Good Meds at the Armageddon Pharmacy—Magic Mouthwash

While selling books at one of the farmers markets last summer, one of the ladies we visited with asked if either of the medicine references contained the recipe for Magic Mouthwash.  I’d never heard of such a creature and asked her to tell me about it.  She gushed about how fabulous it was and how she used it frequently.  After some time to think, she remembered that it contained Benadryl and Maalox.  Jared looked it up on his phone and sent an email to remind me.  I had to wait until getting home to research it further. 

What is Magic Mouthwash?

Magic Mouthwash is a medicated mouthwash most often used to treat oral mucositis, a condition commonly occurring in patients receiving cancer treatment.  However, certain infections also cause oral mucositis.  It’s sometimes employed in relieving the pain of bacterial infections like strep throat, as well as some autoimmune diseases and Behcet’s disease.[1]  And it is used for oral thrush, stomatitis (cold sores, canker sores, herpes virus), and hand, foot, and mouth disease.

There is a whole host of names for Magic Mouthwash, and each of them has slightly different ingredients. 

• Miracle mouthwash
• Mixed medicated mouthwash
• Kaiser mouthwash
• Duke’s mouthwash
• Mary’s mouthwash

The various ingredients:

• Antibiotic, such as tetracycline
• Antifungal, such as nystatin
• Anesthetic, such as lidocaine
• Antihistamine, such as Benadryl
• Steroid, such as hydrocortisone
• Antacid, such as Maalox or Mylanta[2]

The National Cancer Institute’s formula contains Benadryl, nystatin, and lidocaine.[3]  According to Healthline.com, another popular formula contains Benadryl, viscous lidocaine (2%), and Maalox or Mylanta.  Ever concerned for our health and well-being, they advise against attempting to DIY this formula.[4]  And it is also noted that Magic Mouthwash is only available through a compounding pharmacy and has a shelf life of 90 days in the refrigerator. 

When is Magic Mouthwash used?  Both children and adults can use this.  Children and young adults are more likely to be afflicted by mouth sores due to an infection; adults experience the condition most often due to chemotherapy and radiation treatments. 

How to use Magic Mouthwash:

• Pour the Magic Mouthwash into a spoon or measuring cap.
• Put it into your mouth and swish it around for 1-2 minutes.
• Spit it out.  Do not swallow it unless advised to do so, or you risk an upset stomach.
• Avoid eating or drinking anything for 30 minutes.

Your medical provider will recommend the right dosage for you.  For reference, so that you can have sufficient ingredients on hand, here are some common dosages:

• 10 ml every 3 hours, up to 6 times per day for 6 days[5]
• Every 4-6 hours[6]

Magic Mouthwash may worsen some symptoms, including:

• Burning or stinging
• Dryness
• Loss or change of taste
• Soreness or irritation
• Tingling[7]

Side effects of Magic Mouthwash, depending on the exact formula used, include:

• Constipation 
• Diarrhea
• Drowsiness
• Nausea

Magic Mouthwash DIY Formulas

For all formulas, do not eat or drink for 30 minutes after using.  Also, it may take a full week before the patient notices improvement.  Note that according to all sources, you should leave the making of Magic Mouthwash to the professionals or be following the instructions issued by a physician.  The amounts listed below are only a guideline to help you calculate how much of the ingredients you wish to store for future needs.  Prescription strength Magic Mouthwashes often contain viscous lidocaine.  The lidocaine powder you’ve stored may also be used to make the mouthwash.  And that would definitely only by under a physician’s instruction.  An oral lidocaine overdose could be fatal.  And lidocaine is never given to children.[8]

B&M

Combine equal parts Benadryl and Maalox.  Swish 1-2 teaspoons in the mouth every 4-6 hours.  Spit.  Avoid swallowing.  The sores will start feeling better in about one week.

This formula works because Benadryl is an antihistamine and reduces inflammation in the mouth.  Maalox coats the sores and lets them heal.

Salt Water Gargle

Gargle with salt water or cold water.  Mix 1 teaspoon of salt and 2 teaspoons baking soda in 1 cup of water.  Swish for 30 seconds and spit.  Use every 4-6 hours. 

As I was searching the internet, I struck gold as far as this topic is concerned: 

http://painmuse.org/wp-content/uploads/magic-mouth-recipies.pdf

At that site, there are 20 different pharmaceutical formulas for Magic Mouthwash containing all the ingredients mentioned above, plus (most important for our purposes) tetracycline and cherry Kool-Aid.  I reproduced them here in case the internet goes down.  Naturally, these are not included for unlicensed medical personnel to compound.  They are here so that you can show them to your doctor and he can issue a prescription or recommendations, because he probably won’t remember all the formula possibilities.

 

Diphenhydramine 12.5 mg/5 mL 240 mL Hydrocortisone 60 mg Nystatin powder 6 million units Tetracycline 1.5 g Swish and spit 5 mL QID. a.k.a. Mary’s Magic Potion	Distilled water 160 mL Hydrocortisone 80 mg Maalox 80 mL Swish and spit 5 mL QID. a.k.a. Weisman’s Philadelphia Mouthwash
Diphenhydramine 12.5 mg/5 mL 1 part Nystatin suspension 1 part Maalox 1 part Water 1 part	Diphenhydramine 12.5 mg/5 mL 1 part Viscous lidocaine 2% 1 part Maalox 1 part  Swish and swallow 5 mL no more than Q4H. OR For radiation oncology mucositis; palliative care: Swish, hold, and spit or swallow 30 mL Q2H.
Diphenhydramine 12.5 mg/5 mL 240 mL Hydrocortisone powder (wet with 1% CMC f to dissolve) 120 mg Nystatin Suspension 60 mL Tetracycline 125 mg/5 mL (capsule dissolved in flavored syrup) 120 mL CMCf 1% QS 480 mL Swish and swallow 10 mL TID.	Diphenhydramine 12.5 mg/5 mL 30 mL Mylanta or Maalox 60 mL Sucralfate 4 g Swish and spit or swallow 5 mL TID before meals and PRN. 6
Hydrocortisone 60 mg Nystatin Suspension 30 mL OR Powder 3 million units Diphenhydramine 12.5 mg/5 mL QS 240 mL a.k.a. Duke’s Magic Mouthwash	Diphenhydramine 12.5 mg/5 mL 180 mL Hydrocortisone 0.072 g Nystatin suspension 36 mL Tetracycline 0.75 g
Diphenhydramine 12.5 mg/5 mL 100 mL Hydrocortisone 0.02 g Nystatin suspension 4.8 mL Tetracycline 200 mg	Diphenhydramine 12.5 mg/5 mL 1 part Prednisone 5 mg/5 mL 1 part Nystatin suspension 1 part
Nystatin Susp. 100,000 U/mL 83.3 mL Lidocaine Viscous 2% 83.3 mL Distilled Water 83.3 mL Crystal Light-Raspberry with Aspartame crystals8 0.47 g	Cherry flavored Kool-Aid mixed with 2000 mL distilled water (sugar-free) 100 mL Viscous lidocaine 2% 100 mL Nystatin suspension 100 mL Swish and spit or swallow 15 mL QID. OR For radiation oncology mucositis; palliative care: Swish, hold, and spit or swallow 30 mL Q4H. 1 a.k.a. Koolstat
Hydrocortisone 100 mg/2 mL (Solu-Cortef) 12 mL Nystatin suspension 7.2 mL Tetracycline 125 mg/5 mL (capsule dissolved in syrup) 12 mL Diphenhydramine 12.5 mg /5 mL 150 mL Swish and swallow 10 mL QID.	Viscous lidocaine 2% 250 mL Hydrocortisone 100 mg/2 mL (Solu-Cortef) 1 g Nystatin suspension 150 mL Mouth rinse QS 500 mL Do not swallow.
Diphenhydramine 12.5 mg /5 mL 120 mL Dexamethasone 4 mg/mL injection 0.56 mL Nystatin suspension 40 mL Distilled water QS to 200 mL8 Swish and Spit 5 mL QID.	Viscous lidocaine 2% 2000 mL  Cherry flavored Kool-Aid mixed with 1500 mL of sterile water for irrigation (sugar-free) QS 3400 mL
Diphenhydramine 12.5 mg/5 mL 1 part Prednisone 5 mg/5 mL 1 part Nystatin suspension 1 part	Viscous lidocaine 2% 80 mL Mylanta 80 mL Diphenhydramine 12.5 mg/5 mL 80 mL Nystatin suspension 80 mL Prednisolone 15 mg/5 mL 80 mL Distilled water 80 mL Swish, gargle, and spit 5 mL to 10 mL Q6H PRN. May be swallowed if esophageal involvement.10
Viscous lidocaine 2% 150 mL Diphenhydramine 12.5 mg/5 mL 20 mL Hydrocortisone (Solu-Cortef) 100 mg Tetracycline 2 grams Nystatin suspension 20 mL Swish, hold, and swallow 15 to 30 mL Q4-6H. 1 a.k.a. Mile’s Solution
Viscous lidocaine 2% 30 mL Maalox 60 mL Diphenhydramine 12.5 mg/5 mL 30 mL Carafate 1 g/10 mL 40 mL Swish, gargle, and spit 5 mL to 10 mL Q6H PRN. May swallow if esophageal involvement. 10	Dexamethasone 0.5 mg/5 mL 100 mL Diphenhydramine 12.5 mg/5 mL 100mL Nystatin suspension 60 mL Tetracycline 1500 mg Swish, gargle, and spit 5 mL to 10 mL Q6H PRN. May swallow if esophageal involvement.10

a. Elixirs containing alcohol can cause stinging.  Consider using injectable or powder formulation, crushing tablets, or opening capsules in place of elixir formulation to avoid stinging. 

b. Some U.S. clinicians have found the new formulation of Kaopectate (i.e., containing bismuth) to solidify over a short period of time when mixed with other ingredients. U.S. clinicians should consider this potential problem if utilizing recipes which use Kaopectate in place of Maalox. Canadian Kaopectate formulation does not contain bismuth.

c. Nystatin has not been shown to be effective in treating oral fungal infection associated with oral mucositis. 11

d. The use of corticosteroids, such as hydrocortisone or dexamethasone, has not been adequately studied to recommend its inclusion in magic mouthwash. 11

e. According to USP standards, mixtures containing water should have an expiration not longer than two weeks.12

f. CMC=Carboxymethylcellulose.

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[1] https://health.clevelandclinic.org/what-is-magic-mouthwash

[2] https://health.clevelandclinic.org/what-is-magic-mouthwash

[3] https://www.cancer.gov/publications/dictionaries/cancer-drug/def/diphenhydramine-hydrochloride-dexamethasone-nystatin-magic-mouthwash

[4] https://www.healthline.com/health/magic-mouthwash#ingredients

[5] https://www.healthline.com/health/magic-mouthwash#instructions

[6] https://journals.sagepub.com/doi/10.1191/1078155205jp166oa?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed

[7] https://www.wikihow.com/Make-Magic-Mouthwash

[8] https://www.goodrx.com/conditions/cancer/magic-mouthwash