Tegretol (Carbamazepine). 800 - 1200 mg daily (200 mg QDS). Monitor plasma levels 4 - 12 mg / l. Start at 100 mg BD & increase slowly until best result achieved.
Phenytoin.2nd line therapy.300 - 600 mg / daily.
Gabapentin (see above)
Baclofen.2nd line therapy. 60 - 80 mg / daily. The starting dosage is 10 mg / daily, which can be increased, if needed, to 60 - 80 mg / daily administered 3 - 4 x per day (it has a short half-life of 3 - 4 hour). The dose of carbamazepine can be reduced to 500 mg / daily to maintain a putative synergistic effect.
Lamotrigine. 2nd line therapy. 100 - 400 mg / daily. The dosage should be increased slowly for better tolerance (eg 25 mg daily dose each week; up to 250 mg BD).
Some of the medications used for Oral Mucositis can be used for Oral Ulceration.
Interventions to reduce the mucosal toxicity of chemotherapy drugs
Allupurinol M/W 1 mg/ml was administered 1, 2 & 3 h after chemotherapy & 3 consecutive nights or 5 mg / ml of allopurinol in water, 2 – 4x daily for the 3 days subsequent to methotrexate administration; 3mg / mL 4 - 6 daily for at least 6 days. Oral cryotherapy (holding ice water in the mouth) is suggested to be used to prevent oral mucositis in patients receiving high-dose melphalan / 5 FU.
Topical Hyaluronic gel 0.2% act as a barrier Sucralfate (see above) Orabase (see above) Gelclair Bioadherent oral gel (see above) Cyanoacrylate skin adhesives Caphosol (see above) Episil Gel Oralife Gel
Low level laser therapy (at a specific setting: 650nm, 40mW, time required to deliver each cm2 energy of 2J/cm2) is recommended to be used to prevent oral mucositis in patients treated with high-dose chemotherapy for HSCT. Glutamine iv / m/w. 4g glutamine dissolved in water & used QDS.