Prepping Akabutu’s Mouthwash

I’m sharing additional information made available to me about Akabutu’s Magic Mouthwash and how it is prepared.  The information recorded here is stuff I gleaned from discussions with my own pharmacists and interactions observed among the team of pharmacists and pharmacy techs who have provided fabulous services for me.  As they were preparing the solution for use it became obvious that there is a formulation that they were able to reference.

Most of this info may be and should be available from the Alberta Health Services database for pharmacies.  There is a reference document CLINICAL PRACTICE GUIDELINE HN-006 which contains this information and more.

Remember that the solution was originally intended to be used to help patients deal with the oral mucositis that often accompanies chemotherapy and radiation treatments.

The formulation is NOT based on any published literature, but appears to be based on historical use and anecdotal data from physician and pharmacy experiences.  Share your experiences with your clinicians!

Akabutu's Mouthwash 
IngredientsStrengthFormQuantity RequiredTrade Name?
Nystatin100,000 units/MLSUSP (suspension)42 MLthis is an antifungal medication. Nystatin is an oral suspension or it comes as a powder. Flucanozole tablets or suspension, or Itraconzole
Lidocaine HCL, viscous2%Solution50 MLXylocaine Viscous 2%
Sodium chloride0.9%INJ 200 MLbasic saline solution
Hydrocortisone10 MGTAB at the time of spensing5 x tabs
Glycerin100%PO SOLN at the time of dispensing4 ML
1. Combine the viscous lidocaine and nystatin and shake well. If making ten doses of 200 mL at the same time consider using a gallon jug (4L).
2. QS with normal saline
3. Pour into an amber bottle.
4. Grind (triturate) hydrocostisone tablets into a fine powder and mix carefully (levigate) with glycerine to form a paste. Gradually add the pre-mixed nystatin/lidocaine/saline solution. Mix Well. This is done AT THE TIME OF DISPENSING.
5. Transfer to final container and then add the label.
Label (before dispensing) should read: Akabutu's MouthwashThe solution expires 14 days after adding the hydrocortisone.
Hydrocortisone USP powder can be substituted for tablets.
Sodium chloride 0.9% for irrigation can be used instead of injection.This refernce shows up on some of the source material;
THIS FORMULATION IS NOT BASED ON LITERATURE, but is from unpublished data, historical use, or physician/pharmacy experience.
PackagingAmber Plastic Bottle
LabelsRefrigerate, Shake Well
Storage/BUDRefrigerator; up to three months prior to addition of hydrocortisone. (Appears to be an arbitrary expiry period set by Dr. Akabutu)
Refrigerator Expiry 14 days after hydrocortisone added to basic solution.
ReferencesDr. Akabutu;University of Alberta Hospital (UAH)Dr. Yanofsky; Cross Cancer Institute, Edmonton, AB CanadaResearch indicates that most of this information is available as CLINICAL PRACTICE GUIDELINE HN--006 in the Alberta Health Services database.

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