Managing Oxybutynin-Related Dry Mouth in Prostate Cancer Care

Although the protocol in the phase 2 Alliance A222001 trial (NCT04600336) did not outline measures to manage oxybutynin (Ditropan)-emergent dry mouth symptoms, clinician experience and even patient ingenuity may effectively treat this adverse effect (AE). Bradly J. Stish, MD, discussed common strategies for managing dry mouth in patients with prostate cancer being treated with oxybutynin for androgen deprivation therapy-related hot flashes in a conversation with CancerNetwork®.

One strategy Stish highlighted was frequent hydration, which is effective for managing these symptoms but may exacerbate urinary symptoms, particularly urinary incontinence or urgency. Additionally, he advocated for the use of sugar-free gum or candies to stimulate salivary glands without introducing excess sugars in the mouth. Lastly, Stish recommended indoor humidification, particularly to counteract indoor heating during colder months, or while sleeping, which is often more frequently associated with more noticeable dry mouth symptoms.

Then, Stish, section head of Radiation Oncology and radiation oncologist specializing in genitourinary cancers at Mayo Clinic, touched upon potential dose reduction strategies to mitigate dry mouth and other AEs while still providing some relief for hot flash symptoms.

Transcript:

Our protocol didn’t necessarily specify any measures, so this really becomes about clinician experience and strategies they’ve learned over time. Sometimes, [patients] come up with their own strategies. When it comes to dry mouth, frequent hydration is a good tool to manage this. That can feed into other symptoms. Knowing that patients with prostate cancer can [experience] urinary symptoms, if [they’re] drinking lots of fluids, there can be a downstream effect there, literally. Certainly, drinking small volumes of sugar-free liquids is helpful.

We don’t want to introduce a lot of excess sugars in the mouth and cause dental problems as an [adverse] effect. Sugar-free gum is another good strategy to help manage that. Sucking on hard, sugar-free candies is another way to promote those salivary glands in the mouth to stimulate more secretion of saliva. Then, [there is] humidification, especially in some of our colder climates in the winter months; if you have indoor heating running, that can dry out the air in the house. Keep a humidifier where [patients are] sleeping [because sleep] is a common time when people notice dry mouth more regularly. Those are strategies that I’ve seen employed that have been effective at managing [dry mouth].

Then, as we mentioned previously, [you can] think about the dose that you’re using and whether there can be a modification of the dose that might be reasonable to achieve the same effect while decreasing the [adverse] effect profile of the drug.

Reference

Stish BJ, Mazza GL, Nauseef JT, et al. Alliance A222001: oxybutynin versus placebo for the treatment of hot flashes in patients receiving androgen-deprivation therapy for prostate cancer. J Clin Oncol. Published January 26, 2026. doi:10.1200/JCO-25-01486