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.
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
- 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
- daily, lasting for more than two hours and worse at bedtime
- dry mouth, altered taste
- all associated headaches
- depression common
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.