Refractory Burning Mouth – Try Clonazepam and Venlafaxine

Venlafaxine (300 mg/d) and Clonazepam (5 mg/d) in Refractory Burning mouth – All responded with a reduction in pain from 8.6/10 to 3.2/10 after 3 months

J Headache Pain. 2017 Dec;18(1):40.
doi: 10.1186/s10194-017-0745-y.
Refractory burning mouth syndrome: clinical and paraclinical evaluation,comorbiities, treatment and outcome.
Mitsikostas DD et al

  • highest prevalence age 70-79
  • mean age at diagnosis – 60
  • rates vary from 3.7-40% in elderly
  • small fiber neuropathy
  • associated with restless legs and tension headaches
  • topical capsaicin, alpha-lipoic acid and clonazepam rx


Clonazepam rx:

  • Oral solution of clonazepam  (Rivortil® oral solution 2.5 mg/
  •  keep the solution in their mouth for 5 min before swallowing,
  • start with in one evening dose of 2.5 mg.
  • After 5 days the dose increased up to 5 mg
    daily, divided into three doses (1.25 mg in the morning,
    1.25 in the afternoon and 2.5 mg at bedtime).
  • solution should be kept in the mouth for at least five
    minutes before ingestion

Venlafaxine – work up to 300 mg

  • 14 cases – 8 women average age 58
  • pain was triggered or exaggerated by   mastication, tongue movements, altered
    food temperature
  • daily, lasting for more than two hours and worse at bedtime
  • dry mouth, altered taste
  • all associated headaches
  • depression common

Results rx:

Comment  – combined with recent botulinum results:
Burning Mouth Syndrome – Remarkable Improvement with Botulinum Injections

and maybe stopping any Vitamin B6:
Burning Mouth Syndrome – Could a Subgroup With Elevated B6 Levels be Helped by Stopping B6?

Treatment results should be more satisfactory


About 10% have low zinc levels and so looking for that might help:

Yoshida, Hiroaki, et al.
Clinical study of tongue pain: Serum zinc, vitamin B12, folic acid, and copper concentrations, and systemic disease.
British Journal of Oral and Maxillofacial Surgery 48.6 (2010): 469-472.

medications associated with burning mouth include:
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