Recipe - Compounding Worksheet
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These recipes are intended for use by the pharmacy manufacturing departments only.
Magic Mouthwash   .
Lot No Expiry(mm/yyyy) Ingredients Master Formula
    lidocaine HCL, viscous solution  2%     
    diphenhydramine  1.25 mg/mL  PO SOLN   
    aluminum hydroxide - magnesium hydroxide  40 mg - 40 mg/mL  SUSP   
Recipe Total Quantity:
Final Quantity Desired: mL

Directions: 1. Measure viscous lidocaine, diphenydrAMINE and aluminum hydroxide-magnesium hydroxide separately.
2. Combine all three ingredients into an appropriate size container and mix thoroughly.
3. Transfer to final container.

Notes Since no stability data available, assign beyond use date using NAPRA Guidance Document For Pharmacy Compounding Of Non-Sterile Preparations:
For Water Containing Oral Formulations: The BUD is not later than 14 days when stored at controlled cold temperatures.

Per DI Question # 20572, a mouthwash will be considered an oral formulation.

THIS FORMULATION IS NOT BASED ON LITERATURE, but is from unpublished data, historical use or physician/pharmacy experience

Packaging:  Amber Plastic Bottle

Auxiliary Labels: Refrigerate
  Shake Well

Storage/Expiry:Refrigerator: 14 days

Last Date Revised: 26-Aug-21

References:Dodd MJ et al. Randomized clinical trial of the effectiveness of 3 commonly used mouthwashes to treat chemotherapy-induced mucositis. Oral Surg Med Oral Pathol Oral Radiol Endod 2000; 90: 39-47

McElhiney LF. Magic mouthwashes: a literature review and discussion of common compositions. IJPC 2011 15(5); 377-380.

USP 34 NF 29, 2nd Volume 1. Chapter 795: Pharmaceutical compounding Nonsterile preparations. Rockville, MD, USA: United States Pharmacopeial Convention; 2010
  For Water Containing Oral Formulations: The BUD is not later than 14 days when stored at controlled cold temperatures.
National Association of Pharmacy Regulatory Authorities (NAPRA). Guidance Document For Pharmacy Compounding Of Non-Sterile Preparations. Ottawa, ON: National Association of Pharmacy Regulatory Authorities (NAPRA); 2018.
Available at: https://napra.ca/sites/default/files/documents/Mdl_Stnds_Pharmacy_Compounding_Nonsterile_Preparations_Guidance_June2018_FINAL.pdf

Completed Compound Check
Lot NoDate Prepared Expiry DateTechnicianPharmacist
   29-Nov-2021         


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