A 40-year-old patient on long-term antihypertensive therapy presents with bilateral painless parotid gland enlargement. Which drug class is the most common culprit?

• A Beta-blockers
• B Thiazide diuretics
• C Calcium channel blockers ✓
• D ACE inhibitors

Explanation

Bilateral parotid gland enlargement (sialadenosis/sialosis) can be drug-induced. Calcium channel blockers (e.g., nifedipine, amlodipine) are among the most recognised causes; other drugs include antithyroid drugs (propylthiouracil, carbimazole), phenothiazines, and iodine-containing compounds. ACE inhibitors classically cause dry cough (kinin-mediated) and angioedema, not salivary enlargement. Beta-blockers can cause xerostomia, not sialadenosis. Thiazides reduce salivary secretion. Drug-induced sialadenosis is typically painless bilateral parotid enlargement without functional impairment.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.