meds without talking to your doctor or pharmacist first. Thanks.

I read an interesting article in the February 2017 Pharmacist Letter about drugs that cause taste disturbances. Taste disturbances are rare. If they occur, talk to your pharmacist. In general, our strategy will be to wait, put up with short term annoyance, try to counter act the taste, or as a last resort, change the medication.

Angiotensin Converting Enzyme or ACE inhibitors (enalapril, ramipril), and Angiotensin Receptor Blockers or ARB's (losartan, telmisartan) are medications we use to treat high blood pressure. They can dull taste or cause a constant bitter, metallic, salty or sweet taste. It seems ACE inhibitors can affect how zinc is bound up in the taste receptors and thus change how they work. The ACE inhibitor enalapril has been reported to dull the taste buds in less than 5% of cases. The good news is this rare effect goes away on its own after a couple of weeks.

Metformin for diabetes can cause a metallic taste. Metformin seems to directly interfere with how the taste receptors function. These taste disturbances happen in less than 3% of people taking metformin, but they can last a while. This metallic taste seems to persist for up to 6 months.

So for ACE's, ARB's and metformin, usually the answer to the taste disturbance is going to be wait. Within a few weeks to a few months the problem will go away. I know that is easy for me to say, but ACE's and ARB's treat blood pressure. Metformin treats diabetes. High blood pressure and diabetes can cause heart attacks and strokes. The damage or death from a heart attack or stroke is permanent.

Antibiotics like metronidazole, clarithromycin and levofloxacin can cause metallic or abnormal tastes. When it comes to adults, sorry, the answer is suck it up. Antibiotics are usually only given for 5-10 days. I'm not saying you are going to be happy for that weekish with a bad taste in your mouth, but you have a bacterial infection. You have a sore ear, or sinuses or skin wound that won't heal. If the infection is caused by bacteria, there is a good chance the infection won't go away without the antibiotic. But if you finish your antibiotics and put up with the bad taste, when you go off of them, the bad taste will go away.

It is different with children. If you can't get the antibiotic into the child because of the taste, I've got a few tricks for you to try. There are lots and lots of good reasons not to give children soft drinks or pop like Coke, Pepsi and Sprite from diabetes to tooth decay. But pop, especially cola, has been a great antibiotic bribe. Kids usually love it, and cola is great at washing tastes out of the mouth. Often if you tell a child that if they take and swallow their antibiotic that they can have a sip of pop to wash it down, that can work really well. And I said a sip, not two liters of pop. And keep all the dentists from lynching me by brushing their teeth afterwards. Another trick that Nicole from the pharmacy has come up with is honey. Try crushing the antibiotic tablet or capsule into the middle of a spoonful of honey. Then the child takes the whole teaspoon of honey. The sticky, sweet honey seems to get the bitter pill over the tongue and down the throat with considerably less trouble.

Statins like atorvastatin are used to treat high cholesterol. They can distort or dull taste or cause a dry mouth. It seems like the reduction of cholesterol caused by the atorvastatin interferes with taste neurons working properly. The good news is this happens in less than 1% of people using atorvastatin. But we have no good reports about how long these taste disturbances will last. Before we try switching drugs, it would be reasonable to try an artificial saliva like Biotene. Biotene can really help with a dry mouth.

Zopiclone can cause a bitter, metallic taste. Zopiclone is taken at bedtime to help someone sleep. Zopiclone's taste in the mouth the next morning does come up in the pharmacy often. One of my standard answers is if you drink something plain like water the next day, it tends to make the taste worse. If you drink something acidic like orange juice, it tends to make the taste go away.

Maybe Sheldon isn't cut out for politics. I think he'd do okay in question period. Although usually a quiet dog, if he wants something, he will stand in front of you and bark until you pay attention to him. That should drown out his political critics. But his attention span might be a little short, especially when it comes to small, wind blown objects. "Mr. Speaker, I'd like to rise on a Point of Order. When the Honorable Member opposite says…..Leaf!"

As always if you have any questions or concerns about these or other products, ask your pharmacist.

The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at www.dcp.ca


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