Background <p>Xerostomia is a common complaint among elderly patients. Due to the anti-inflammatory effect, Manuka honey could be a promising alternative remedy for many medical conditions, including xerostomia. The present study aimed to evaluate the effectiveness of Manuka honey oral rinse as a novel management for xerostomia in elderly patients.</p> Methods <p>This study was designed as a randomized, single-blinded clinical trial. 42 elderly patients who were all evaluated for the presence of xerostomia and hyposalivation were randomly allocated into 3 equal groups, the interventions were used 3 times per day for 1 month as follows: Manuka honey oral rinse in group I, natural honey oral rinse in group II, and saline in group III (control). The Summated Xerostomia Inventory (SXI) score, The Clinical Oral Dryness Score (CODS), and the salivary flow rate were evaluated for all groups at different intervals. The Oral Health Impact Profile (OHIP-14) questionnaire was assessed 1 month after intervention.</p> Results <p>Manuka honey oral rinse caused a significant reduction of the subjective SXI score (2 ± 0.39) and objective clinical oral dryness (5.71 ± 0.91) scores compared to the other 2 groups. Moreover, the salivary flow rate was significantly higher after one month of using Manuka honey oral rinse (1.51 ± 0.34) than honey oral rinse group (1.01^a ± 0.19), and the control group (0.81a ± 0.19). The most significant improvement of OHIP scores was seen in the Manuka honey group (5.50 ± 1.16) compared to the honey group (7.57^a ± 1.02), and the control group (9.36^ab ± 1.78).</p> Conclusion <p>Manuka honey oral rinse demonstrated high efficiency in the management of xerostomia among elderly patients when compared with natural honey as it relieved the symptoms and severity of xerostomia in the elderly along with a high rate of patient satisfaction.</p> Trial registration <p>The study was registered at Clinical Trials.gov (NCT06240806) on 01/14/2024.</p>