Burning mouth syndrome

/Home/Burning Mouth Syndrome Treatments/Medications for Burning Mouth Syndrome

Burning mouth syndrome
John Buchanan and Joanna Zakrzewska

Web publication date: 14 Mar 2008 (based on February 2007 search)

Treatments
Benzodiazepines

Clonazepam compared with placebo Topical clonazepam is more effective at reducing pain at 14 days in people with burning mouth syndrome compared with placebo ( moderate quality evidence).
Adverse effects

Topical clonazepam may be absorbed systemically and could lead to benzodiazepine dependence if used in the long term.
For GRADE evaluation of burning mouth syndrome, see table.

Benefits

We found one systematic review, [23] which identified one small, short-term RCT comparing topical clonazepam versus placebo (1 mg tablet of clonazepam or placebo sucked and held in the mouth for 3 minutes and then expectorated, 3 times/day) for 14 days. [25] The RCT found that clonazepam decreased pain compared with placebo after 2 weeks' treatment (48 people; pain measured on a numerical scale of 0 = no pain to 10 = worst pain imaginable; mean decrease in pain score from baseline [intention to treat analysis]: 2.2 with clonazepam v 0.6 with placebo; P = 0.027).

Harms

The RCT found no significant difference between clonazepam and placebo in the frequency of adverse events (9/24 [38%] with clonazepam v 6/24 [25%] with placebo; P more than 0.05). The adverse events experienced included drowsiness (4/24 [17%] with clonazepam v 3/24 [13%] with placebo), increased burning sensation (2/24 [8%] in both groups), dry mouth (1/24 [4%] with clonazepam v 0/24 [0%] with placebo), spasmophilia (1/24 [4%] with clonazepam v 0/24 [0%] with placebo), and euphoria (1/24 [4%] with clonazepam v 0/24 [0%] with placebo; statistical assessments not performed for individual adverse effects). Two participants (2/24 [8%]) in the clonazepam group and one participant (1/24 [4%]) in the placebo group withdrew from the trial because of adverse events (statistical assessment not performed). Five participants using topical clonazepam were assessed for systemic absorption after the 14-week treatment period. While the blood concentration of clonazepam did not reach therapeutic ranges (defined as 20 µg/L or more), there was evidence of some systemic absorption, with blood concentrations of clonazepam reaching about 8 µg/L after sucking one tablet, and about 12 µg/L after swallowing one tablet. Systemic use of benzodiazepines such as clonazepam can lead to dependence. [26]

Comment

In view of the possibility of systemic absorption and concerns about benzodiazepine dependence, the use of clonazepam in the management of burning mouth syndrome should be limited, and people should be made aware of the potential consequences of clonazepam use.

© BMJ Publishing Group Limited 2009. All rights reserved.