Magic Mouthwash Formulations
Magic Mouthwash is used to topically manage many conditions.
Generally, the formulations are specific to the condition being treated and the variations are as numerous as there are treating Practitioners. These are many Possible formulations to treat conditions as varied as oral thrush (candida or fungal infections of the mouth and throat), burning mouth, mucositis (inflammation of the mouth secondary to chemo or radiation treatment) as well as many other issues.
1. Instructions are to Swish, Hold for one minute and Spit 10mL q6h prn pain. May be swallowed for suspected esophageal involvement.
2. Diphenhydramine is also known as Benadryl. It is used in many Magic Mouthwash Formulations as an anti-histamine to decrease the itching that can be secondary to inflammation.
3. Ciprofloxacin is a Fluoroquinolone broad-spectrum antibiotic. This formulation was changed from previous recommendations for Tetracycline due to previous reports of bacterial resistance as well as the recent increase in cost of Tetracycline antibiotics. Growing children should not swallow Ciprofloxacin or Tetracycline.
4. Fluconazole is an antifungal that was substituted for older formulations containing Nystatin due to the lack of evidence of Nystatin providing effective oral topical relief for fungal infections.
5. Dexamethasone was substituted for Hydrocortisone, Prednisone, and Prednisolone wherever possible due to its much-increased steroid activity as well as its comparable cost.
6. Maalox is a coating that increases the thickness of the mouthwash that allows the patient to maintain it in the mouth for much longer and increase surface coating.
7. Sucralfate is used to treat duodenal ulcers. Formulations with sucralfate are meant to be swished and swallowed.
8. Thick-It is a brand name thickener used primarily to increase the thickness of liquids for patients unable to swallow due to Dysphagia.
9. Viscous Lidocaine is a medication that is used to dull the sensation of pain. Patients should be warned that it can make their whole mouth including their tongue feel numb for a period of 30 minutes to 2 hours.
10. Most of the ingredients listed can be swished and swallowed for known or suspected esophageal involvement. Caution for sleepiness for all formulations that include Diphenhydramine.
11. Non-calories sweeteners are added in some formulations for patients on palliative maintenance therapy secondary to radiation or chemotherapy Mucositis. Caution in patients with Phenylketonuria.