Hospice / Palliative Care: Dry Mouth (xerostomia)
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Pilocarpine, misoprostol, carboxy-methyl-cellulose, and more are available at Phusion Pharmacy. We are able to compound flavored artificial saliva sprays and mouth rinses as well. Just call to speak to one of our compounding pharmacists. 401-823-0000.
Dry Mouth & Stomatitis
There are many factors that can interfere with the ability to eat when a person is receiving chemotherapy. Malnutrition may result, yet it is often preventable. Our pharmacy can compound medications to help combat mouth tenderness and infections, which may enable patients to enjoy eating again.

Cancer. 2002 Nov 15;95(10):2230-6 Effect of topical morphine [mouthwash] for mucositis-associated pain following concomitant chemoradiotherapy for head and neck carcinoma.
Cerchietti LC, Navigante AH, Bonomi MR, Zaderajko MA, Menendez PR, Pogany CE, Roth BM.
Supportive Care Division, Department of Medical Oncology, Angel H. Roffo Cancer Institute, University of Buenos Aires, Buenos Aires, Argentina.
Click here to access the PubMed abstract of this article.

A three-drug mouthwash (lidocaine, diphenhydramine and sodium bicarbonate in normal saline) can provide effective symptomatic relief in patients with chemotherapy-induced mucositis.
Support Care Cancer. 2000 Jan;8(1):55-8 Efficacy of treatment to relieve mucositis-induced discomfort.
Turhal NS, Erdal S, Karacay S. Click here to access the PubMed abstract of this article.

Loss of saliva (xerostomia) is one of the most common complaints among patients who have received radiation therapy of the head and neck. Xerostomia contributes to radiation-induced periodontal infection, dental caries, osteoradionecrosis, and poor digestion of carbohydrates. Ask us about sialogogues (saliva stimulants) in customized dosage forms.
The following article discusses the benefits of using pilocarpine in a sustained release dosage form to treat xerostomia.
Yakugaku Zasshi. 1997 Jan;117(1):59-64 [Preparation and evaluation of solid dispersions of pilocarpine hydrochloride for alleviation of xerostomia] [Article in Japanese]
Oda M, Sato M, Yagi N, Ohno K, Miyazaki S, Watanabe S, Takada M.
Click here to access the PubMed abstract of this article.

Pilocarpine Troches for Xerostomia
Pilocarpine is indicated for the treatment of xerostomia secondary to radiation therapy of the head and neck. Pilocarpine is a cholinergic agent that stimulates residual-functioning exocrine glands. In a study by Vivino et al., pilocarpine at oral doses of 2.5mg and 5mg four times daily significantly increased saliva production and alleviated symptoms of dry mouth when compared to placebo. The higher dose produced the most improvement but also the highest incidence of adverse effects, such as sweating, diarrhea, and urinary frequency.
Arch Intern Med. 1999; 159:174-181
Pilocarpine tablets for the treatment of dry mouth and dry eye symptoms in patients with Sjogren syndrome: a randomized, placebo-controlled, fixed-dose, multicenter trial. P92-01 Study Group. Click here to access the PubMed abstract of this article. Int'l J Pharm Compounding. Sep/Oct 2000; 4(5):381 Pilocarpine HCl 2-mg Troches                       Click here to access the abstract of this article.
Aust Dent J 2002 Sep;47(3):249-53
An investigation into the use of pilocarpine as a sialagogue in patients with radiation induced xerostomia. Click here to access the PubMed abstract of this article.

Topical Oral Solutions for the Treatment of Chemo-Induced Oral Mucositis   “Magic mouthwashes” are topical solutions or suspensions prepared to relieve symptoms of various oral pathologies. As compounding pharmacists, we recognize the need for practitioners to have the ability to prescribe customized preparations to meet specific patient needs. We can compound various medications into a stable, pleasantly-flavored, alcohol-free suspension.   J Oncol Pharm Pract. 2005 Dec;11(4):139-43. Survey of topical oral solutions for the treatment of chemo-induced oral mucositis. Click here to access the PubMed abstract of this article.

Misoprostol: Mucosal Protectant and Anti-Secretory Misoprostol is a synthetic prostaglandin E1 analogue, with mucosal cytoprotectant and antisecretory properties. A mouthrinse containing misoprostol and lidocaine in a non-irritating neutral vehicle can be used to provide immediate pain relief and aid in the healing of the oral cavity.
A mucoadhesive powder containing misoprostol can be used to aid in the healing of mucosal ulcers and irritations. It is applied by using a powder "puffer" or by direct application of the powder to the affected area. The carriers will hydrate and adhere to the mucosal surface, keeping the misoprostol in prolonged contact with the area.
Int'l J Pharm Compounding. May/June 2000; 4(3):211 Misoprostol 0.001% and Lidocaine 0.5% Oral Rinse Click here to access the abstract of this article. Int'l J Pharm Compounding. May/June 2000; 4(3):212 Misoprostol 0.0027% Mucoadhesive Powder Click here to access the abstract of this article. Int'l J Pharm Compounding. Jan/Feb 1999; 3(1):48 Misoprostol 0.0024% and Lidocaine 1% in Glycerin Mouth Paint                Click here to access the abstract of this article

Please select a topic below to learn more about our pharmacists' abilities to compound custom palliative care products:


Therapy for Dry-Mouth (xerostomia)

Anti-Secretory Agents

Pain Management

Wound Care


Prevention / Treatment of Radiation Mucositis / Proctitis

Examples of Compounded Medications