Magic Mouthwash
Prescription Rx Recipes and Formulas
There is no standard formula for Magic Mouthwash. It's like trying to find the "best" meatloaf recipe; you will find many!
When the pharmacy gets a prescription for Magic Mouthwash, the pharmacist makes each one ("compounds") according to the prescribing physician's instructions or recipe.
Many health care providers know about Magic Mouthwash, but assume there is ONE formulation, and don't know the exact ingredients or proportions. When a prescription for Magic Mouthwash is given to a patient, it must contain specific ingredients, amounts, and patient instructions, so the pharmacist knows which one to make.
Here are some of the more common adult formulations.
Magic Mouthwash Recipe 1
Rx:
- 80 ml viscous lidocaine 2%
- 80 ml Mylanta
- 80 ml diphenhydramine 12.5 mg per 5 ml elixir
- 80 ml nystatin 100,000U suspension
- 80 ml prednisolone 15mg per 5ml solution
- 80 ml distilled water
Sig: Swish, gargle, and spit one to two teaspoonfuls every six hours as needed. May be swallowed if esophageal involvement.
Magic Mouthwash Recipe 2 (also called "Xyloxadryl" or "BMX")
Rx:
- 1 Part viscous lidocaine 2%
- 1 Part Maalox (do not substitute Kaopectate)
- 1 Part diphenhydramine 12.5 mg per 5 ml elixir
Quantity: 120 ml
Sig: Swish, gargle, and spit one to two teaspoonfuls every six hours as needed. May be swallowed if esophageal involvement. Shake well before using.
Magic Mouthwash Recipe 3
Rx:
- 30 ml viscous lidocaine 2%
- 60 ml Maalox (do not substitute Kaopectate)
- 30 ml diphenhydramine 12.5 mg per 5 ml elixir
- 40 ml Carafate 1 gm per 10 ml
Sig: Swish, gargle, and spit one to two teaspoonfuls every six hours as needed. May be swallowed if esophageal involvement. Shake well before using.
Magic Mouthwash Recipe 4
Rx:
- 100 ml dexamethasone 0.5 mg per 5 ml elixir
- 60 ml nystatin 100,000U suspension
- 100 ml diphenhydramine 12.5 mg per 5 ml elixir
- contents of 3 capsules tetracycline 500 mg
Sig: Swish, gargle, and spit one to two teaspoonfuls every six hours as needed. May be swallowed if esophageal involvement.
Here are some other mouthwashes that I've seen referenced, but are lesser known and don't have the measurements listed:
"Dr. Weisman's Philadelphia Mouthwash"
- Contains: Maalox, Lidocaine, Benadryl, water
"Radiotherapy mixture"
- Contains: Maalox Plus, Lidocaine, Diphenhydramine
"Mary's Magic Potion"; "Benacort-Tetrastat"
- Contains: Tetracycline, Nystatin powder, Diphenhydramine, Hydrocortisone
"Stomafate suspension (Methodist standard)"
- Contains: Sucralfate, water, benadryl, Maalox)
"Powell's Suspension"
- Contains: Nystatin, Hydrocortisone, Tetracycline, Diphenhydramine
"Duke's Magic Mouthwash"
- Contains: Nystatin, Hydrocortisone, Diphenhydramine
"Stanford Mouthwash"
- Contains: Tetracycline, Nystatin, 2-Deoxy-D-Glucose, Chlorpheniramine
"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
"Miracle Mouthwash"
- Contains: Dexamethasone, Tetracycline, Nystatin, Diphenhydramine
Other terms and phrases
- Magic Mouth Gargle
- Magic Swizzle
- Magic Mouth Rinse
- Mayo Mouthwash
- Larry's Solution
- Kaiser's Mouthwash
- Kraemer's Mouthwash
- Reynold's Mouthwash
- Mile's Solution
- Koolstat
Saltwater Mouthwash
- 16-ounce bottle of water
- 1 teaspoon salt
- 1 teaspoon baking soda
Keep a bottle by bathroom and kitchen sinks.
Rinse, gargle, and spit after meals, before bed, and anytime your mouth feels dry or sore.
Premade compounding kits from CutisPharma:
(more convenient; easier billing; higher cost; less compounding flexibility)
- First™ Mouthwash BLM
- Benadryl, Lidocaine, Maalox
- See package insert
- First™ BXN Mouthwash
- Benadryl, Xylocaine, Nystatin
- See package insert
- First™ Duke's Mouthwash
- Diphenhydramine, Hydrocortisone, Nystatin
- See package insert
- First™ Mary's Mouthwash
- Diphenhydramine, Hydrocortisone, Nystatin, Tetracycline
- See package insert
Articles:
- "Magic Mouthwash". Pharmacist's Letter/Prescriber's Letter 2009; 25(11):251103
References:
- "Updated clinical practice guidelines for the prevention and treatment of mucositis". Cancer, 109: 820–831.
- MASCC Mucositis Guidelines
- Drug Mechanisms in Dermatology
- mouthulcers.org
- "Magic Mouthwash Plus Sucralfate Versus Benzydamine Hydrogen Chloride (HCl) for the Treatment of Radiation-Induced Mucositis". ClinicalTrials.gov
- USP Compounding Standards and Resources
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.
- Kaopectate can cause solidifaction problems.
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