ORAL AGENTS IN ORAL MUCOSITIS AND FUNGAL INFECTION

1. List of drug used for gargle in cancer patient

NO DRUG INDICATION ACTION DOSAGE/ ADMINISTRATION

1 Aspirin tablet Systemic Reduce inflammation Crush 1 tablet of aspirin 300mg and dissolve in
analgesics 1 glass of plain water, can use for gargle
throughout the day, 3-4 times a day

2 Sodium To promote Debride oral mucosa Top up 100 ml of plain water to dissolve
bicarbonate 2% cleanliness (removal of dead, sodium bicarbonate powder in the bottle.
mouth wash To dissolve damaged, or infected Gargle, swish around mouth and spit out; 10-
saliva tissue to improve the 15 ml TDS-QID
healing potential of the
remaining healthy tissue.)
Sometimes radiation
therapy can cause thick,
stringy saliva thus sodium
bicarbonate in
the mouthwash can help
dissolve saliva.

3 Benzydamine hcl Topical Reduce pain by anti- Rinse mouth with 10-15 mL q 4-6 hours;
0.15% solution analgesics inflammatory swish around mouth and spit out
(Difflam) effect May have a drying effect (from alcohol in
formulation)

4 Lignocaine 2% Topical Reduce It is a thick paste, most patients dislike the

viscous solution anaesthetics pain by numbing the sensation of this viscous product
mouth Swish and swallow slowly or spit out of
mouth 5-10 mL q4h PRN; do not eat or drink
for at least 30 minutes after dose
Anesthetic effects occur in 5 minutes and
last 20-30 minutes

5 Mixture Topical anti- Coat temporarily the Swish and swallow, 5-10mL 4-6 times daily to
Magnesium inflammatory mucosal surfaces, coat the mucosal surfaces
Trisilicate-MMT agent increase coating of other
ingredient on the mouth

6 Diphenhydramine Topical anti- Soothing oral mucosa Swish and swallow 5-10 mL q4h PRN
syrup inflammatory Topical anesthetics
agent

7 Nystatin Anti-fungal To stop any fungal growth Adult: Use 5 mL QID for 7-14 days. Swish
suspension (Fungal Infections around and hold in the mouth for at least one
including minute, then swallow.
Candidiasis)
Children: Use 2mL for infants or 4-6 mL for
children. Swish and swallow or swab mouth
QID

8 Thymol gargle Topical For oral hygiene, soothe Dilute 1 part of solution with 3 parts of warm
antiseptic sore throat and minor water, once or twice daily as needed (TDS-
 mouth inflammation QID)

9 Allopurinol tablet To maintain Unknown, but may Administer topically, must be freshly prepared
integrity of decrease intensity of each time before use, crush 300mg tablet and
oral mucosa mucositis and provide dissolved in one glass of water
comfort
10 Sodium chloride mechanical to keep food debris out of These mouthwashes tend to be advised about
cleansing healing wounds and to 6 times per day, especially after meals to
action and an prevent infection. remove food from the socket.
antiseptic Remove loose debris
action
from teeth

2. Magic mouthwash
Magic mouthwash is commonly prescribed for conditions such as chemotherapy/radiation
induced mucositis, canker sores, mouth pain, etc. The logic behind magic mouthwash is to combine
ingredients with different potential mechanisms of action to treat a variety of oral conditions.
There are numerous magic mouthwash formulations. Most contain at least three ingredients.
Concoctions may contain a combination of an antibiotic (to reduce the bacterial flora around the
lesion), antihistamine (for local anesthetic effect), antifungal (to stop any fungal growth), steroid (to
reduce inflammation), a local anesthetic/pain reliever, or an antacid (to enhance coating of the
ingredients on the mouth).

DOSAGE: Most of the formulations are used every 4-6 hours with instructions to hold in the mouth
for 1-2 minutes then spit out or swallow if esophageal involvement. Patients should be instructed not
to eat or drink for 30 minutes after use.

Common formula
Diphenhydramine 12.5 mg/5 mL 1 part
Viscous lidocaine 2% 1 part
Magnesium trisilicate 1 part

Diphenhydramine 12.5 mg/5 mL 1 part

Viscous lidocaine 2% solution 1 part
Nystatin oral suspension 1 part

Diphenhydramine 12.5 mg/5 mL 1 part

Nystatin suspension 1 part
Magnesium trisilicate 1 part

3. Mucositis in cancer patient

1. Mucositis occurs when cancer treatments break down the rapidly divided epithelial cells
lining the gastro-intestinal tract (which goes from the mouth to the anus), leaving the
mucosal tissue open to ulceration and infection.
2. Mucosal tissue, also known as mucosa or the mucous membrane, lines all body passages
that communicate with the air, such as the respiratory and alimentary tracts, and have cells
and associated glands that secrete mucus. The part of this lining that covers the mouth,
called the oral mucosa, is one of the most sensitive parts of the body and is particularly
 vulnerable to chemotherapy and radiation. The oral cavity is the most common location for
mucositis.
3. Oral mucositis is probably the most common, debilitating complication of cancer treatments,
particularly chemotherapy and radiation. It can lead to several problems, including pain,
nutritional problems as a result of inability to eat, and increased risk of infection due to open
sores in the mucosa. It has a significant effect on the patients quality of life and can be dose-
limiting (i.e., requiring a reduction in subsequent chemotherapy doses).

REFERENCES
Best Practice Guidelines for the Management of Oral Complications from Cancer Therapy; Quick
Reference Version
Magic mouthwash: an update. Pharmacists Letter/Prescribers Letter 2009;25 (11):251103.