Can [my CML treatment drug] cause painful sores in my mouth? If so, what can I do?

It is not uncommon for individuals taking a Tyrosine Kinase Inhibitor (TKI) such as Imatinib, Dasatanib, Nilotinib, and others to experience mouth sores or ulcerations. This condition, called Oral Mucositis, is quite painful and can prevent one from eating and drinking, as well as swallowing and even speaking. 

If you are experiencing this condition, call your doctor. He or she may be able to prescribe for you a product widely referred to in the United States as "Magic Mouthwash." This term is used interchangeably for several products, some of which are compounded by a pharmacy and some pre-mixed. While the ingredients vary by product, they generally contain at least three of the following basic ingredients: 

  • an antibiotic to kill bacteria
  • an antihistamine or anesthetic to ease pain
  • a corticosteriod to reduce inflammation
  • an antifungal
  • an antacid to help other ingredients adhere to the inside of the mouth*

Magic Mouthwash is generally used every four to six hours, held in the mouth for one to two minutes, and then spit out or swallowed. One should refrain from eating or drinking for at least 30 minutes after using the mouthwash to allow the medications time to work and produce relief. 

While this product is helpful in providing some relief for side effects, it TOO has the potential to disrupt taste or cause burning or tingling in the mouth. Additionally, some users have reported nausea, constipation, diarrhea, and drowsiness. Speak with your doctor if you have concerns about the potential for additional side effects.

Some tips to minimize oral mucositis:

  • practice good oral hygiene
  • avoid spicy or acidic foods, as well as hot foods and beverages
  • eat soft foods to avoid aggrevating any ulcers or sores
  • use mild or "baby" toothpaste or brush with baking soda
  • use a saline or saline/peroxide rinse three to four times a day

Some brand names for pre-mixed, prescription Magic Mouthwash include:

Your doctor can recommend the appropriate product for you which may be compounded specifically for you by a local pharmacy.

More information on oral mucositis is available from the National Cancer Institute and can be found here.

*while some Magic Mouthwash products may contain antacids, the amount of antacid in the mouthwash may not pose any particular issue, especially when it is spit out following use. One should exercise caution when using antacids and proton pump inhibitors while taking TKIs for CML.