Methyldopa
Central alpha-2 agonist (antihypertensive)
Brand names: Aldomet
Oral health effects
Xerostomia / lichenoid reaction
Dry mouth and oral lichenoid reactions; can also cause autoimmune hemolytic anemia (positive Coombs).
Clinical management: Hydration; biopsy uncertain lichenoid lesions; note hematologic effects.
Dizziness on standing (orthostatic hypotension)
Orthostatic hypotension is listed on the label (managed by dose reduction); methyldopa is centrally acting and commonly causes dizziness and sedation.
Clinical management: Raise the chair back slowly at the end of the appointment, let the patient sit upright for 1–2 minutes before standing, and steady them as they get up. Take extra care in older patients, after long supine procedures and when other blood-pressure-lowering drugs are taken.
Salivary gland inflammation and sore or black tongue (sialadenitis)
The methyldopa label lists sialadenitis and a sore or "black" tongue among digestive adverse reactions, alongside dryness of the mouth. Frequency is not given.
Clinical management: Note any salivary-gland swelling/tenderness or tongue discolouration; exclude other causes (e.g. infection, hairy tongue from poor hygiene, staining) and refer persistent findings to the prescriber. Tongue brushing and hydration help.
Sources
- A Guide to Medications Inducing Salivary Gland Dysfunction, Xerostomia, and Subjective Sialorrhea: A Systematic Review Sponsored by the World Workshop on Oral Medicine VI. Wolff A, Joshi RK, Ekström J, et al. Drugs in R&D, 2017.
- A review and guide to drug-associated oral adverse effects-Oral mucosal and lichenoid reactions. Part 2. Teoh L, Moses G, McCullough MJ. Journal of oral pathology & medicine : official publication of the International Association of Oral Pathologists and the American Academy of Oral Pathology, 2019.
- Methyldopa prescribing information (FDA label) Rising Pharma Holdings, Inc. / DailyMed, 2025.