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BMC Oral Health Journal
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BMC Oral Health publishes original research articles in all aspects of the prevention, diagnosis and management of disorders of the mouth, teeth and gums, as well as related molecular genetics, pathophysiology, and epidemiology.
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Dysgeusia and burning mouth syndrome by eprosartan.
BMJ. 2002 November 30; 325(7375): 1277.
by Xavier Castells, Isidre Rodoreda, Consuelo Pedros, Gloria Cereza, Joan-Ramon Laportea
Background
Eprosartan is an angiotensin II receptor antagonist.
Dysgeusia and burning mouth syndrome attributed to angiotensin converting enzyme
inhibitors have been reported.1 Several case reports related to angiotensin II receptor
antagonists have also been published. We report the case of a patient in whom oral
eprosartan induced reversible taste disturbance and burning mouth sensation on two
occasions. This case was reported to the Catalan pharmacovigilance centre.
A 48 year old woman with a 10 year history of essential hypertension was being treated
with valsartan 160 mg daily. She had no other medical condition and was not taking any
other drugs. She started taking eprosartan 600 mg daily because her blood pressure
remained uncontrolled with valsartan. Three weeks later she complained of a metallic
taste and a burning sensation in her mouth. The oral cavity was normal and no underlying
medical causes were identified. She stopped taking eprosartan and one week later her
taste had returned to normal. The dysgeusia was not attributed to eprosartan and she
started taking the drug again. A few days later, dysgeusia and the burning sensation
in her mouth returned. She stopped taking eprosartan and her taste recovered in two days.
Taste disorders related to angiotensin II receptor antagonists had not been described
in clinical trials,2 but several cases of dysgeusia have been reported in patients treated
with losartan3–5 and with valsartan.6 To our knowledge, this is the first reported case of
dysgeusia induced by eprosartan and the first case of dysgeusia induced by angiotensin II
receptor antagonists with positive rechallenge. Dysgeusia with losartan but not with
angiotensin converting enzyme inhibitors has been reported to occur in the same patient,
suggesting that angiotensin converting enzyme inhibitors or angiotensin II receptor
antagonists produce this effect by acting through different mechanisms.5 Because the
incidence of dysgeusia in patients treated with drugs from these two therapeutic
groups is low,1 2 it is possible that this adverse effect appears only in patients
with some predisposing condition.
In our case report, the temporal sequence of events—and, in particular, positive
rechallenge—and the lack of underlying concomitant diseases or other drugs strongly
suggest that the association between dysgeusia, burning mouth syndrome, and eprosartan
was causal. Because these effects occurred with eprosartan but not with valsartan at
equivalent doses, however, our observation does not favour the theory of an effect due
to the angiotensin II receptor antagonist class of drug. Factors predisposing to this
adverse effect remain to be identified and the mechanism remains to be elucidated.
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