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Topics:
Head and Neck Cancers • Radiation Oncology
Should I avoid prescribing lidocaine-containing magic mouthwash to head and neck cancer patients?
Because patients with locally advanced H&N cancers are at increased risk for aspiration, and radiation may increase that risk, some clinicians remove lidocaine from magic mouthwash. Is there a general feeling that this should be done?
Answer from: Radiation Oncologist at Community Practice
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...
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Answer from: Radiation Oncologist at Academic Institution
I use lidocaine-containing magic mouthwash all the time and don't see there is a connection between their use and increased aspiration
Answer from: Radiation Oncologist at Academic Institution
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.
Answer from: Radiation Oncologist at Academic Institution
No
Radiation Oncologist
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, f...
Answer from: Radiation Oncologist at Academic Institution
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...
Radiation Oncologist
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.