The metallic taste driving me to despair

Q SEVERAL years ago, I suffered for six months with a metallic taste in my mouth. Tests couldn’t reveal a cause and eventually it disappeared. But it has now come back – and it is unbearable. Last year I was diagnosed with Parkinson’s disease and I wonder if this is a reaction to my medication?

A SYMPTOMS that disrupt our sense of taste are incredibly distressing. They can occur from issues within the gums, the tongue nerves, the nasal passages and the salivary glands, but also from the gut and even from the respiratory system. Teeth and gum infections commonly cause a metallic taste, as do infections from the sinuses and the tonsils, but these would usually be resolved within weeks.

Acid reflux from the stomach is a very common issue: while people expect it to give rise to heartburn, it can also lead to a persistent cough or a horrible taste in the mouth. Testing this theory is easy enough with a trial of over-thecounter antacid medication.

Levodopa, the medication commonly used for Parkinson’s, is known to give some users a metallic taste in their mouth.

Interestingly, there is not always a physical cause found for such a taste – it is known to be associated with psychological issues such as anxiety and depression. It may happen during periods of stress and clear up without treatment but this can take up to two years. Some patients will benefit from stress-relief or therapy.

Q I HAVE been on a drug called risedronate for osteoporosis since suffering two fractures. I read there is a better medication called romosozumab which makes the chance of fractures much lower. Can I ask my GP for it?

A RISEDRONATE, along with alendronate, is a commonly used drug for osteoporosis and works by increasing bone density. Romosozumab works in a different way, but the outcome is the same.

A large study this year was published in the New England Journal Of Medicine which compared the effectiveness of romosozumab and alendronate at preventing fractures.

Looking at more than 4,000 post-menopausal women, the results showed that giving romosozumab led to a 48 per cent lower risk of fracture of the spine and a 38 per cent less risk of suffering a hip fracture. These are certainly impressive results.

However, trials have also raised some safety concerns regarding the newer drug as more side effects were seen with romosozumab, in particular affecting the heart. At this stage it is not something that we can prescribe for the treatment of osteoporosis in the UK.

If romosozumab is approved, there will be a cost implication. Prescribing any medication involves weighing up the pros and the cons.

If a medicine for osteoporosis is working to prevent fractures with little or no side effects, then there is really no reason to look beyond that.

You would only look to change medication if fractures had happened while taking the treatment or side effects were occurring.

Risedronate is also convenient as it is usually taken as a pill, while romosozumab is administered via injections.