Doxepin rinse for management of mucositis pain in patients with cancer: one week follow-up of topical therapy


  • Joel B. Epstein DMD, MSD, FRCD(C), FRCSEd,

    Corresponding author
    1. Formerly Medical-Dental Staff, British Columbia Cancer Agency, Vancouver, British Columbia, Canada and Department of Oral Medicine, University of Washington, Seattle, Wash., currently Department of Oral Medicine and Diagnostic Sciences, College of Dentistry, and Chicago Cancer Center, College of Medicine, University of Illinois, Chicago, Illinois
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  • Joshua D. Epstein MA,

    1. Research Assistant, Department of Pharmaceutical Economics and Policy, University of Southern California, Los Angeles, California
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  • Matthew S. Epstein BS,

    1. Research Assistant, Fred Hutchinson Cancer Research Center, Seattle, Washington
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  • Hal Oien DDS,

    1. Private General Dental Practice, Beaverton, Oregon
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  • Edmond L. Truelove DDS, MSD

    1. Department of Oral Medicine, University of Washington.
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*Corresponding author e-mail:


This study assessed the effectiveness of oral doxepin rinse for mucositis-related pain management in patients following 1 week of repeated dosing. Patients with oral mucositis due to head and neck radiation therapy or hematopoietic stem cell transplant (HSCT) were recruited to participate in a 1-week follow-up study. Subjects who gave informed consent rinsed with doxepin (5 ml) during the initial visit and were then told to use doxepin rinse over the next week as needed, three to six times per day, and return for a follow-up visit. At each visit, mucositis was scored using the Oral Mucositis Assessment Scale and oral pain was assessed using a visual analogue scale before and after rinsing. The use of a systemic analgesic was recorded, and side effects were documented. At the follow-up visit, subjects were also asked to retrospectively report average pain scores they experienced over the past week, 5 and 15 minutes following rinse. Nine subjects were enrolled in the study. Statistically significant reductions in pain scores were reported for 2 hours following doxepin rinse during the initial visit (p < .05). Patients recalled that their pain significantly dropped within 5 minutes of rinsing over the week of repeated dosing (p < .05). At the follow-up visit, subjects reported statistically significant pain reduction 5 minutes after doxepin rinsing (p < .05).

These results indicate that doxepin rinsing continues to produce reduced intensity of pain levels over a 1-week span of repeated dosing.