Magic Mouthwash Recipes
Full update February 2022
The following chart lists examples of “magic mouthwash” recipes. Magic mouthwash may be prescribed to reduce oral pain from oral mucositis, etc. Magic mouthwash should be held or swished in the mouth for one or two minutes before being spit out or swallowed (see footnote e). In general, patients should then avoid eating or drinking for 30 minutes.1,2 Widespread use of magic mouthwashes is discouraged in cancer patients with mucositis, because they don’t seem to be more effective than simple salt/baking soda rinses (e.g., one teaspoonful of table salt in 32 oz [~1 L] of water, with or without one to two tablespoonfuls of baking soda [sodium bicarbonate]).3,19-21 However, doxepin or morphine mouth rinses may be helpful for mucositis in some cases (recipes included below).3-5,9,12,13
|
Ingredientsa-d |
Amount |
||
|
|
|||
|
diphenhydramine 12.5 mg/5 mL |
1 part |
||
|
viscous lidocaine 2% |
1 part |
||
|
Maalox |
1 part |
||
|
Swish, gargle, and spit 5 to 10 mL Q6H prn7 OR spit or swallowe 30 mL Q2H prn (severe mucositis)6 (NCI cocktail, Sleepy Butter, Xyloxadryl, or BMX;6,7,12,15,24 also commercially available as a compounding kit, First-Mouthwash BLM [with simethicone]) |
|||
|
|
|||
|
diphenhydramine |
0.45 g |
||
|
hydrocortisone |
0.06 g |
||
|
nystatin powder |
1.2 g |
||
|
tetracycline |
1.5 g |
||
|
Total volume 240 mL1 (Mary’s Mouthwash)1 |
|||
|
|
|||
|
hydrocortisone |
60 mg |
||
|
nystatin |
30 mL (susp) OR 3 million units (powder) |
||
|
diphenhydramine 12.5 mg/5 mL |
QS 240 mL |
||
|
(Duke Magic Mouthwash)7,8,24 |
|||
|
|
|||
|
cherry-flavored Kool-Aid mixed with 2,000 mL distilled water |
100 mL |
||
|
viscous lidocaine 2% |
100 mL |
||
|
nystatin suspension |
100 mL |
||
|
Swish, hold, and spit or swallowe 30 mL Q4H6 (Koolstat)6 |
|||
|
|
|||
|
viscous lidocaine 2% |
150 mL |
||
|
diphenhydramine 12.5 mg/5 mL |
20 mL |
||
|
hydrocortisone |
100 mg |
||
|
tetracycline |
2 g |
||
|
nystatin suspension |
20 mL |
||
|
Swish, hold, and swallowe 15 to 30 mL Q4 to Q66 (Mile’s Solution)6 |
|||
|
|
|||
|
nystatin suspension 100,000 U/mL |
42 mL |
||
|
viscous lidocaine 2% |
50 mL |
||
|
hydrocortisone 10 mg tablet |
5 tabs |
||
|
glycerin (to dissolve hydrocortisone) |
4 mL |
||
|
sodium chloride 0.9% for injection or irrigation |
QS 200 mL |
||
|
(Dr. Akabutu’s Mouthwash)16 |
|||
|
|
|||
|
viscous lidocaine 2% |
50 mL |
||
|
diphenhydramine 12.5 mg/5 mL |
50 mL |
||
|
sodium bicarbonate 1 mEq/mL |
100 mL |
||
|
normal saline |
500 mL |
||
|
Swish and spit 10 to 15 mL four to six times daily.15 |
|||
|
|
|||
|
diphenhydramine 12.5 mg/5 mL |
120 mL |
||
|
nystatin suspension |
30 mL |
||
|
dexamethasone |
2.25 mg |
||
|
tetracycline |
0.5 g |
||
|
distilled water |
QS 203 mL |
||
|
(Noll’s Solution)17 |
|||
|
|
|||
|
Maalox |
1 to 3 parts |
||
|
viscous lidocaine 2% |
1 part |
||
|
(Pink Lady)16,17 |
|||
|
|
|||
|
doxepin 10 mg/mL |
2.5 mL |
||
|
sterile or distilled water |
2.5 mL |
||
|
Swish, gargle, and spit 5 mL Q4H PRN14 (Doxepin 0.5% mouth rinse)9 |
|||
|
|
|||
|
morphine chlorhydrate |
2,000 mg |
||
|
purified water |
1,000 mL11 |
||
|
Swish and spit 15 mL Q3H PRN12,13 (Morphine 0.2% mouth rinse)12,13 |
|||
- Elixirs can cause stinging due to alcohol content. Consider using powder from injectable, tablets, or capsules instead.7
- Some US clinicians have found that Kaopectate solidifies when mixed with other ingredients because it contains bismuth. Consider this if using Kaopectate in place of Maalox. (Canadian Kaopectate doesn’t contain bismuth.)7,18
- There is not sufficient evidence to use empiric antimicrobials, steroids, or sucralfate in mouthwashes for oral mucositis in cancer patients.3,10
- Per United States Pharmacopeia (USP) standards, oral mixtures (i.e., swallowed) with water should have a beyond-use date (BUD) ≤2 weeks (refrigerated) and mucosal mixtures with water (i.e., NOT swallowed) should have a beyond-use date (BUD) ≤30 days (room temp).11,24
- Swallowing these formulations (for ulcers that extend into the pharynx or esophagus) may lead to systemic absorption of ingredients.19,22 Swallowing viscous lidocaine may adversely affect the gag reflex.23
References
- Woodland Hills Pharmacy. Mary’s Mouthwash. https://www.woodlandhillspharmacy.com/compounds/mouthwashes/marys-mouthwash/. (Accessed January 12, 2022).
- Mayo Clinic. Magic mouthwash: effective for chemotherapy sores? December 2, 2021. https://www.mayoclinic.org/tests-procedures/chemotherapy/expert-answers/magic-mouthwash/faq-20058071. (Accessed January 12, 2022).
- Uberoi AS, Brown TJ, Gupta A. Magic mouthwash for oral mucositis. A teachable moment. JAMA Intern Med 2019;179:104-5.
- Saunders DP, Epstein JB, Elad S, et al. Systemic review of antimicrobials, mucosal coating agents, anesthetics, and analgesics for the management of oral mucositis in cancer patients. Support Care Cancer 2013;21:3191-207.
- McElhiney LF. Magic mouthwashes: a literature review and discussion of common compositions. Int J Pharm Compd 2011;15:376-80.
- The Erie St. Clair Palliative Care Management Tool. January 2007. http://www.palliativecareswo.ca/docs/PalliativeCareManagmenTool_v3.2.pdf. (Accessed January 12, 2022).
- Magic mouthwash: prescriptions, recipes, and formulas. https://1mpages.com/magicmouthwash. (Accessed January 12, 2022).
- North Carolina Board of Pharmacy. http://www.ncbop.org/Newsletters/January%201995.pdf#search=%22duke magic mouthwash%22. (Accessed January 12, 2022).
- Leenstra JL, Miller RC, Qin R, et al. Doxepin rinse versus placebo in the treatment of acute oral mucositis pain in patients receiving head and neck radiotherapy with or without chemotherapy: a phase III, randomized, double-blind trial (NCCTG-N09C6 [Alliance]). J Clin Oncol 2014;15:1571-7.
- Chan A, Ignoffo RJ. Survey of topical oral solutions for the treatment of chemo-induced oral mucositis. J Oncol Pharm Pract 2005;11:139-43.
- Chapter 795 Pharmaceutical Compounding--Nonsterile Preparations. The United States Pharmacopeia and The National Formulary (USP-NF). https://www.uspnf.com/sites/default/files/usp_pdf/EN/USPNF/revisions/gc795.pdf. (Accessed January 12, 2022).
- Cerchietti LC, Navigante AH, Bonomi MR, et al. Effect of topical morphine for mucositis-associated pain following concomitant chemotherapy for head and neck carcinoma. Cancer 2002;95:2230-6.
- Jacobsen J. Topical opioids for pain. Palliative Care Network of Wisconsin. https://www.mypcnow.org/blank-cu2j4. (Accessed January 12, 2022).
- ClinicalTrials.gov. Doxepin hydrochloride in treating oral mucositis pain in patients with head and neck cancer undergoing radiation therapy with or without chemotherapy. https://clinicaltrials.gov/ct2/show/NCT01156142?term=doxepin&cond=mucositis&rank=2. (Accessed January 12, 2022).
- Negrin RS. Oral toxicity associated with chemotherapy. Last updated September 22, 2021. In UpToDate, Post TW (Ed.), UpToDate, Waltham, MA.
- Alberta Health Services. Oral and dental care management in head and neck cancer. Clinical practice guideline HN-006. Version 1. January 2017. https://www.albertahealthservices.ca/assets/info/hp/cancer/if-hp-cancer-guide-hn006-dental-oral.pdf. (Accessed January 12, 2022).
- BC Cancer Provincial Health Services Authority. Oral care of the cancer patient. March 2018. http://www.bccancer.bc.ca/family-oncology-network-site/Documents/2018%20Fall%20Oral%20Care%20Manual.pdf. (Accessed January 12, 2022).
- Health Canada. Product Information. https://health-products.canada.ca/lnhpd-bdpsnh/info.do?licence=02229952. (Accessed January 12, 2022).
- NCI. Oral mucositis. http://www.cancer.gov/cancertopics/pdq/supportivecare/oralcomplications/HealthProfessional/page5. (Accessed January 12, 2022).
- Bensinger W, Schubert M, Ang K, et al. NCCN task force report: prevention and management of mucositis in cancer care. January 2008. https://jnccn.org/view/journals/jnccn/6/S1/article-pS-1.xml. (Accessed January 31, 2022).
- Memorial Sloan Kettering Cancer Center. Mouth care during your cancer treatment. August 19, 2021. https://www.mskcc.org/cancer-care/patient-education/mouth-care-during-your-treatment. (Accessed January 12, 2022).
- Worthington HV, Clarkson JE, Bryan G, et al. Interventions for preventing oral mucositis for patients with cancer receiving treatment. Cochrane Database Syst Rev 2011;(4):CD000978.
- Mekonnen S. Poison Control. Lidocaine can cause harmful effects. https://www.poison.org/articles/lidocaine-can-cause-harmful-effects-172. (Accessed January 12, 2022).
- North Carolina Board of Pharmacy. Pharmacist FAQs. http://www.ncbop.org/faqs/Pharmacist/faq_CompoundedProducts.htm. (Accessed January 12, 2022).
Cite this document as follows: Clinical Resource, Magic Mouthwash Recipes. Pharmacist’s Letter/Prescriber’s Letter. February 2022. [380231]