Pharmacology · patient case question
Which of her medications most likely explains the persistent ALTERED TASTE?
Patient case: Chest pain during treatment in a patient with angina
Patient: Female, 65 years old
Chief Complaint: Presenting for a scheduled restoration.
Background: Stable angina for six years, hypertension, hyperlipidaemia. Medications: sublingual nitroglycerin as required, atorvastatin, losartan, aspirin 81 mg. She has brought her own nitroglycerin spray and it is in her handbag.
Vital Signs: On seating BP 142/84 mmHg · HR 78 bpm. During treatment she reports MILD central chest tightness, the same as her usual angina, with no radiation, no sweating and no shortness of breath.
Findings: Restoration in progress on tooth #30. She has complained of a persistent metallic, altered taste since her medication was changed some months ago, and of a dry mouth.
Show answer and explanation
Correct answer: D. Losartan
- A. Statins are associated with myalgia, transaminase elevation and, rarely, rhabdomyolysis. Taste disturbance is not characteristic.
- B. Sublingual nitroglycerin is used intermittently for minutes at a time. It causes headache and flushing, not a persistent taste change.
- C. Low-dose aspirin causes gastrointestinal irritation and bleeding tendency, not dysgeusia. High-dose salicylates can cause tinnitus.
- D. CORRECT. LOSARTAN, like other angiotensin receptor blockers and the ACE inhibitors, is a recognised cause of DYSGEUSIA — a persistent metallic or altered taste. The ACE inhibitors are the more notorious for it, alongside their dry cough, but the sartans share the effect. It is dose-related and reversible on withdrawal, and it is worth raising with the prescribing physician, because taste disturbance is a common reason patients quietly stop taking antihypertensives.
Note: The dental drug-induced taste list worth knowing: ACE inhibitors and ARBs, metronidazole, clarithromycin, metformin, captopril, lithium, terbinafine, chlorhexidine and many chemotherapeutic agents. Distinguish drug-induced dysgeusia from the other causes — zinc or B12 deficiency, xerostomia, chorda tympani injury, burning mouth syndrome, and upper respiratory infection.