How to use Princess Margaret mouthwash?

Princess Margaret Mouthwash: How to Use

"Princess Margaret mouthwash" is not a standardized formulation—the term likely refers to "magic mouthwash," a compounded topical oral solution used for chemotherapy-induced oral mucositis, which should be administered as 15 mL per application, held in the mouth for 1-2 minutes before spitting out, avoiding eating or drinking for 30 minutes afterward. 1

Standard Administration Protocol

• Dose: Use 15 mL per application 1
• Technique: Hold the solution in your mouth for 1-2 minutes, swishing gently to coat all affected areas, then spit out (do not swallow) 1
• Frequency: Typically administered every 3-4 hours as needed, particularly before meals 1, 2
• Post-application: Avoid eating or drinking for 30 minutes after use to maximize effectiveness 1

Typical Components

The most common formulation includes:

• Viscous lidocaine 2% (15 mL per application) for pain relief 1
• Nystatin oral suspension (100,000 units) to treat or prevent candidal infections 1
• Sodium bicarbonate-containing components to neutralize the oral environment 1

Note that surveys show significant variation in "magic mouthwash" formulations across institutions, with the top five ingredients being diphenhydramine, viscous lidocaine, magnesium hydroxide/aluminum hydroxide, nystatin, and corticosteroids 3

Important Usage Considerations

Timing and Frequency

• Most institutions administer every 4 hours (36%) or every 6 hours (36%) 3
• Use particularly before eating when pain is most problematic 2

Critical Precautions

• Use alcohol-free formulations to avoid additional irritation 1
• Perform regular oral examinations to monitor effectiveness and detect secondary infections 1
• The solution should always be spit out, never swallowed, due to the anesthetic components that could affect swallowing reflexes

Adjunctive Measures to Enhance Effectiveness

• Maintain good oral hygiene with a soft toothbrush or swab after meals and before sleep 1
• Apply white soft paraffin ointment to lips every 2 hours throughout treatment 1, 2
• Avoid potential irritants including smoking, alcohol, spicy foods, citrus fruits, and hot beverages 1
• Consider oral cryotherapy (ice chips) for prevention of mucositis in patients receiving certain chemotherapy regimens 1

Common Pitfall to Avoid

Never use undiluted commercial mouthwashes with high alcohol content, as severe mucosal injuries can occur—one case report documented extensive oral ulcerations from misuse of a 70% alcohol mouthwash that was supposed to be diluted 5:1 with water 4