Should I avoid prescribing lidocaine-containing magic mouthwash to head and neck cancer patients?

The debate on whether to use lidocaine containing "magic mouthwash" was partially fueled by a confusing set of recommendations from the American Academy of Nursing's Choosing Wisely list of 20 things nurses and patients should question. Many radiation and medical oncologists routinely use MMW with v...

I use lidocaine-containing magic mouthwash all the time and don't see there is a connection between their use and increased aspiration

I agree, and I think lidocaine may be the only active ingredient in several commonly prescribed rinses. I'm not aware of any evidence that viscous lidocaine can cause aspiration, although you should probably avoid it (along with other rinses) in someone who is aspirating already.

No

May I refer to a lidocaine package insert. In part it states

"Information for Patients

When topical anesthetics are used in the mouth or throat, the patient should be aware that the production of topical anesthesia may impair swallowing and thus enhance the danger of aspiration. For this reason, foo...

Patients should be evaluated before, during and after radiation therapy to assess their swallowing function and if they have impaired gag or sensation resulting in deep penetration with inability to clear or frank aspiration they should be on feeding tube support anyway. Lidocaine is not the problem...

Its use in triple mix with antiacid in the patient with reduced gag response or reduced levels of consciousness from any cause can result in aspiration.