Magic mouthwash is a treatment that some doctors prescribe to treat oral mucositis. This condition is a severe inflammation of the lining of the mouth.
Oral mucositis is a common side effect of cancer treatments, especially radiation for head and neck cancer. While some studies support the use of magic mouthwash, others do not. Some expert organizations also warn of its dangers.
Keep reading to learn more about magic mouthwash, including factors to consider before using it.
Magic mouthwash is a product that compounding pharmacies usually make.
Compounding a medication means that a pharmacist combines specific amounts of several commercially available medications to create a new medication. A doctor will write the prescription, which may look more like a recipe, for a compounded medication.
Other names for magic mouthwash include “Duke’s magic mouthwash” or “Mary’s magic mouthwash.”
Magic mouthwash usually contains:
- nystatin, an antifungal medication
- hydrocortisone, a steroid to reduce inflammation
- diphenhydramine, which can help dry out the mouth.
According to the North Carolina Board of Pharmacy, the specific mixture for magic mouthwash contains the following:
- 30 milliliters (ml) of nystatin suspension at 100,000 units/ml, or 3 million units of nystatin powder
- 60 milligrams hydrocortisone
- enough diphenhydramine HCL syrup to bring the total volume up to 240 ml
A person will usually store the mixture in a refrigerator. Most people should not use a formulation once 14 days have passed since the pharmacist first mixed the solution.
However, some recipes for magic mouthwash can vary. Sometimes, a pharmacy will add viscous lidocaine, which has a numbing effect.
Other times, they will add an antacid or other medication that coats the mouth’s lining to reduce discomfort. Examples include kaolin, aluminum or magnesium hydroxide, or sucralfate.
A pharmacy may supply magic mouthwash in small containers for individual use or a large container from which a person will pour each dose.
The typical administration is about 30 ml every 4–6 hours. A person may use a syringe to pull up the medication, or they may have a small measuring cup.
Magic mouthwash is only suitable for swishing in the mouth before a person spits it out. They should never drink the mouthwash.
The exact directions of use may vary, depending on the pharmacy compounding the mouthwash or the prescribing doctor. However, this is a general guide on using magic mouthwash:
- Obtain the correct dose of magic mouthwash, either by syringe, spoon, or measuring cup.
- Pour the liquid into the mouth.
- Swish the liquid in the mouth from side to side or in a swirling pattern for at least 1 minute. Setting a phone timer can help ensure that a person uses the mouthwash long enough.
- Spit out the mouthwash. Do not rinse the mouth after spitting, as this could reduce the medication’s effectiveness by washing away the mouthwash remnants.
- Refrain from eating or drinking for at least 30 minutes after using the mouthwash to maximize its effects.
Using or ingesting too much of the mouthwash can cause a person to experience nausea or numbness in the throat afterward.
Doctors usually prescribe magic mouthwash to reduce symptoms of oral mucositis. This condition can cause severe side effects, including bleeding ulcers in the mouth and significant oral pain. As a result, some people may not be able to eat or drink because their mouth hurts so much.
According to the Oncology Nursing Society, more than one-third of people undergoing cancer treatments discontinue the treatment responsible for mucositis due to the severity of their symptoms. Doctors may prescribe magic mouthwash and other solutions to try to help people continue to tolerate their treatments.
While the concept that magic mouthwash could help treat mucositis may be good in theory, researchers have not proven its effectiveness.
A 2016 randomized, double-blind study comparing magic mouthwash with another mouthwash and a placebo found that the magic mouthwash preparation was more effective than the placebo in reducing radiation-related mucositis pain.
The researchers asked the participants questions about pain reduction straight after they used the mouthwash and at intervals until 4 hours after using it. The researchers found that the participants tolerated the mouthwash well.
An older 2011 randomized study did not find magic mouthwash plus sucralfate to be more effective than another mouthwash type that included the medication benzydamine hydrochloride.
This study focused on whether the mouthwash could prevent oral mucositis. Therefore, the participants used the mouthwash both before and during their radiation treatments, rather than just during treatment.
Differences in formulations and uses for magic mouthwash — for example, treatment vs. prevention — make it difficult to conclude whether it is effective.
Magic mouthwash can cause several side effects. These include:
- changes in taste sensations
If a person uses magic mouthwash and experiences these or other unwanted symptoms, they should stop using the mouthwash and call their doctor. The doctor can recommend how they should proceed or prescribe another oral mucositis treatment.
Magic mouthwash is one example of a compounded mouthwash that doctors may prescribe to treat oral mucositis. Other options include:
- “Pink lady”: This mouthwash contains an antacid suspension (usually Maalox) and viscous lidocaine.
- “Noll’s solution”: This mouthwash contains diphenhydramine, nystatin, dexamethasone (another steroid type), and tetracycline (an antibiotic).
Doctors may also prescribe oral antibiotics or antifungal medications to reduce infection risks from ulcers. They may also prescribe pain-relieving medications to reduce the incidence of mucositis pain, allowing patients to continue with their cancer treatments.
Magic mouthwash may help relieve pain from the mouth ulcers and irritation that cancer treatments can cause.
However, the mouthwash can also cause side effects, and it may not work for some individuals struggling with mouth pain.
A person should contact their doctor if they are using magic mouthwash, and they experience worsening or new symptoms relating to its use.