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Author: Admin | 2025-04-28
4Rx:100 mL dexamethasone (of the elixir, which is 0.5 mg per 5 mL)60 mL nystatin (100,000 U/5 mL) suspension100 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 water1 teaspoon salt1 teaspoon baking sodaSig: Rinse, gargle, and spit after meals and before bed as needed. Oral hygeine antisepticchlorhexidine (Peridex)Disp: #473 mLSig: 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 mLDisp: #280 mLSig: 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) FIRST Kits Mouthwash (diphenhydramine, Maalox, simethicone, lidocaine) 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, DiphenhydramineReferences:"Magic Mouthwash". Pharmacist's Letter/Prescriber's Letter 2009; 25(11):251103 "Updated clinical practice guidelines for the prevention and treatment of mucositis". Cancer, 109: 820–831.MASCC Mucositis Guidelines 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 Shon NN, Yarbrough T, Shah AD. Aluminum Hydroxide. [Updated 2021 Jul 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan https://www.ncbi.nlm.nih.gov/books/NBK546669/Apthosis and diseases of the mucous membranes. https://www.sciencedirect.com/topics/neuroscience/maaloxENTHealth on burning mouth syndrome/glossodyniaGeneral Notes:USP standards recommend that compounded mixtures containing water have an
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