Magic mouthwash

Magic mouthwash and magic swizzle are terms referring to a number of different mouthwash formulations. Typically, a magic mouthwash is prescribed to treat the pain associated with mucositis caused by radiation therapy or chemotherapy. It is also prescribed for aphthous ulcers, other oral ulcers, and other mouth pain.

The thinking behind magic mouthwash is to combine ingredients to treat a variety of oral conditions. Magic mouthwashes are typically compounded in a pharmacy from a doctor's prescription. The prescription should always specify a recipe, since there is not a standard formulation, and problems can arise when patients receive a product different from what the prescriber intended.

Formulations
The most popular formulation of magic mouthwash contains viscous lidocaine as a topical anesthetic, diphenhydramine as an anti-inflammatory, and Maalox to help coat the tissues in the mouth. Other formulations include antifungals, corticosteroids and/or antibiotics.

Common ingredients include:
 * Diphenhydramine - an antihistamine to reduce inflammation
 * Glucocorticoids - to reduce inflammation
 * Lidocaine - a local anesthetic to relieve pain
 * Maalox - an antacid formulation which acts as a coating agent
 * Nystatin- an antifungal for candidiasis
 * Sucralfate - a coating agent
 * Tetracycline - an antibiotic
 * Erythromycin- an antibiotic

Efficacy
Despite a lack of evidence that magic mouthwashes are effective in decreasing the pain of oral lesions, many patients and prescribers continue to use them. There has been only one controlled study to evaluate the efficacy of magic mouthwash; it shows no difference in efficacy among the most common formulation and other agents such as chlorhexidine and a saline/baking soda solution. Current guidelines suggest that saline solution is just as effective as magic mouthwash in pain relief or shortening of healing time of oral mucositis from cancer therapies.

Patient safety
Because magic mouthwash has no standard formulation, its use involves concerns about patient safety. It is important that the prescriber and pharmacist are in specific agreement about exactly what is being prescribed. Failure to communicate about this can result in the patient receiving something not intended by the prescriber. This, of course, can have many undesirable consequences, including drug interaction and the possibility of drug allergy.