Loss of taste due to clopidogrel; early recognition is rewarding

Rajbir Singh; Sonal Grover; RS Bhatia

doi:10.4103/2348-3334.196070

Users Online: 1029

CASE REPORT

Year : 2017 | Volume : 4 | Issue : 1 | Page : 59-60

Loss of taste due to clopidogrel; early recognition is rewarding

Rajbir Singh¹, Sonal Grover², RS Bhatia³
¹ Consultant Periodontist and Implantologist, SGHS (Sohana) Hospital, Private Clinician, Model Town, Punjab, India
² Department of Oral and Maxillofacial Pathology, Christian Dental College, CMC, Punjab, India
³ Consultant Chest Physician, Model Town, Ludhiana, Punjab, India

Date of Web Publication

19-Dec-2016

Correspondence Address:
Sonal Grover
Department of Oral and Maxillofacial Pathology and Microbiology, Christian Dental College, CMC, Ludhiana, Punjab
India

Source of Support: None, Conflict of Interest: None

Check

DOI: 10.4103/2348-3334.196070

Abstract

Hyperplastic dental follicles are very commonly seen associated with an impacted tooth. Multiple calcifying hyperplastic dental follicles (MCHDF), a term used for multiple unerupted teeth with abundant calcifications and rests of odontogenic epithelium in enlarged dental follicles is a rare entity. Varied pattern of calcifications have been observed in such follicles. We report one such case with four patterns of calcifications and odontogenic epithelium associated with bilaterally impacted canines.

Keywords: Adverse drug reaction, ageusia, clopidogrel

How to cite this article:
Singh R, Grover S, Bhatia R S. Loss of taste due to clopidogrel; early recognition is rewarding. CHRISMED J Health Res 2017;4:59-60

How to cite this URL:
Singh R, Grover S, Bhatia R S. Loss of taste due to clopidogrel; early recognition is rewarding. CHRISMED J Health Res [serial online] 2017 [cited 2021 Sep 18];4:59-60. Available from: https://www.cjhr.org/text.asp?2017/4/1/59/196070

Introduction

Morbidity and mortality due to adverse drug reactions (ADRs) have been a major health problem, significantly being recognized for last one and a half decades. Not discussing the hospitalization arising of ADRs, ADRs observed in routine outpatient department (OPD) practice are not being reported for lack of awareness and esthetic approach by busy practitioners. Limited information, therefore, is found on ADRs from developing countries and countries in transition. Apart from genetic predisposition, old age, liver disorders, infections, and malnutrition predispose as well as aggravate the occurrence and nonrecognition of ADRs. ^[1] Widespread use of multiple drugs, i.e., polypharmacy does complicate and precipitate ADRs. In modern era, antiplatelet therapy has been widely used for prevention of coronary artery disease. Among the other common side effects of clopidogrel such as indigestion, bleeding disorder, rash, and diarrhea, the loss of taste sensation is very rare. We came across one such case of clopidogrel-induced loss of taste in a 65-year-old patient.

Case report

A 65-year-old male patient reported to the dental OPD with a chief complaint of loss of taste sensation for 2 months. On examination, no pathology was suspected clinically. The color and texture of mucosa were clinically normal. The quantity and quality of saliva was also found to be normal. Oral hygiene status of the patient was fairly good enough. Dental history did not reveal any significant intervention in the past 6 months. Medical history of the patient revealed that the patient has been taking antianginal, beta-blocker, acetylsalicylate, angiotensin-converting enzyme inhibitor, and statin along with clopidogrel for the last couple of months, as prescribed by a cardiologist. Consult from neurologist and ear, nose, and throat (ENT) specialist ruled out the possibility of any cranial nerve involvement. After ruling out all the possible pathological factors that might lead to ageusia, a provisional diagnosis of clopidogrel-induced ageusia was made. The drug was stopped after consulting the cardiologist, and subsequently, the patient noticed a gradual regain of taste sensation.

Discussion

Clopidogrel, a thienopyridine derivative, is commonly used drug in various atherosclerotic disorders involving peripheral, coronary, and cerebral arteries. It is often an additional drug prescribed to enhance lysine acetylsalicylate effect in preventing the rate of thromboembolic events in high-risk patients such as atrial fibrillation, non-ST-segment elevation acute coronary syndrome, postmyocardial infarction, postangiography, peripheral vascular disease, stroke patients, and coronary artery disease in diabetes mellitus. Loss of taste which is usually reversible and is a rarely reported delayed type of ADR with clopidogrel. ^[2] Recognition of ageusia as an adverse effect is often delayed and recognizing the offending drug is further delayed because of utilization of polypharmacy in these high-risk patients suffering from cardiovascular disorders.

Mechanism of loss of taste may involve, apart from the taste of the drug itself, destruction of mitosis in the replicating receptor cell, blockade of apical ion channels on the taste bud, inhibition of cytochrome P450-dependent enzymes at receptor level, disturbing propagation of nerve impulse, causing neurotransmitter dysfunction, and changing high-order critical processing of taste-related sensory information, production, and chemical constituents of saliva and mucosal elements. ^[2],[3] Drug-induced ageusia is very common but not commonly reported; at the same time, other causes of psycho origin, systemic diseases, local oral etiologies, and neuropathologies must be ruled out. Loss of taste directly influences disturbed peace of mind although it may not put the life at risk but it does, indirectly, influence the daily routine of dietary intake. Pathophysiology of this ADR, however, is not well understood. ^[4],[5]

In general, it is drug-related effect that mostly goes off spontaneously after drug discontinuation in case it is an immediate type of ADR. Since clopidogrel is routinely added as a codrug to multiple drug prescriptions of cardiovascular patients and the adverse effect of loss of taste takes 6-8 weeks to appear, the normal reinstation of taste may take even months after discontinuation of offending drug.

Conclusion

This report carries importance in only creating awareness among dental clinicians where a dentist should seek neurologist and ENT specialist opinion in case of facing such a situation.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1.	Badyal D, Bhatia RS. Adverse Drug Reactions. New Delhi: PeePee Publishers; 2006.
2.	Ksouda K, Affes H, Hammami B, Sahnoun Z, Atheymen R, Hammami S, et al. Ageusia as a side effect of clopidogrel treatment. Indian J Pharmacol 2011;43:350-1. [PUBMED]
3.	Cave AJ, Cox DW, Vicaruddin O. Loss of taste with clopidogrel. Can Fam Physician 2008;54:195-6.
4.	Rajandram RK. Clopidogrel-induced ageusia: a possible overlooked etiology by dentists? Oral Surg Oral Med Oral Pathol Oral Radiol 2012;113:706-7.
5.	Koc F, Ozeren A. Reversible ageusia associated with clopidogrel treatment. Neurol India 2006;54:218-9. [PUBMED]