Mucositis is a frequent problem encountered by hospice and palliative care services. Its treatment remains a major focus of holistic and medical therapy. Mucositis is found among 40-50% of patients receiving standard chemotherapy or head / neck radiation. This percentage is nearly doubled for bone marrow transplant patients. It can occur as a direct consequence of the radiation or chemotherapy or indirectly from infections compounding immunosuppression. Once the offending agent is stopped mucosal integrity gradually returns. In the meantime the inflammatory pain reduces the patient’s quality of life while also decreasing their oral intake leading to dehydration and malnutrition. Magic mouthwash, known by many names and aliases, reduces the pain, the disability of mucositis. Its basic constituents are as follows (1);

1) A topical anesthetic (eg. an antihistamine to reduce pain).

2) An antibiotic or antifungal.

3) A corticosteroid to decrease inflammation.

4) An antacid to coat and protect the mucosa.

The type and quantity of the constituents will vary according to the practitioner and their locale. Some common recipes are as follows (2,3);

University of Florida

60 ml Benadryl (liq)

60 ml Viscous Xylocaine

60 ml Nystatin

60 ml Maalox

sig 5 ml swish / spit q2 hrs prn

Mary’s Magic Potion

240 ml Benadryl 12.5 mg / 5 ml

1.5 grams Tetracycline

6 million units Nystatin

60 mg Hydrocortisone

sig 5 ml swish / spit QID

Weisman’s Philadelphia Mouthwash

160 ml Distilled water

80 mg Hydrocortisone

80 ml Maalox

sig 5 ml swish / spit QID

Koolstat

100 ml Cherry-flavored Kool-Aid mixed w/ 2000 ml distilled water (sugar- free)

100 ml Viscous Xylocaine 2%

100 ml Nystatin

sig 15 ml swish / spit or swallow QID

Mile’s Solution

20 ml Benadryl 12.5 mg / 5 ml

150 ml Viscous Lidocaine 2%

2 grams Tetracycline

20 ml Nystatin

100 mg Hydrocortisone (Solu-Cortef)

sig 15-30 ml swish / swallow q4-6 hrs

Data are scarce supporting the efficacy of the individual components (especially the steroids and the antibiotics) in the treatment of mucositis. However, for many of our patients who suffer from the debilitation of mucositis, the relief that this concoction offers has earned their faith and our respect.

Robert Killeen MD

References;

1) Moynihan T. Magic Mouthwash; Effective in Treating Chemotherapy Mouth Sores? MayoClinic.com – 10/31/09.

2) Tom WC. Magic Mouthwash. Pharmacist’s Letter / Prescriber’s Letter. 2007;23(7):230703.

3) Covinsky K. Management of Mucositis: Requesting Your Wisdom. Geriatrics and Palliative Blog – 7/8/10.