What exactly is “Magic” Mouthwash? 

“Magic” Mouthwash is the term used for a generic compounded medication used to relieve mouth sores and oral pain. There are many different recipes for magic mouthwash each of which contains a combination of ingredients that may include diphenhydramine, Maalox, aluminum hydroxide, lidocaine, glucocorticoids, the anti-fungal medication Nystatin, and/or tetracycline antibiotics.

In veterinary medicine, I have exclusively used a 1:1:1 combination of children’s Benadryl, Maalox (which contains aluminum hydroxide and magnesium hydroxide), and 2% viscous lidocaine.  Magic Mouthwash can be easily prescribed as a compound from nearly any pharmacy, which is highly preferred to mixing up this stuff in house. Trust me, it’s not worth the sticky counters and even stickier possible scenarious that could result from in house compounding. See below for an example on how specifically to write a prescription for Magic Mouthwash.

Sample prescription for veterinary use:

How do you use it? 

Remember, lidocaine toxicity in cats?! Well, it happens in dogs too at high doses. Signs can include CNS depression, seizures, and bradycardia. Thus, the maximum recommended dose for lidocaine in cats is 5mg/kg and in dogs it should not exceed 10mg/kg.* The typical duration of therapy is not to exceed 5-7 days though dogs being treated for radiation induced oral mucositis might require longer treatment.

*To minimize drug risks in general always dose your patients based on their lean body weight.

In cats, do not exceed 0.25mL by mouth every 6 hours.
In dogs, doses range from 0.25-1mL every 4-6 hours depending on the size of the patient.

For example, you want to prescribe Magic Mouthwash to a lean 16kg dog. The max dose of lidocaine in this patient is 160mg lidocaine which is equivalent to the amount in 23mL of Magic Mouthwash (at 6.67mg/mL).

At a dose of 0.5mL every 6 hours the prescription would provide 12 days of dosing whereas at 1mL every 4 hours the prescription provides just shy of 4 days’ worth. The dose can be titrated as needed up or down as needed for each individual case scenario as long as the max dose is not exceeded. Refills are not recommended, and the owners should be instructed to throw any remaining liquid away. The absolute expiration date is 21 days after mixing.

Practically speaking the Magic Mouthwash may be better tolerated if kept cold in the refrigerator for dosing although it is not required.

When do you use it?

My favorite uses for magic mouthwash are any case with oral ulcerative disease. Typically, we are talking about feline oral stomatitis but also any patient with painful caustic or chemical oral injuries, electrical burns (puppies with the electrical cords hanging out of their mouth- I am looking at you), uremic ulcers, or infectious or autoimmune oral ulcerative diseases.  Magic Mouthwash is not a specific treatment, but it is a good option for adjunct pain management and control of inflammation and “itch” that might be associated with loss of the oral mucosal layer and regrowth.

Signs of oral pain that might benefit from specific topical therapy with Magic Mouthwash include drooling (with or without the lower jaw hanging open), slight head and neck extension, bruxism, and unwillingness or inability to eat despite apparent interest/hunger.

Importantly, when oral ulcerative injury is suspected to be caused by gastroesophageal reflux Magic Mouthwash may not be the best choice as it could theoretically numb the larynx and lower esophageal sphincter potentially worsening GERD.

#practicepearls 

About the Guide: Heather Kvitko-White, DVM, DACVIM (SAIM)

Dr. Heather Kvitko-White is an internal medicine specialist who left private specialty practice to pursue her love of education. With a background in clinical case consulting, she started creating content as the Pragmatic Professor. As a writer and national speaker, she promotes a cost-conscientious and common-sense approach to caring for animals without sacrificing quality. She founded KW Veterinary consulting with the goal of helping to bridge the gaps between academia, industry, and private practice.