Maalox and Lidocaine Mouthwash Dosage
The recommended dose for Maalox and lidocaine mouthwash is 5-10 mL of the mixture, swished in the mouth for 1-2 minutes and then expectorated (spit out), used every 4-6 hours as needed for oral pain relief.
Composition and Preparation
A typical "magic mouthwash" formulation containing Maalox and lidocaine consists of:
- Equal parts of Maalox (aluminum hydroxide/magnesium hydroxide)
- 2% viscous lidocaine
- Optional: diphenhydramine (Benadryl) may be added in equal parts
Dosing Considerations and Safety
Lidocaine Dosing Safety
- For adults, the maximum safe dose of lidocaine should not exceed 4.5 mg/kg without epinephrine or 7.0 mg/kg with epinephrine in a single treatment 1
- When using 2% viscous lidocaine (20 mg/mL), each 5 mL dose contains approximately 100 mg of lidocaine
- Frequent use can lead to systemic absorption and potential toxicity
Important Precautions
- Do not swallow the mixture as this increases the risk of systemic lidocaine absorption
- Limit use to every 4-6 hours to prevent lidocaine toxicity
- Total daily lidocaine should not exceed 500 mg for adults 1
- Patients should wait at least 30 minutes after using the mouthwash before eating or drinking to:
- Prevent choking (due to numbing effect)
- Maximize therapeutic contact time with oral mucosa
Warning Signs of Lidocaine Toxicity
Monitor for signs of lidocaine toxicity, which can occur at serum concentrations above 5 μg/mL 1:
- Tingling of tongue/lips
- Light-headedness
- Tinnitus (ringing in ears)
- Slurred speech
- Muscle twitching
- Drowsiness
Special Populations
Children
- For children, maximum lidocaine dose should not exceed 1.5-2.0 mg/kg without epinephrine or 3.0-4.5 mg/kg with epinephrine 1
- Lidocaine should not be used in patients weighing less than 40 kg without careful dose adjustment 1
- Pediatric dosing requires careful calculation based on weight
Elderly or Patients with Hepatic/Renal Impairment
- Consider reducing the dose and frequency
- These patients may have decreased clearance of lidocaine
Clinical Evidence
Research has shown that "magic mouthwash" formulations containing Maalox, lidocaine, and sometimes diphenhydramine can be effective for treating oral mucositis pain, particularly in patients undergoing cancer treatment 2. However, a randomized clinical trial found that simple salt and soda mouthwash was equally effective and less costly than more complex formulations for chemotherapy-induced mucositis 3.
Common Pitfalls to Avoid
Overuse: Excessive use can lead to systemic lidocaine toxicity, as documented in case reports of patients using viscous lidocaine too frequently 4
Improper dilution: Using undiluted preparations can cause mucosal injury 5
Occlusion effects: Covering the area after application of lidocaine significantly increases systemic absorption (up to 3-fold) 6
Drug interactions: Avoid using with other local anesthetics within a 4-hour window to prevent cumulative toxicity 1
Masking symptoms: The numbing effect may mask worsening of underlying conditions requiring medical attention
Remember that while this mouthwash provides symptomatic relief, it does not treat the underlying cause of oral pain or ulceration, which should be addressed separately.