Metallic Taste Causes and Management

Medication-Induced Metallic Taste

Clarithromycin causes metallic taste as one of its most common gastrointestinal toxicities, along with nausea and vomiting, and this effect is dose and serum-level related, according to the American Thoracic Society 1
Adult patients generally cannot tolerate clarithromycin at more than 1,000 mg/day, with elderly patients with low creatinine clearance or body weight requiring even lower doses (250-500 mg/day) due to toxicity, as recommended by the American College of Chest Physicians 1
Azithromycin also causes gastrointestinal symptoms but primarily manifests as diarrhea rather than metallic taste, as reported in the American Journal of Respiratory and Critical Care Medicine 1
Trientine (used for Wilson disease) may cause loss of taste, particularly when used in patients with primary biliary cirrhosis, with a strength of evidence level of moderate, according to the American Association for the Study of Liver Diseases 2, 3

Metal hypersensitivity to nickel, aluminum, vanadium, and titanium in dental or orthopedic implants can cause both local and systemic symptoms including metallic taste, with approximately 10-15% of the population exhibiting allergy to one or more metals, as reported in the International Journal of Oral Science 4
Pre-implantation screening via skin patch tests or lymphocyte transformation tests is recommended for patients with history of metal intolerance, according to the American Academy of Oral and Maxillofacial Surgery 4
Contact dermatitis from nickel exposure in earrings and jewelry is common and can cause local reactions, as reported in the American Academy of Pediatrics 5

For patients with metal implants and suspected hypersensitivity, skin patch tests or lymphocyte transformation tests may be indicated, with a strength of evidence level of high, according to the International Journal of Oral Science 4

The American Academy of Sleep Medicine reports that zopiclone and eszopiclone consistently cause bitter/metallic taste in 7-26% of patients, representing the most common adverse effect of these agents 6
The risk difference of unpleasant taste compared to placebo is +0.07, with some studies reporting rates as high as 26.1% versus 5.6% with placebo, according to the American Academy of Sleep Medicine 7, 6
The American Thoracic Society notes that ethionamide commonly causes profound metallic taste along with nausea and vomiting, and symptoms may improve if doses are taken with food or at bedtime 8

The International Journal of Oral Science reports that metal hypersensitivity to nickel, aluminum, vanadium, and titanium in dental or orthopedic implants can cause local and systemic symptoms including metallic taste 9

The American Geriatrics Society states that healthy aging contributes to alterations in olfaction and gustatory sensation, and changes in the muscles of mastication and lower salivary flow rates exacerbate taste problems in older adults 10
The American Geriatrics Society also notes that many medications consumed by older adults contribute to taste disturbances 10

The American Thoracic Society, the American Academy of Sleep Medicine, and Praxis Medical Insights recommend a systematic assessment when evaluating metallic taste, prioritizing medication review, laboratory testing, oral examination, and psychiatric screening 8, 7, 6

Ethionamide commonly causes profound metallic taste along with nausea and vomiting, and symptoms may improve if doses are taken with food or at bedtime, as recommended by the Centers for Disease Control and Prevention 11
Intravenous lidocaine can cause metallic taste along with peri-oral numbness and tinnitus in approximately 6.8% of patients, according to the American Society of Anesthesiologists 12

Metal hypersensitivity to nickel, aluminum, vanadium, and titanium in dental or orthopedic implants can cause both local and systemic symptoms including metallic taste, with approximately 10-15% of the population exhibiting allergy to one or more metals, as reported by the International Journal of Oral Science 13, 14
Pre-implantation screening via skin patch tests or lymphocyte transformation tests is recommended for patients with history of metal intolerance to jewelry, belt buckles, watches, or prior metal implants, according to the International Journal of Oral Science 13, 14

Examine oral health status, as dental alloy restorations can release metals into bodily fluids and create metallic taste, as noted by the Alzheimer's Association 15