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 various combos of lidocaine, Benadryl, and nystatin +/- a corticosteroid. Yet the AAN came out and said that any combination of what constitutes MMW should NOT be used.

http://www.aannet.org/initiatives/choosing-wisely/choosing-wisely---magic-mouthwash

They promote the use of salt and sodium bicarb rinses as being less expensive and "Other interventions for mucositis-associated pain have been shown to be more effective than magic mouthwash" withou...

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, food should not be ingested for 60 minutes following use of local anesthetic preparations in the mouth or throat area. This is particularly important in children because of their frequency of eating.

Numbness of the tongue or buccal mucosa may increase the danger of biting trauma. For this reason food and/or chewing gum should not be used while the mouth or throat area is anesthetized."

I do not suggest lidocaine containing magic mouthwash not be us...

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, the underlying physiology is 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.