What to do for a swollen lip caused by medication?

Management of Medication-Induced Swollen Lip

For medication-induced swollen lip, discontinue the suspected medication immediately and provide supportive care with saline/sodium bicarbonate rinses, lip balm, and non-alcoholic mouthwashes. 1

Assessment of Severity

First, determine the severity of the lip swelling:

• Grade 1 (Mild): Erythema or mild swelling without pain
• Grade 2 (Moderate): Patchy swelling with moderate discomfort
• Grade 3 (Severe): Confluent swelling, significant pain, or difficulty eating/speaking
• Grade 4 (Life-threatening): Tissue necrosis, significant spontaneous bleeding, or airway compromise

Immediate Management Based on Severity

For Mild to Moderate Swelling (Grade 1-2):

1. Discontinue the suspected medication and notify the prescribing physician 2
2. Apply supportive measures:
   • 0.9% saline or sodium bicarbonate rinses (mix 1 teaspoon salt and 3/4 teaspoon baking soda in 500ml water) 1
   • Use non-alcoholic mouthwash 1
   • Apply lip balm regularly to reduce dryness 1
   • Drink plenty of water 1

For Severe Swelling (Grade 3):

1. Discontinue the medication immediately
2. Seek urgent medical attention
3. Consider hospitalization for supportive care 1
4. Pain management with topical anesthetics or systemic analgesics 1
5. Monitor for airway compromise

For Life-Threatening Swelling (Grade 4):

1. Emergency medical attention - call emergency services
2. Airway management may be required
3. Specialist dermatology assessment should be sought, especially if Stevens-Johnson Syndrome is suspected 1

Specific Considerations by Medication Type

ACE Inhibitor-Induced Angioedema:

• If swelling is due to ACE inhibitors (like lisinopril), complete resolution typically occurs within 24-72 hours after discontinuation 2
• The prescribing physician should substitute with an alternative antihypertensive medication class

Antibiotic-Induced Swelling:

• For antibiotic reactions (e.g., clindamycin), discontinue the medication and switch to an alternative antibiotic class 3
• Monitor for signs of systemic allergic reaction

EGFR Tyrosine Kinase Inhibitors:

• For mild reactions, continue medication with supportive care
• For moderate reactions, consider dose interruption or reduction 1
• For severe reactions, discontinue medication until toxicity resolves to Grade 1 1

Supportive Care Measures

Dietary Modifications:

• Eat soft, moist, non-irritating foods 1
• Avoid acidic, spicy, salty, rough/coarse foods 1, 4
• Serve food at room temperature or cold 1
• Stay well hydrated 4

Oral Care:

• Use soft toothbrush and mild non-foaming toothpaste 4
• Rinse with saline solution 4-6 times daily 4
• Use alcohol-free mouthwash 1, 4
• Consider topical pain relief with 0.2% morphine mouthwash for severe pain 1

Follow-Up and Monitoring

• Monitor for resolution of symptoms
• Any lip swelling that persists beyond 2 weeks requires further investigation 4
• Document the reaction in the patient's medical record as a medication allergy
• Consider patch testing or allergy specialist referral for recurrent episodes

Special Considerations

• Rule out infectious causes if swelling persists despite medication discontinuation 5, 6
• Consider fungal infection if patient wears dentures 4
• For persistent cases, evaluate for underlying conditions such as orofacial granulomatosis 7

Remember that prompt identification and discontinuation of the causative medication is the most important step in managing medication-induced lip swelling.