Having Side Effects of Dry Mouth & Constipation
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Q:  Having Side Effects of Dry Mouth & Constipation

Hi Dr. Phelps,

I am hoping you be able to give me some advice on how to deal with two major side effects that have been plaguing me - dry mouth and constipation.  The dry mouth has caused my gums to recede prematurely, and the constipation has resulted in anal fissures.  I am at my wits' end.  Medically, what can I do to keep myself healthy?  

For the dry mouth, I drink liters of water a day.  I tried all of the biotene products as well as a series of different dry mouth sprays and gels.  I've stopped using alcohol based mouth washes.  Nothing has worked. I've switched to a high fluoride toothpaste, which helps take the slime off my teeth, but...Besides candies/gum/mastication, any suggestions?

For constipation,  I have put myself on a high fiber diet (100% of recommended value), and like I said I drink liters of water each day....I tried using Colace to no avail...

The culprits:  Seroquel (750 mg/day), Lamictal (400 mg/day), Wellbutrin (300mg/day), Provigil (100-400mg, as needed).

It seems that many patients deal with these two medical problems.  To make matters worse, many of us don't have dental insurance. 

I can't find a good resource that provides insight into how to manage these side effects, and was hoping you could help.

Thanks for reading!

Dear Map --
Youíve found and used most of the usual recommendations, and surely you know about fiber products like Metamucil, which are often helpful but must not have been for you. Gum and hard sugarless candies, which some people use with success for the dry mouth, are probably likewise tried and not sufficient for you.

I have no great ideas beyond that, except to wonder if Seroquel, the probable basis of the constipation (bupropion/Seroquel a close second out of these 4), has been established as absolutely necessary. These are serious quality-of-life-limiting side effects, so the medication causing them must be cross-examined in that light.

Concerned that this too will be no new news, Iíll add one more much more controversial and very possibly not-on-target-for-you idea. Bupropion/Wellubutrin is not a standard requirement for long-term management in the opinion of many mood specialists (although it may have proved itself necessary for you through careful trials of discontinuation?). Itís possible that Seroquel is needed when bupropion is there but not otherwise? That might be true if your manic phases were only hypomanic, i.e. bipolar II. In other words, in some circumstances, very possibly not yours though, lamotrigine can be adequate all by itself (especially if augmented with serious non-medication stabilizing practices like regular sleep hours and exercise, careful attention to stress and mood-destabilizing social experiences, etc.).

Perhaps if that strategy is not applicable for you (e.g. if you have Bipolar I, which requires a reliable anti-manic component; Seroquel is one, though there are numerous other candidates, as you probably know) there is something in this logic that might still be useful to you. Good luck with the process.

Dr. Phelps

Published January, 2010


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