Monday Pharmaceutical Mystery: February 17
Why is your patient using clonazepam for burning mouth syndrome?
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
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- 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.