Magic Mouthwash formulas

The term “magic mouthwash” has no single defined composition, but is a general phrase used to reference a soothing or therapeutic oral rinse of multiple ingredients. Different mixtures may be used depending on the intended effects, though a trial of a magic mouthwash is sometimes used for a broad treatment strategy without necessarily having a specific diagnosis confirmed. The following is not medical advice, but a compilation of some reported recipes. The term “stomatitis cocktail” is also used with the same meaning as “magic mouthwash.”

Downsides of using magic mouthwash include potential unnecessary medication use, the cost (which may be significant given frequent need for a compounding pharmacy and multiple ingredients), as well as non-specificity of the term “magic mouthwash,” leading to potential ambiguity when communicating prior therapies to a physician. Additionally, care may be needed to avoid treating symptoms only while an underlying process progresses.

 

Magic Mouthwash Recipe 1

Rx:

  • 50 mL viscous lidocaine 2%

  • 50 mL Mylanta

  • 50 mL diphenhydramine (Benadryl) at 12.5 mg per 5 ml elixir

  • 50 mL nystatin (100,000U per 5 mL) suspension

  • 50 mL prednisolone at 15mg per 5ml solution

  • 50 mL distilled water

Disp: #300 mL (15 day supply)

Sig: Swish thoroughly, gargle, and spit one teaspoonful (5 mL) after meals and before bed. Shake well before using.

Note to prescriber: May be swallowed if the pharynx or esophagus is involved, but prescriber should consider systemic dosing as well as precautions against alimentation while the pharynx and larynx are numb. Oral, pharyngeal, and/or laryngeal numbness increases risk for aspiration, and therefore I tell my patients to use this after eating or drinking, not before, which may seem counterintuitive.

Magic Mouthwash Recipe 2 (also called "Xyloxadryl," "BMX," or “Radiotherapy Mixture”)

Rx:

  • 70 mL viscous lidocaine 2%

  • 70 mL Maalox (do not substitute Kaopectate)

  • 70 mL diphenhydramine (Benadryl) (of the elixir, which is 12.5 mg per 5 mL)

Disp: 210 ml (10 day supply)

Sig: Swish thoroughly, gargle, and spit one teaspoonful (5 mL) after meals and before bed. Shake well before using.

Note to prescriber: May be swallowed if the pharynx or esophagus is involved, but prescriber should consider systemic dosing as well as precautions against alimentation while the pharynx and larynx are numb. Oral, pharyngeal, and/or laryngeal numbness increases risk for aspiration, and therefore I tell my patients to use this after eating or drinking, not before, which may seem counterintuitive.

Magic Mouthwash Recipe 3

Rx:

  • 38 mL viscous lidocaine 2%

  • 75 mL Maalox (do not substitute Kaopectate)

  • 38 mL diphenhydramine (Benadryl) 12.5 mg per 5 ml elixir

  • 50 mL sucralfate (Carafate) at 1 gm per 10 ml

Disp: #200 mL (10 day supply)

Sig: Swish thoroughly, gargle, and spit one teaspoonful (5 mL) after meals and before bed. Shake well before using.

Note to prescriber: May be swallowed if the pharynx or esophagus is involved, but prescriber should consider systemic dosing as well as precautions against alimentation while the pharynx and larynx are numb. Oral, pharyngeal, and/or laryngeal numbness increases risk for aspiration, and therefore I tell my patients to use this after eating or drinking, not before, which may seem counterintuitive.

Magic Mouthwash Recipe 4

Rx:

  • 100 mL dexamethasone (of the elixir, which is 0.5 mg per 5 mL)

  • 60 mL nystatin (100,000 U/5 mL) suspension

  • 100 mL diphenhydramine (Benadryl) (of the elixir, which is 12.5 mg per 5 mL)

  • 1500 mg tetracycline powder (contents of 3 capsules tetracycline, 500 mg each) Note: may substitute 3 capsules of doxycycline, 100 mg each.

Disp: #260 mL (13 day supply)

Sig: Swish thoroughly, gargle, and spit one teaspoonful (5 mL) after meals and before bed. Shake well before using.

Note to prescriber: tetracycline and doxycycline are relatively contraindicated in children under 8 years of age due to tooth enamel hypolasia and discoloration.

Also note: May be swallowed for pharyngeal or esophageal involvement, but prescriber should consider systemic dosing.

Saltwater Mouthwash (non-prescription)

Rx:

  • 6-12 ounces of water

  • 1 teaspoon salt

  • 1 teaspoon baking soda


Sig: Rinse, gargle, and spit after meals and before bed as needed.

Oral hygeine antiseptic

chlorhexidine (Peridex)

Disp: #473 mL

Sig: swish and SPIT 15 mL after meals and before bed (or four times a day). Swabbing this rinse on oral surfaces in an incapacitated patient is also sometimes performed.

Note: Long-term (usually longer than 2 week) use of chlorhexidine may discolor the teeth brown or yellow.

sucralfate (Carafate)

sucralfate suspension 10 mg/10 mL

Disp: #280 mL

Sig: swish and spit 10 mL after meals and before bed (or four times a day).

Note: Sucralfate works by making a protective coating over a mucosal wound. May be swallowed for pharyngeal or esophageal involvement. Sucralfate tablets are generally less expensive and more readily available, but unless crushed and suspended, taken as a pill, it would not treat proximal to the stomach. Sucralfate may block absorption of other drugs and therefore do not take sucralfate within 2 hours of other enteral medications.

Premade compounding kits from AzurityPharma:
  (more convenient; easier billing; higher cost; less compounding flexibility) 

Here are some other mouthwashes sometimes referenced, but are lesser known and don't have the measurements listed:

"Dr. Weisman's Philadelphia Mouthwash" contains: Maalox, lidocaine, diphenhydramine (ratio of 3:3:1)

"Mary's Magic Potion"; "Benacort-Tetrastat” contains: Tetracycline, Nystatin powder, Diphenhydramine, Hydrocortisone

"Stomafate suspension (Methodist standard)": contains: Sucralfate, water, diphenhydramine, Maalox

"Powell's Suspension": contains: Nystatin, Hydrocortisone, Tetracycline, diphenhydramine

"Duke's Magic Mouthwash": contains: Nystatin, Hydrocortisone, Diphenhydramine

"Stanford Mouthwash": Tetracycline (48 mL of 25mg/mL), Nystatin (12 mL of 100,000U/mL) hydrocortisone powder (46 mg), Chlorpheniramine (#5 tablets, 4 mg each), and purified water qs to 100 mL.

"Modified Stanford Mouthwash": contains: Tetracycline, Nystatin, Hydrocortisone, Diphenhydramine, flavor, Mouth Kote

"Silegy's Mouthwash": contains: Tetracycline, Nystatin, 2-Deoxy-D-Glucose, Chlorpheniramine, Hydramine

"Daniel's Mouthwash": contains: Sumycin, Dexamethasone, Nystatin, Diphenhydramine

References:

  • "Magic Mouthwash". Pharmacist's Letter/Prescriber's Letter 2009; 25(11):251103

General Notes:

  • USP standards recommend that compounded mixtures containing water have an expiration date of no more than two weeks.

  • Avoid alcohol-containing components; they can be irritating to ulcerated mucosa and cause systemic effects if swallowed.

  • Kaopectate can cause solidification problems.

  • Maalox is a mixture of MAgnesium and ALuminum as OXides. The oxides and hydroxides react with the hydrochloric acid produced in the stomach, neutralizing it. It also contains simethicone, an anti-foaming agent which helps eliminate bloating from gas. In large doses, Maalox can act as a laxative. Avoid use with renal insufficiency.

Swish and spit, done thoroughly, covers the oral cavity.

Swish, gargle, and spit covers the oral cavity and of the oropharynx, though reliable coverage of the entire oropharynx is unlikely.

Swish and swallow covers the oral cavity, oropharynx, and esophagus, but not the endolarynx or nasopharynx.