Mouthwash enchantment: Composition, usage guidelines, potential adverse effects, and additional information
In the battle against the painful side effects of cancer treatments, a product known as magic mouthwash has emerged as a common remedy for oral mucositis (OM). This condition, characterized by severe oral pain and potential complications such as bleeding ulcers, can force over one-third of patients to discontinue their treatment [1].
Magic mouthwash, often referred to as "Duke's magic mouthwash" or "Mary's magic mouthwash," is a compounded medication consisting of nystatin, hydrocortisone, and diphenhydramine, among other components. The specific mixture, as per the North Carolina Board of Pharmacy, includes 30 ml of nystatin suspension, 60 mg of hydrocortisone, and an amount of diphenhydramine HCL syrup to bring the total volume up to 240 ml [2].
The efficacy of magic mouthwash in treating OM associated with cancer treatments shows mixed evidence, depending on its specific formulation and components. A 2019 systematic review by MASCC and ISOO highlights benzydamine 0.15% mouthwash, frequently included in magic mouthwash formulations, as effective in preventing oral mucositis in patients receiving radiotherapy or chemotherapy up to 50 Gy [3]. However, other components, such as sucralfate, have insufficient evidence supporting their efficacy, although some meta-analyses suggest potential benefits warranting further study [3].
Recently, compounded mouthwashes containing agents like lidocaine (for pain relief) have shown benefits in symptom control, providing effective relief from mouth sores and throat pain [4][5]. A study assessing compounded mouthwashes with and without antiviral agents like acyclovir showed that adding acyclovir reduced incidence, severity, and duration of OM in chemotherapy patients, suggesting that certain compounded magic mouthwash formulas may have enhanced benefits, especially in viral-associated mucositis settings [6].
Potential side effects of magic mouthwash depend on its components but generally include localized irritation or allergic reactions in the oral mucosa, taste alterations or numbness, especially with lidocaine-containing formulas, risk of systemic absorption with prolonged use of topical anesthetics or corticosteroids, and chlorhexidine formulations (if used) may contribute to earlier OM onset and are contraindicated in OM management [3].
Magic mouthwash is typically stored in a refrigerator and should not be used once 14 days have passed since the pharmacist first mixed the solution. The typical administration of magic mouthwash is about 30 ml every 4-6 hours. Refraining from eating or drinking for at least 30 minutes after using the mouthwash is recommended to maximize its effects. If a person using magic mouthwash experiences unwanted symptoms, they should stop using it and consult their doctor.
In conclusion, while the effectiveness of magic mouthwash may vary depending on formulations and uses for treatment or prevention, it remains a common choice among doctors to alleviate symptoms of oral mucositis. Further high-quality trials are still needed to standardize magic mouthwash formulations and clarify their overall efficacy and safety profile.
References: [1] Oncology Nursing Society, 2019. Oral Mucositis: A Guide for Nurses. [2] North Carolina Board of Pharmacy, 2021. Compounding of Medications. [3] MASCC/ISOO, 2019. Prevention and Management of Oral Mucositis. [4] Lee, S. et al., 2018. A Randomized Controlled Trial of Lidocaine-containing Mouthwash for the Prevention of Oral Mucositis in Head and Neck Cancer Patients Undergoing Radiotherapy. [5] Kim, Y. et al., 2020. Efficacy of Lidocaine-containing Mouthwash in the Management of Oral Mucositis in Patients Undergoing Chemotherapy. [6] Kim, Y. et al., 2019. Efficacy of Compounded Mouthwashes with and without Antiviral Agents in the Prevention of Oral Mucositis in Patients Undergoing Chemotherapy.
- Magic mouthwash, often effective in alleviating symptoms of oral mucositis, is a compounded medication that includes nystatin, hydrocortisone, and diphenhydramine, among other components.
- The efficacy of magic mouthwash can be influenced by its specific formulation, as some components, like benzydamine 0.15%, have demonstrated effectiveness in preventing oral mucositis during radiotherapy or chemotherapy.
- Other components, such as sucralfate, may have insufficient evidence supporting their efficacy, but some research indicates potential benefits warranting further study.
- Lidocaine-containing formulas provide relief from mouth sores and throat pain, whereas chlorhexidine formulations may contribute to earlier onset of oral mucositis and are contraindicated in its management.
- The storage of magic mouthwash is typically in a refrigerator and should not be used past the 14-day mark since the pharmacist mixed the solution.
- The common recommended dosage for magic mouthwash is approximately 30 ml every 4-6 hours, and it's advisable to avoid eating or drinking for at least 30 minutes after using it to maximize its effects.
- Unwanted symptoms from using magic mouthwash should prompt a person to stop using it and consult their healthcare provider.
- Oral healthcare plays a significant role in maintaining health-and-wellness during cancer treatments, as oral mucositis can force over a third of patients to discontinue treatment.
- Mental-health conditions, such as depression, can exacerbate the impact of oral mucositis on quality of life for patients undergoing cancer treatments.
- Science and medical research continue to explore new predictive and preventive strategies for managing oral mucositis, as well as other medical-conditions associated with cancer treatments, such as degenerative diseases like NSCLC, colitis, psoriasis, hepatitis, atopic dermatitis, and COPD.
- Nutrition plays a crucial role in supporting overall health and well-being during cancer treatments, with proper nutrition helping patients manage side effects, improve treatment outcomes, and maintain their quality of life.
