Monday Pharmaceutical Mystery: February 17

You are entering prescriptions from the electronic queue, and while you are typing a prescription from a neurologist for clonazepam (Klonopin) 0.5 mg, the directions catch you off guard: use 1/2 to 1 tablet as directed after each meal for burning mouth syndrome (BMS).

Mystery: Why is this patient taking clonazepam for BMS, and what is this condition?

Solution: BMS is a painful condition where the patient experiences a burning or tingling feeling in the mouth, occurring daily for months or even longer. Patients may also have a dry mouth or altered taste. BMS, found more frequently in women than men, is most common in adults over age 60 years.¹

Primary BMS is caused by nerve damage. Secondary BMS can be caused by medical conditions, such as acid reflux; allergies to dental products or foods, or medications that include those for treating blood pressure. With secondary BMS, if the underlying reason is treated, symptoms may disappear.¹

Helpful measures include: avoiding irritating substances, such as tobacco, alcohol, spicy foods, and acidic foods; sucking on ice chips, and drinking cold beverages.¹

BMS treatment is targeted at treating symptoms, like other neuropathic pain conditions.

Studies support the (off-label) use of low-dose clonazepam, low-dose gabapentin (Neurontin), chlordiazepoxide (Librium), or tricyclic antidepressants for treating BMS.²

As a pharmacist, your insight has a direct effect on patient outcomes. Help drive medicine forward with your opinions. Participate in a quick survey of OTC products for a chance to win a $1,000 Visa gift card. Vote now by clicking here: https://hraresearchnetwork.com/wix/p6499706.aspx?hPTsource=5

REFERENCES

• National Institute of Dental and Craniofacial Research. Burning Mouth Syndrome. NIDCR website. https://www.nidcr.nih.gov/health-info/burning-mouth Accessed February 1, 2020.
• Grushka M, Epstein J, Gorsky, M. Burning Mouth Syndrome. Am Fam Physician. 2002 Feb 15;65(4):615-621. https://www.aafp.org/afp/2002/0215/p615.html Accessed February 1, 2020.