Magic Mouthwash Ingredients
The standard magic mouthwash formulation consists of three equal parts: viscous lidocaine 2%, diphenhydramine (typically 2.5 mg/mL), and an antacid (magnesium aluminum hydroxide/Maalox). 1
Core Three-Component Formulation
The National Comprehensive Cancer Network (NCCN) defines the standard magic mouthwash as containing equal parts of: 1
- Viscous lidocaine 2% - provides local anesthetic effect for pain relief 2, 1
- Diphenhydramine 2.5 mg/mL - antihistamine component 1, 3
- Antacid (magnesium aluminum hydroxide or Maalox) - neutralizes oral environment 1, 3
This 1:1:1 ratio formulation is the most commonly recommended by major oncology guidelines. 1
Standard Dosing and Administration
- Use 15 mL per application 2
- Hold in mouth for 1-2 minutes before spitting out 2
- Avoid eating or drinking for 30 minutes after use 2
- Administer every 3-4 hours as needed, particularly before meals 4, 5
Alternative Ratio Formulation
A 1:2.5:2.5 ratio (lidocaine:diphenhydramine:antacid) has also been studied and shows similar stability with a 21-day beyond-use date when stored at room temperature. 3
Additional Components for Specific Situations
For Fungal Coverage
- Nystatin oral suspension 100,000 units - add when candidal infection is suspected or for prophylaxis 4, 2, 5
- Miconazole oral gel 5-10 mL - alternative antifungal option 4
For Enhanced Anti-inflammatory Effect
- Sodium bicarbonate - helps neutralize acidic oral environment 6, 1
- Clobetasol propionate 0.05% mixed with Orabase - for severe inflammation, applied directly to affected areas 4, 2
For Severe Pain
- Cocaine 2-5% - reserved for severe refractory pain, used three times daily 4, 2
- Benzydamine hydrochloride - NSAID with supporting data for mucositis prevention and treatment 6, 1
Important Clinical Considerations
The evidence supporting magic mouthwash ingredients varies significantly, and compositions differ widely across institutions. 6 Historical surveys show that while the top ingredients remain consistent (diphenhydramine, viscous lidocaine, and antacids), many institutions add antibiotics, antifungals, and corticosteroids without strong evidence. 5
Consider dispensing lidocaine separately from other ingredients due to stability concerns and lack of proven efficacy for combination formulations. 3 When packaged separately, lidocaine maintains a 90-day beyond-use date versus only 21 days when combined. 3
Bland mouth rinses using sodium bicarbonate are often recommended as simpler alternatives given the variable evidence supporting complex magic mouthwash formulations. 6, 1
Common Pitfalls to Avoid
- Do not use alcohol-containing formulations - these cause additional irritation 2
- Ensure proper storage - combined formulations have limited stability (21 days at room temperature in amber syringes) 3
- Avoid metoclopramide in complete bowel obstruction - though this relates to systemic use rather than mouthwash 6
- Monitor for secondary infections - perform regular oral examinations during treatment 2