Magic mouthwash: Difference between revisions

Revision as of 15:19, 14 September 2019

In infants, do NOT use oral lidocaine due to risk of methemoglobinemia and FDA black box warning^[1]^[2]

Background

Some experts recommend Magic Mouthwash / oral Lidocaine in children if not tolerating PO intake, although evidence suggests no better than placebo^[3]

Warnings

DO NOT EXCEED dosing limits especially for lidocaine.
DO NOT use under 2 years old
Never give a family an amount that can be toxic if unintentionally swallowed in its entirety

Lidocaine

1 cc Viscous 2% lidocaine = 20mg lidocaine
Max dose = 5mg/kg
For a 10 kg child = 50mg lidocaine = 2.5 cc

Diphenhydramine

Diphenhydramine 6.25mg/5cc or 12.5mg/5cc
Max dose = 5mg/kg/day
For a 10 kg child = 50mg benadryl =20 cc of 12.5mg/5cc

Makeup

Equal parts:

Management

0.5-1mL before feeds

References

↑ FDA recommends not using lidocaine to treat teething pain. http://www.fda.gov/Drugs/DrugSafety/ucm402240.htm
↑ Curtis LA, Dolan TS, Seibert HE. Are one or two dangerous? Lidocaine and topical anesthetic exposures in children. J Emerg Med 2009;37:32-39
↑ Hopper S. et al. Topical lidocaine to improve oral intake in children with painful infectious mouth ulcers: a blinded, randomized, placebo-controlled trial. Ann Emerg Med. 2014 Mar;63(3):292-9

Authors:

[1] FDA recommends not using lidocaine to treat teething pain. http://www.fda.gov/Drugs/DrugSafety/ucm402240.htm

[2] Curtis LA, Dolan TS, Seibert HE. Are one or two dangerous? Lidocaine and topical anesthetic exposures in children. J Emerg Med 2009;37:32-39

[3] Hopper S. et al. Topical lidocaine to improve oral intake in children with painful infectious mouth ulcers: a blinded, randomized, placebo-controlled trial. Ann Emerg Med. 2014 Mar;63(3):292-9

[1]

[2]

[3]

@@ Line 1: / Line 1: @@
-==Treatment==
+;In infants, do NOT use oral lidocaine due to risk of methemoglobinemia and FDA black box warning<ref>FDA recommends not using lidocaine to treat teething pain. http://www.fda.gov/Drugs/DrugSafety/ucm402240.htm</ref><ref>Curtis LA, Dolan TS, Seibert HE. Are one or two dangerous? Lidocaine and topical anesthetic exposures in children. J Emerg Med 2009;37:32-39</ref>
-Equal parts:
-#Viscous lido 2%
-#Benadryl
-#Maalox
-.5-1cc before feeds
-DO NOT EXCEED  dosing limits especially for lidocaine.
-cc Viscous 2% lidocaine = 20 mg lidocaine
+==Background==
+*Some experts recommend Magic Mouthwash / oral [[Lidocaine]] in children if not tolerating PO intake, although evidence suggests no better than placebo<ref>Hopper S. et al. Topical lidocaine to improve oral intake in children with painful infectious mouth ulcers: a blinded, randomized, placebo-controlled trial. Ann Emerg Med. 2014 Mar;63(3):292-9</ref>
-Max dose = 5mg/kg
+==Warnings==
+*DO NOT EXCEED dosing limits especially for [[lidocaine]].
+*DO NOT use under 2 years old
+*Never give a family an amount that can be toxic if unintentionally swallowed in its entirety
-For a 10 kg child = 50 mg lidocaine = 2.5 cc
+===[[Lidocaine]]===
+*1 cc Viscous 2% lidocaine = 20mg lidocaine
+*Max dose = 5mg/kg
+*For a 10 kg child = 50mg lidocaine = 2.5 cc
+===[[Diphenhydramine]]===
+*[[Diphenhydramine]] 6.25mg/5cc or 12.5mg/5cc
+*Max dose = 5mg/kg/day
+*For a 10 kg child = 50mg benadryl =20 cc of 12.5mg/5cc
-Benadryl 6.25mg/5cc or 12.5mg/5cc
+==Makeup==
+Equal parts:
-Max dose = 5mg/kg/day
+#Viscous [[lidocaine]] 2%
+#[[Diphenhydramine]]
-For a 10 kg child = 50 mg benadryl =20 cc of 12.5mg/5cc
+#[[Bismuth subsalicylate|Maalox]]
-Never give a family an amount that can be toxic if unintetionally swallowed in its entirety.
+==Management==
+.5-1mL before feeds
-==Source==
+==See Also==
-DONALDSON (6/04)
+*[[Herpangina]]
+*[[Hand foot and mouth disease]]
-Hsiao 7/6/09
+==References==
+<references/>
-[[Category:Peds]]
+[[Category:Pediatrics]]
 [[Category:ENT]]
+[[Category:Pharmacology]]