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Development of palliative medicine in the United Kingdom and Ireland
Published in Eduardo Bruera, Irene Higginson, Charles F von Gunten, Tatsuya Morita, Textbook of Palliative Medicine and Supportive Care, 2015
Although the data are scarce, the primary approach in management of mucositis is the use of topical oral formulations including, but not limited to, equal parts lidocaine/diphenhydramine/Mylanta. Some have added dexamethasone, ibuprofen, morphine, and other opioids to the mixture [44-47]. Recently, topical ketamine has shown a trend in improvement of mucositis pain [48]. Based on the available literature, our institution dilutes 20mg of IV ketamine in 5 mL of artificial saliva or normal saline to be "swished for 1 min and spit" every 3 hours. Gelclair  ® is a concentrated bioadherent oral gel indicated for the relief and management of pain [49]. Initial results were promising, but due to high cost and lack of sustained efficacy, Gelclair is not used frequently. Interestingly, there is an OCT agent, Rincinol  ®, that is advertised as "mouth sore rinse" that has the same active ingredient as Gelclair but much less expensive. Usually, the topical agents are not adequate and patients need additional systemic therapy mainly including opioids through PCA [44,50]. Unfortunately, until the mucositis resolves, patients are at high risk for developing infections, respiratory complications when the mucositis is endangering the breathing pathway, and severe morbidity [51,52].
Chitosan as a potential biomaterial for the management of oral mucositis, a common complication of cancer treatment
Published in Pharmaceutical Development and Technology, 2023
Sudhanshu Ranjan Rout, Biswakanth Kar, Deepak Pradhan, Prativa Biswasroy, Jitu Haldar, Tushar Kanti Rajwar, Manoj Kumar Sarangi, Vineet Kumar Rai, Goutam Ghosh, Goutam Rath
The healing of the ulcerative lesions of oral mucositis naturally occurs on the submucosal layer and depends on various biological processes (Sonis 2009; Kusiak et al. 2020). Clinically, mucositis of the oral cavity can be mainly treated by preventing, repairing, and protecting the ulcerated mucosa without promoting tumor cell growth. The drugs being administered conventionally for treating oral mucositis remain on the oral mucosa for less than 5–10 min; hence the effectiveness was not satisfactory (Salamat-Miller et al. 2005). Some topical such as antibiotics, analgesics, adrenocortical hormones, and glucocorticoids were also employed to reduce the ulcer healing time. Nevertheless, prolonged use of these topical might also have undesirable side effects (Luo et al. 2020). Certain protectants like Gelclair and Orabase, the mucosal adherent ointments, have been used to prevent oral ulcers from additional discomfort caused by eating and drinking. However, these ointments were ineffective in managing oral mucositis as their adhesiveness towards the oral mucosa was minimal; hence they can be easily washed out by food, liquids, and even saliva (Ryu et al. 2020). Thus, new interventions based on mucoadhesive polymers were introduced to overcome this issue (Salamat-Miller et al. 2005). Mostly the mucoadhesive polymers are hydrophilic and have received a great deal of interest in the past two decades because of their direct accessibility, sustained drug delivery, and prolonged drug retention time on the oral mucosa by allowing the polymer to interact with the mucin glycoproteins (Shaikh et al. 2011; Alves et al. 2020). A few examples of mucoadhesive polymers that can adhere to the mucosal surface by providing better retention time to the oral mucosa involve Sodium Alginate, Hydroxypropyl cellulose (HPC), Hydroxypropyl methylcellulose (HPMC), Hydroxyethyl cellulose (HEC), Sodium carboxymethyl cellulose (CMC), Polyvinyl pyrrolidone (PVP). Among these mucoadhesive polymers, a modified natural carbohydrate polymer, chitosan, could be very useful for preventing and treating the consequences caused by oral mucositis because of its inherent properties.