“Magic mouthwash” is the popular name of an oral suspension solution containing different ingredients (Benadryl Lidocaine Maalox) that treats mouth sores (oral mucositis). Most of all, sores are caused by chemotherapy and radiation therapy that’s why the name “Oncology Mouth Rinse”. Also known as “Miracle mouthwash”, it helps to relieve pain mouth sores due to oral ulcers and upper throat irritations.
Oral mucositis is a painful inflammation of mucous membranes that may lead to a wide range of symptoms: mouth sores and/or throat irritation, pain on the gums or tongue, swallowing eating and even talking difficulty.
Patients exposed to radiation therapy due to head or neck cancer as well as certain types of chemotherapy are at high risk to develop mucositis also known as esophagitis. Other mucositis causes include mouth infection, poor oral hygiene, dehydration, oxygen therapy, abuse of alcohol and/or tobacco.
Some magic mouthwash recipes require ingredients like Lidocaine Tetracycline and Diphenhydramine that you can buy with medical prescription only.
(OTC) over the counter magic oral rinse with different formulas is also available for adults and pediatric usage. OTCs contain natural ingredients for homemade treatment.
Many patients reported that magic mouthwash is also effective to relieve symptoms of burning mouth syndrome, canker sore and oral thrush (candidiasis).
Active ingredients and formulations
The most common magic mouthwash recipe includes three ingredients:
- An antihistamine: like Diphenhydramine is included to reduce inflammation and pain (its commercial name is Benadryl);
- An anesthetic: the scope of the anesthetic is to numb the painful area in the mouth or throat (the most used is called Lidocaine and it needs the doctor prescription);
- A coating agent: commercially known as Maalox and Mylanta. They are included in the magic mouthwash recipe because make the active ingredients to remain longer on the open sores and affected areas of the mouth and throat.
Example of magic mouthwash prescription:
- Viscous lidocaine 2%;
- Maalox or Mylanta;
- Diphenhydramine 12.5 mg each 5 ml.
The ingredients listed above should be mixed in equal proportions (1:1:1).
Many articles and studies report the three ingredients as “ben/lid/maal” standing for Benadryl Lidocaine Maalox.
The ingredients in magic mouthwash recipe may vary from brand to brand or based on your specific prescription.
Radiation therapy and/or chemotherapy may cause different side effects. Each patient had his/her own tolerance level, that’s why the oncology mouth rinse prescription may include or exclude certain ingredients.
Here is a brief list of most common elements and agents your pharmacist should include in the formula based on the medical prescription:
• Tetracycline: an antibiotic to kill bacteria that cause the oral infection;
• Diphenhydramine: an antihistamine that has the scope to reduce pain and discomfort;
• Nystatin: an antifungal to effectively fight oral thrush (candidiasis)
• Hydrocortisone: A corticosteroid to heal inflammation;
• Maalox/Mylanta: antacids that help to ensure other ingredients effectively coat the oral cavity and the upper part of the throat.
Magic mouthwash directions and dosage
[Prescription-only formula] The most common miracle mouthwash dosage for adults is 15 ml (two teaspoon) every 4–6 hours or follow your dentist directions.
[Non-prescription formula] For adults and children over 12 years of age, use every 3 hours or as described in the product indications, do not use more than 8 times per day.
- Shake well before using the compounded oral rinse;
- Prescription-only formula or over the counter magic mouthwash can be used as regular oral rinse;
- Swish the compounded mixture around in your mouth, gargle to relieve throat irritation and spit it;
- The rinsing procedure shouldn’t last more than 15 seconds to 2 minutes depending on the formulation;
- In case of esophagitis, your doctor may advise you to swallow magic mouthwash in order to gently numb that area and give you temporary pain relief;
- If the taste is unpleasant or too strong, you can dilute the mouthwash dosage with water;
- After rinsing your oral cavity, wait for 30 to 40 minutes before to eat or drink again in order to avoid to wash away the active ingredients from the sore areas;
Expiration date and storage
The oncology mouth rinse should be stored at room temperature 20° to 25°C (68° to 77°F).
Commonly indicated as beyond-use dating (BUD), the expiration date of magic mouthwash containing lidocaine should be 21 days maximum. For more info, feel free to read this study published on the National Center for Biotechnology Information (NCBI) website.
In order to avoid unwanted side effects, Dottox.com staff strongly recommend you to ask your pharmacist more info about the expiration date of your prescribed mouth rinse or to read carefully the label in the box of over the counter products.
Do not use the rinse containing tetracycline beyond the expiration date because antibiotic degradation is highly dangerous for your health.
- Numb your mouth especially your tongue. If that happen, you should pay attention not to bite the inside part of your cheek;
- Burning mouth (usually the burning feeling disappears after a few minutes);
- Unpleasant taste (metallic feeling);
- Dizziness, headache;
- Swallowing magic mouthwash may cause you nausea, constipation, or drowsiness.
If the taste of the oral rinse or the burning mouth sensation is too strong, talk to your doctor in order to change or modify the formula.
Is magic mouthwash safe during pregnancy and breastfeeding?
During pregnancy it is better to avoid category D antibiotics like tetracycline.
Antihistamine like diphenhydramine (commercially known as Benadryl) is not indicated while breastfeeding.
It is proven that lidocaine, tetracycline and corticosteroids pass in the breast milk. Although lidocaine is not dangerous for the child, it makes breast milk bitter.
Recipe and pediatric dosage for kids and toddlers
There are not enough available indications for pediatric dosage but USP (United States Pharmacopeia) standards recommend not to exceed 3 mg / kg of 2% lidocaine per dose in topical use. Parents should wait at least 2 hours between one administration and the next one.
Some pediatric formulations may include artificial or natural flavors to make the taste of topical rinsing more enjoyable for children.
Tetracycline in children younger than 8 years may cause two main side effects:
• Teeth discoloration:
• Abnormal bone formation.
Cost without insurance
How much does magic mouthwash cost without insurance? This is the one-million dollar question!
Since there isn’t a unique recipe but several and each of those contains different ingredients, it is very difficult to indicate a single price.
Many patients reported a cost range from $45 to $84 for dentist prescribed mouthwash that was 8 oz.
Non-prescription or homemade formulas are cheaper (about $15 to $40) but they cannot contain active ingredients like lidocaine, antibiotics, antifungal or corticosteroid.
The oncology oral rinses used to relieve chemotherapy mouth sores and tongue ulcers are not covered by health insurance because they are compounded medication. Nevertheless there is the possibility that some of the prescribed active elements may be covered by the insurance depending on your own plan.
In case of some of prescribed drugs are not covered by your insurance, you may ask your doctor to try to replace them with those accepted by your insurance company’s drug formulary.
Best brand and manufacturers
Here is a brief list of the most reviewed products you can find by online store like Amazon and Walgreens:
• Ulcer Ease – Anesthetic Oral Rinse for Relief of Mouth Sores and Throat Irritations (Price: $17.38);
• Prevention Oncology Mouth Rinse (Price: $17.95);
• Uncle Harry’s Natural Alkaline Miracle Mouthwash (Price: $39.99).