Magic mouthwash
Encyclopedia
Magic mouthwash and magic swizzle are terms referring to a number of different mouthwash
formulation
s. Typically, a magic mouthwash is prescribed to treat the pain associated with mucositis
caused by radiation therapy
or chemotherapy
. It is also prescribed for aphthous ulcer
s, other oral ulcers, and other mouth pain.
The thinking behind magic mouthwash is to combine ingredient
s to treat a variety of oral conditions. Magic mouthwashes are typically compounded
in a pharmacy
from a doctor's prescription
. The prescription should always specify a recipe
, since there is not a standard formulation, and problems can arise when patient
s receive a product different from what the prescriber intended.
as a topical anesthetic
, diphenhydramine
as an anti-inflammatory
, and Maalox
to help coat the tissues in the mouth. Other formulations include antifungal
s, corticosteroid
s and/or antibiotic
s.
Common ingredients include:
s, many patients and prescribers continue to use them. There has been only one controlled study to evaluate the efficacy
of magic mouthwash; it shows no difference in efficacy among the most common formulation and other agents such as chlorhexidine and a saline
/baking soda solution. Current guidelines suggest that saline solution is just as effective as magic mouthwash in pain relief or shortening of healing time of oral mucositis from cancer therapies.
. It is important that the prescriber and pharmacist are in specific agreement about exactly what is being prescribed. Failure to communicate about this can result in the patient receiving something not intended by the prescriber. This, of course, can have many undesirable consequences, including drug interaction
and the possibility of drug allergy
.
Mouthwash
Mouthwash or mouth rinse is a product used to enhance oral hygiene. Some manufacturers of mouthwash claim that antiseptic and anti-plaque mouth rinse kill the bacterial plaque causing cavities, gingivitis, and bad breath. Anti-cavity mouth rinse uses fluoride to protect against tooth decay...
formulation
Formulation
Formulation may refer to:* Clinical formulation* Formulations * Formulation science* Pharmaceutical formulation:** Galenic formulation* Pesticide formulation...
s. Typically, a magic mouthwash is prescribed to treat the pain associated with mucositis
Mucositis
Mucositis is the painful inflammation and ulceration of the mucous membranes lining the digestive tract, usually as an adverse effect of chemotherapy and radiotherapy treatment for cancer. Mucositis can occur anywhere along the gastrointestinal tract, but oral mucositis refers to the particular...
caused by radiation therapy
Radiation therapy
Radiation therapy , radiation oncology, or radiotherapy , sometimes abbreviated to XRT or DXT, is the medical use of ionizing radiation, generally as part of cancer treatment to control malignant cells.Radiation therapy is commonly applied to the cancerous tumor because of its ability to control...
or chemotherapy
Chemotherapy
Chemotherapy is the treatment of cancer with an antineoplastic drug or with a combination of such drugs into a standardized treatment regimen....
. It is also prescribed for aphthous ulcer
Aphthous ulcer
An aphthous ulcer , also known as a canker sore, is a type of mouth ulcer which presents as a painful open sore inside the mouth or upper throat characterized by a break in the mucous membrane. Its cause is unknown, but they are not contagious...
s, other oral ulcers, and other mouth pain.
The thinking behind magic mouthwash is to combine ingredient
Ingredient
An ingredient is a substance that forms part of a mixture . For example, in cooking, recipes specify which ingredients are used to prepare a specific dish. Many commercial products contain a secret ingredient that is purported to make them better than competing products...
s to treat a variety of oral conditions. Magic mouthwashes are typically compounded
Compounding
Compounding is the mixing of drugs by a compounding pharmacist to fit the unique needs of a patient...
in a pharmacy
Pharmacy
Pharmacy is the health profession that links the health sciences with the chemical sciences and it is charged with ensuring the safe and effective use of pharmaceutical drugs...
from a doctor's prescription
Medical prescription
A prescription is a health-care program implemented by a physician or other medical practitioner in the form of instructions that govern the plan of care for an individual patient. Prescriptions may include orders to be performed by a patient, caretaker, nurse, pharmacist or other therapist....
. The prescription should always specify a recipe
Recipe
A recipe is a set of instructions that describe how to prepare or make something, especially a culinary dish.-Components:Modern culinary recipes normally consist of several components*The name of the dish...
, since there is not a standard formulation, and problems can arise when patient
Patient
A patient is any recipient of healthcare services. The patient is most often ill or injured and in need of treatment by a physician, advanced practice registered nurse, veterinarian, or other health care provider....
s receive a product different from what the prescriber intended.
Formulations
The most popular formulation of magic mouthwash contains viscous lidocaineLidocaine
Lidocaine , Xylocaine, or lignocaine is a common local anesthetic and antiarrhythmic drug. Lidocaine is used topically to relieve itching, burning and pain from skin inflammations, injected as a dental anesthetic or as a local anesthetic for minor surgery.- History :Lidocaine, the first amino...
as a topical anesthetic
Topical anesthetic
A topical anesthetic is a local anesthetic that is used to numb the surface of a body part. They can be used to numb any area of the skin as well as the front of the eyeball, the inside of the nose, ear or throat, the anus and the genital area. Topical anesthetics are available in creams,...
, diphenhydramine
Diphenhydramine
Diphenhydramine hydrochloride is a first-generation antihistamine possessing anticholinergic, antitussive, antiemetic, and sedative properties which is mainly used to treat allergies. Like most other first-generation antihistamines, the drug also has a powerful hypnotic effect, and for this reason...
as an anti-inflammatory
Anti-inflammatory
Anti-inflammatory refers to the property of a substance or treatment that reduces inflammation. Anti-inflammatory drugs make up about half of analgesics, remedying pain by reducing inflammation as opposed to opioids, which affect the central nervous system....
, and Maalox
Maalox
Maalox is a brand name antacid containing aluminium hydroxide and magnesium hydroxide to neutralize or reduce stomach acid.Maalox helps relieve symptoms of excessive stomach acidity in patients with indigestion, heartburn, gastroesophageal reflux disease, or stomach or duodenal ulcers. In large...
to help coat the tissues in the mouth. Other formulations include antifungal
Antifungal
* Antifungal medication, a medication used to treat fungal infection s such as athlete's foot , ringworm, candidiasis, etc.* Antifungal protein, a protein family* an adjective referring to a fungicide compound...
s, corticosteroid
Corticosteroid
Corticosteroids are a class of steroid hormones that are produced in the adrenal cortex. Corticosteroids are involved in a wide range of physiologic systems such as stress response, immune response and regulation of inflammation, carbohydrate metabolism, protein catabolism, blood electrolyte...
s and/or antibiotic
Antibiotic
An antibacterial is a compound or substance that kills or slows down the growth of bacteria.The term is often used synonymously with the term antibiotic; today, however, with increased knowledge of the causative agents of various infectious diseases, antibiotic has come to denote a broader range of...
s.
Common ingredients include:
- DiphenhydramineDiphenhydramineDiphenhydramine hydrochloride is a first-generation antihistamine possessing anticholinergic, antitussive, antiemetic, and sedative properties which is mainly used to treat allergies. Like most other first-generation antihistamines, the drug also has a powerful hypnotic effect, and for this reason...
- an antihistamineAntihistamineAn H1 antagonist is a histamine antagonist of the H1 receptor that serves to reduce or eliminate effects mediated by histamine, an endogenous chemical mediator released during allergic reactions...
to reduce inflammation - GlucocorticoidGlucocorticoidGlucocorticoids are a class of steroid hormones that bind to the glucocorticoid receptor , which is present in almost every vertebrate animal cell...
s - to reduce inflammation - LidocaineLidocaineLidocaine , Xylocaine, or lignocaine is a common local anesthetic and antiarrhythmic drug. Lidocaine is used topically to relieve itching, burning and pain from skin inflammations, injected as a dental anesthetic or as a local anesthetic for minor surgery.- History :Lidocaine, the first amino...
- a local anestheticLocal anestheticA local anesthetic is a drug that causes reversible local anesthesia, generally for the aim of having local analgesic effect, that is, inducing absence of pain sensation, although other local senses are often affected as well...
to relieve pain - MaaloxMaaloxMaalox is a brand name antacid containing aluminium hydroxide and magnesium hydroxide to neutralize or reduce stomach acid.Maalox helps relieve symptoms of excessive stomach acidity in patients with indigestion, heartburn, gastroesophageal reflux disease, or stomach or duodenal ulcers. In large...
- an antacidAntacidAn antacid is a substance which neutralizes stomach acidity.-Mechanism of action:Antacids perform a neutralization reaction, increasing the pH to reduce acidity in the stomach. When gastric hydrochloric acid reaches the nerves in the gastrointestinal mucosa, they signal pain to the central nervous...
formulation which acts as a coating agent - NystatinNystatinNystatin is a polyene antifungal medication to which many molds and yeast infections are sensitive, including Candida. Due to its toxicity profile, there are currently no injectable formulations of this drug on the US market...
- an antifungalAntifungal* Antifungal medication, a medication used to treat fungal infection s such as athlete's foot , ringworm, candidiasis, etc.* Antifungal protein, a protein family* an adjective referring to a fungicide compound...
for candidiasisCandidiasisThrush redirects here. For the hoof infection see Thrush .Candidiasis or thrush is a fungal infection of any of the Candida species , of which Candida albicans is the most common... - SucralfateSucralfateSucralfate is a cytoprotective agent, an oral gastrointestinal medication primarily indicated for the treatment of active duodenal ulcers. Brand names include Sucramal in Italy; Carafate in U.S.A.; Pepsigard, Sucral, Sucrafil, Hapifate in India; Sutra or Musin in parts of South-East Asia; Sulcrate...
- a coating agent - Tetracycline - an antibioticAntibioticAn antibacterial is a compound or substance that kills or slows down the growth of bacteria.The term is often used synonymously with the term antibiotic; today, however, with increased knowledge of the causative agents of various infectious diseases, antibiotic has come to denote a broader range of...
- ErythromycinErythromycinErythromycin is a macrolide antibiotic that has an antimicrobial spectrum similar to or slightly wider than that of penicillin, and is often used for people who have an allergy to penicillins. For respiratory tract infections, it has better coverage of atypical organisms, including mycoplasma and...
- an antibioticAntibioticAn antibacterial is a compound or substance that kills or slows down the growth of bacteria.The term is often used synonymously with the term antibiotic; today, however, with increased knowledge of the causative agents of various infectious diseases, antibiotic has come to denote a broader range of...
Efficacy
Despite a lack of evidence that magic mouthwashes are effective in decreasing the pain of oral lesionLesion
A lesion is any abnormality in the tissue of an organism , usually caused by disease or trauma. Lesion is derived from the Latin word laesio which means injury.- Types :...
s, many patients and prescribers continue to use them. There has been only one controlled study to evaluate the efficacy
Efficacy
Efficacy is the capacity to produce an effect. It has different specific meanings in different fields. In medicine, it is the ability of an intervention or drug to reproduce a desired effect in expert hands and under ideal circumstances.- Healthcare :...
of magic mouthwash; it shows no difference in efficacy among the most common formulation and other agents such as chlorhexidine and a saline
Saline (medicine)
In medicine, saline is a general term referring to a sterile solution of sodium chloride in water but is only sterile when it is to be placed intravenously, otherwise, a saline solution is a salt water solution...
/baking soda solution. Current guidelines suggest that saline solution is just as effective as magic mouthwash in pain relief or shortening of healing time of oral mucositis from cancer therapies.
Patient safety
Because magic mouthwash has no standard formulation, its use involves concerns about patient safetyPatient safety
Patient safety is a new healthcare discipline that emphasizes the reporting, analysis, and prevention of medical error that often leads to adverse healthcare events. The frequency and magnitude of avoidable adverse patient events was not well known until the 1990s, when multiple countries reported...
. It is important that the prescriber and pharmacist are in specific agreement about exactly what is being prescribed. Failure to communicate about this can result in the patient receiving something not intended by the prescriber. This, of course, can have many undesirable consequences, including drug interaction
Drug interaction
A drug interaction is a situation in which a substance affects the activity of a drug, i.e. the effects are increased or decreased, or they produce a new effect that neither produces on its own. Typically, interaction between drugs come to mind...
and the possibility of drug allergy
Drug allergy
A drug allergy is an allergy to a drug, most commonly a medication. Medical attention should be sought immediately if an allergic reaction is suspected....
.