From the Guidelines
Magic mouthwash, a compounded oral rinse, is recommended for the management of oral mucositis, particularly in patients undergoing cancer treatments, as it provides temporary relief from symptoms such as mouth sores, inflammation, and pain. The most recent and highest quality study, 1, suggests that magic mouthwash can be used to assist in the management of persistent mucositis or if the oropharynx/larynx is involved. A typical formulation of magic mouthwash includes equal parts of an antihistamine (like diphenhydramine), an antacid (such as aluminum/magnesium hydroxide), and a topical anesthetic (like viscous lidocaine) [ 1 ].
Some key points to consider when using magic mouthwash include:
- The standard dosage is 5-10 mL swished in the mouth for 1-2 minutes and then either spit out or swallowed, used every 4-6 hours as needed [ 1 ].
- For best results, avoid eating or drinking for 30 minutes after use.
- Magic mouthwash works by combining ingredients that reduce inflammation, neutralize acid, numb pain, and potentially fight infection.
- While it provides temporary relief, it's essential to note that it treats symptoms rather than underlying causes.
- Side effects may include numbness that could affect swallowing, taste alterations, and drowsiness from the antihistamine component.
It's also important to consider other management strategies for oral mucositis, such as:
- Avoiding crunchy, spicy, acidic, or hot food/drink as appropriate for comfort [ 1 ].
- Ensuring adequate hygiene and protecting against the risk of dental caries [ 1 ].
- Using proton pump inhibitors (PPI) or H2 blockade [ 1 ].
- Considering the use of topical corticosteroids, such as clobetasol 0.05% gel or compounded budesonide 3 mg/10 mL solution [ 1 ].
Overall, magic mouthwash can be a useful tool in the management of oral mucositis, but it's crucial to use it in conjunction with other evidence-based strategies to optimize patient outcomes.
From the Research
Definition and Purpose of Magic Mouthwash
- Magic mouthwash is a topical oral solution used to treat chemotherapy-induced oral mucositis (CIOM) and relieve associated pain and discomfort 2.
- The solution typically contains a combination of ingredients such as diphenhydramine, viscous lidocaine, magnesium hydroxide/aluminum hydroxide, nystatin, and corticosteroids 2.
Ingredients and Administration
- The top five ingredients used to compound magic mouthwash are diphenhydramine, viscous lidocaine, magnesium hydroxide/aluminum hydroxide, nystatin, and corticosteroids 2.
- Most institutions administer the mouthwash every 4 hours (36%) or every 6 hours (36%) 2.
- A study found that a three-drug mouthwash containing lidocaine, diphenhydramine, and sodium bicarbonate in normal saline provided effective symptomatic relief in patients with chemotherapy-induced mucositis 3.
Efficacy and Safety
- A randomized clinical trial found that doxepin mouthwash or diphenhydramine-lidocaine-antacid mouthwash significantly reduced oral mucositis pain during the first 4 hours after administration, but the effect size was less than the minimal clinically important difference 4.
- Another study found that low-level laser treatment reduced the severity of mucositis, and patient-controlled analgesia (PCA) compared to continuous infusion method reduced the duration of pain and the amount of opiate used 5.
- A study on nystatin and lidocaine pastilles found that the formulation was well accepted by patients and allowed for accurate drug dosing and control of retention time in the oral cavity 6.