12.3.1 Drugs for Oral Ulceration and Inflammation


First choice: HYDROCORTISONE 2.5mg OROMUCOSAL TABLETS
Second choice: BENZYDAMINE HYDROCHLORIDE
 

Hydrocortisone (2.5mg oromucosal tablets) are held in the mouth in contact with the ulcer and allowed to dissolve slowly. Dose: adult and child over 12 years, 1 lozenge 4 times daily; child under 12 years, only on medical advice.

Benzydamine hydrochloride mouthwash (oral rinse, spray, Difflam®) relieves the pain of inflammatory conditions. It is also effective in reducing the discomfort of post-irradiation mucositis. Some patients find that the full-strength mouthwash causes stinging and in these cases it can be diluted with an equal volume of water. It is only recommended for use when the other products have failed. Benzydamine is also available in a spray and, in hospital, this is occasionally used in palliative care.

SPECIAL INDICATIONS

Betamethasone 500microgram soluble tablet is used off-label for the treatment of oral ulceration. Dose: adult and child over 12 years, 500micrograms dissolved in 20mL water and rinsed around the mouth 4 times daily; not to be swallowed.

Caphosol® mouthwash is classified as a medical device rather than a licensed medicine.
Caphosol® supersaturated calcium phosphate rinse was approved for restricted use for the prevention of oral mucositis in patients undergoing radiotherapy for head and neck cancer, and for patients undergoing chemotherapy. For chemotherapy patients use is restricted to prescribing by haematologists or oncologists for the prevention of mucositis in patients undergoing chemotherapy for AML, in patients who have previously developed mucositis or prior to haematopoietic stem cell transplant. prevention of oral mucositis in patients .
Recommended for hospital use only.

Gelclair® is classified as a medical device rather than a licenced medicine. Gelclair® is a viscous gel specially formulated to aid in the management of lesions of the oral mucosa. It forms a protective film that, by coating and sticking to the lining of the mouth and throat, offers rapid and effective pain management. The contents of one sachet should be diluted with 40mLs of water and used as a mouthwash. This should be repeated three times a day one hour before eating or drinking.

PRESCRIBING POINTS, DRUGS FOR ORAL ULCERATION AND INFLAMMATION

  • Treatment with corticosteroid preparations can cause oral candidiasis.
  • Increased discomfort and delayed healing of mouth ulcers can be caused by secondary bacterial infection. Use of chlorhexidine mouthwash may be beneficial (see 12.3.4).
  • A saline mouthwash made up with warm water may relieve the pain of traumatic ulceration and radiotherapy mucositis.

PAEDIATRIC NOTES - DRUGS FOR ORAL ULCERATION AND INFLAMMATION

Benzydamine mouthwash
is suitable for children over 12 years only; the spray may be used in those under 6 years old, dose - one spray per 4kg in weight (to maximum 4 sprays) onto affected area every 1½ - 3 hours.  

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