Dry Mouth, Stomatitis, and Mucositis

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Topical Oral Solutions for the Treatment of Chemo-Induced Oral Mucositis

“Magic mouthwashes” are topical solutions or suspensions prepared to relieve symptoms of various oral pathologies. As compounding pharmacists, we recognise the need for practitioners to have the ability to prescribe customised preparations to meet specific patient needs. We can compound various medications into a stable, pleasantly-flavoured, alcohol-free suspension.

J Oncol Pharm Pract. 2005 Dec;11(4):139-43.
Survey of topical oral solutions for the treatment of chemo-induced oral mucositis.
Click here to access the PubMed abstract of this article.


Misoprostol: Mucosal Protectant and Anti-Secretory

Misoprostol is a synthetic prostaglandin E1 analogue, with mucosal cytoprotectant and antisecretory properties. A mouthrinse containing misoprostol and lidocaine in a non-irritating neutral vehicle can be used to provide immediate pain relief and aid in the healing of the oral cavity.

A mucoadhesive powder containing misoprostol can be used to aid in the healing of mucosal ulcers and irritations. It is applied by using a powder “puffer” or by direct application of the powder to the affected area. The carriers will hydrate and adhere to the mucosal surface, keeping the misoprostol in prolonged contact with the area.

Int’l J Pharm Compounding. May/June 2000; 4(3):211
Misoprostol 0.001% and Lidocaine 0.5% Oral Rinse
Click here to access the abstract of this article.

Int’l J Pharm Compounding. May/June 2000; 4(3):212
Misoprostol 0.0027% Mucoadhesive Powder
Click here to access the abstract of this article.

Int’l J Pharm Compounding. Jan/Feb 1999; 3(1):48
Misoprostol 0.0024% and Lidocaine 1% in Glycerin Mouth Paint
Click here to access the abstract of this article


Burning Mouth Syndrome (BMS) Relieved with Alpha Lipoic Acid (ALA)

A double blind, controlled study compared alpha lipoic acid with placebo for two months on 60 patients with constant BMS, in whom there was no laboratory evidence of deficiencies in iron, vitamins or thyroid function and no hyperglycemia. Following treatment with alpha lipoic acid 600 mg orally daily, there was a significant symptomatic improvement compared with placebo. This improvement was maintained in over 70% of patients at the 1 year follow-up.

J Oral Pathol Med. 2002 May;31(5):267-9.
Burning mouth syndrome (BMS): double blind controlled study of alpha-lipoic acid (thioctic acid) therapy.
Click here to access the PubMed abstract of this article.


Saliva Substitute for Dry Mouth/Throat

Saliva replacement is an important adjunct to relieving the symptoms of xerostomia in patients with Sjogren’s Syndrome. Saliva substitutes which contain thickening agents like carboxymethylcellulose are used because water alone can not adequately moisten and lubricate the oral mucosa and teeth. Dry mouth or throat secondary to a number of conditions can be relieved with a customised saliva substitute that can be administered throughout the day and night and can be flavoured to please each patient. Keeping the mucosal membranes moist can improve comfort for the patient and minimise irritation and the risk of infection.

Int’l J Pharm Compounding. May/June 2000; 4(3):215
Saliva Substitute for Dry Mouth/Throat
Click here to access the abstract of this article.

Int’l J Pharm Compounding. Sep/Oct 2000; 4(5):340
Saliva Substitute
Click here to access the abstract of this article.


Pilocarpine Troches for Xerostomia

Pilocarpine is indicated for the treatment of xerostomia secondary to radiation therapy of the head and neck. Pilocarpine is a cholinergic agent that stimulates residual-functioning exocrine glands. In a study by Vivino et al., pilocarpine at oral doses of 2.5mg and 5mg four times daily significantly increased saliva production and alleviated symptoms of dry mouth when compared to placebo. The higher dose produced the most improvement but also the highest incidence of adverse effects, such as sweating, diarrhoea, and urinary frequency.

Arch Intern Med. 1999; 159:174-181
Pilocarpine tablets for the treatment of dry mouth and dry eye symptoms in patients with Sjogren syndrome: a randomised, placebo-controlled, fixed-dose, multicenter trial. P92-01 Study Group.
Click here to access the PubMed abstract of this article.

Int’l J Pharm Compounding. Sep/Oct 2000; 4(5):381
Pilocarpine HCl 2-mg Troches
Click here to access the abstract of this article.


Treatment for Dry Mouth, Stomatitis, and Mucositis

Loss of saliva (xerostomia) is one of the most common complaints among patients who have received radiation therapy of the head and neck. Xerostomia contributes to radiation-induced periodontal infection, dental caries, osteoradionecrosis, and poor digestion of carbohydrates. Ask us about sialogogues (saliva stimulants) in customised dosage forms.

Aust Dent J 2002 Sep;47(3):249-53
An investigation into the use of pilocarpine as a sialagogue in patients with radiation induced xerostomia.
Click here to access the PubMed abstract of this article.


When a person is receiving chemotherapy or radiation, mouth tenderness and infections can interfere with the ability to eat. Malnutrition may result, yet it is often preventable. Our pharmacy can compound medications which may enable patients to enjoy eating again. We can compound numerous medications into a preparation such as an oral rinse that contains the needed concentrations of each drug.

A three-drug mouthwash (lidocaine, diphenhydramine and sodium bicarbonate in normal saline) can provide effective symptomatic relief in patients with chemotherapy-induced mucositis.

Support Care Cancer. 2000 Jan;8(1):55-8
Efficacy of treatment to relieve mucositis-induced discomfort.
Click here to access the PubMed abstract of this article.