Effective Treatment of Methotrexate Induced Oral Mucositis With a Morphine Mouthwash Solution: A Case Report

Area of Science:

• Pharmacology
• Rheumatology
• Oncology

Background:

• Methotrexate (MTX) is a widely used medication for rheumatoid arthritis (RA) and other conditions, known to cause significant side effects due to its inhibition of rapid cell turnover.
• Oral mucositis, characterized by painful ulcerating lesions, is a severe acute toxicity associated with MTX therapy, impacting patients' ability to eat and speak.
• Standard supportive care for MTX-induced oral mucositis includes magic mouthwash and oral viscous lidocaine for pain management and to facilitate healing.

Observation:

• A 67-year-old female rheumatoid arthritis patient on MTX developed worsening oral lesions and significant pain, reporting 2 weeks of folic acid non-compliance.
• Initial treatment with magic mouthwash failed to provide adequate pain relief, leaving the patient unable to swallow after 24 hours.
• An oral morphine mouthwash solution was administered, leading to improved pain control within 48 hours and noticeable lesion improvement over 6 days.

Findings:

• Topical morphine mouthwash provided effective pain management for severe MTX-induced oral mucositis.
• The patient experienced significant symptom relief and lesion healing with morphine mouthwash when standard treatments were insufficient.
• This case highlights the potential benefits of topical opioids in managing oral mucositis pain and promoting mucosal healing.

Implications:

• Morphine mouthwash presents a viable and potentially safer alternative to systemic opioids for managing severe oral mucositis pain.
• Topical opioids may possess properties that positively influence cellular processes, aiding in the healing of oral lesions.
• Further research into topical opioid formulations for managing chemotherapy and immunosuppressive drug-induced mucositis is warranted.