What is the composition and use of magic mouthwash (mouth rinse)?

From the Guidelines

The composition of magic mouthwash, also known as prophylactic mouth rinses, can vary significantly, but often includes ingredients such as antibiotics, antihistamines, antifungals, corticosteroids, and antacids, with bland mouth rinses using sodium bicarbonate or the NSAID benzydamine being recommended due to limited evidence supporting the effectiveness of other ingredients 1. The use of magic mouthwash is primarily for the prevention and treatment of mucositis, pharyngitis, and esophagitis, which can be caused by certain cancer treatments, such as systemic therapy, head and neck radiation, or hematopoietic stem cell transplant.

• Key ingredients that may be included in magic mouthwash formulations are:
  • Antibiotics
  • Antihistamines
  • Antifungals
  • Corticosteroids
  • Antacids
  • Sodium bicarbonate
  • Benzydamine, an NSAID with some evidence supporting its use in oral rinses for mucositis prevention and treatment 1
• Local anesthetics, such as lidocaine, may also be used to treat mucositis, either as a component of a mouth rinse or separately, in a liquid or gel formulation. The effectiveness of magic mouthwash ingredients in preventing or treating mucositis varies, and due to this, bland mouth rinses using ingredients such as sodium bicarbonate are often recommended 1.
• To use magic mouthwash, patients typically swish the rinse in their mouth for 1-2 minutes before spitting it out or swallowing as directed, usually every 4-6 hours as needed. It is essential to note that magic mouthwash requires a prescription and should be used as directed by a healthcare provider, as overuse can mask symptoms of more serious conditions requiring different treatment.

From the Research

Composition of Magic Mouthwash

• The composition of magic mouthwash may vary, but common ingredients include:
  • Diphenhydramine 2
  • Viscous lidocaine 2, 3
  • Magnesium hydroxide/aluminum hydroxide 2, 3
  • Nystatin 2, 4
  • Corticosteroids 2
• The specific formulation of magic mouthwash can differ between institutions, with some using a combination of these ingredients 2

Use of Magic Mouthwash

• Magic mouthwash is used to manage oral mucositis, a common side effect of cancer treatment 3, 2, 5, 6
• It is typically administered every 4-6 hours, with patients receiving 10 ml of the solution for every 3 hours, six times a day, for 6 days 3
• The effectiveness of magic mouthwash in reducing the severity of oral mucositis has been evaluated in several studies, with mixed results 3, 2, 6
• Topical treatments, including magic mouthwash, can help alleviate and prevent oral mucositis by modulating oral bacteria and replacing saliva 5