Cancers of the Oral Mucosa Medication

Updated: Jun 29, 2017
  • Author: Chelsia Q Sim, DDS, MSc; Chief Editor: Dirk M Elston, MD  more...
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Medication

Medication Summary

The goals of pharmacotherapy for oral squamous cell carcinoma (OSCC) are to reduce morbidity associated with secondary infection and to prevent complications.

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Antiviral agents

Class Summary

Nucleoside analogs are initially phosphorylated by viral thymidine kinase to eventually form a nucleoside triphosphate. These molecules inhibit herpes simplex virus (HSV) polymerase with 30- to 50-times the potency of human alpha-DNA polymerase.

Acyclovir (Zovirax)

Acyclovir inhibits the activity of both HSV-1 and HSV-2. Patients experience less pain and faster resolution of cutaneous lesions when used within 48 hours of rash onset. It may prevent recurrent outbreaks.

Famciclovir (Famvir)

Famciclovir is a prodrug that when biotransformed into the active metabolite penciclovir, may inhibit viral DNA synthesis/replication.

Penciclovir (Denavir) topical

Penciclovir is an inhibitor of DNA polymerase in HSV-1 and HSV-2 strains, inhibiting viral replication.

Foscarnet (Foscavir)

Foscarnet is an organic analog of inorganic pyrophosphate that inhibits replication of known herpesviruses, including cytomegalovirus (CMV), HSV-1, and HSV-2. It inhibits viral replication at the pyrophosphate-binding site on virus-specific DNA polymerases. A poor clinical response or persistent viral excretion during therapy may result from viral resistance. Patients who can tolerate foscarnet well may benefit from initiation of maintenance treatment at 120 mg/kg/d early in treatment. Individualize dosing based on renal function status.

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Antibiotics

Class Summary

Antimicrobials are not especially effective because the tissues are avascular; therefore, prolonged treatment is necessary.

Tetracycline (Sumycin)

Tetracycline is useful because of selective bone uptake. It treats gram-positive and gram-negative organisms as well as mycoplasmal, chlamydial, and rickettsial infections. It inhibits bacterial protein synthesis by binding with 30S and possibly 50S ribosomal subunit(s). Add metronidazole in cases of severe infection or when anaerobes are implicated.

Metronidazole (Flagyl)

Metronidazole is used as an adjunct to tetracycline in cases of severe infection or when anaerobes are implicated. It is an imidazole ring-based antibiotic that is active against various anaerobic bacteria and protozoa. It is used in combination with other antimicrobial agents (except in Clostridium difficile enterocolitis).

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Antifungal agents

Class Summary

Their mechanism of action may involve an alteration of RNA and DNA metabolism or an intracellular accumulation of peroxide that is toxic to the fungal cell.

Clotrimazole (Lotrimin, Mycelex, Femazole, Gyne-Lotrimin)

Clotrimazole is a broad-spectrum antifungal agent that inhibits yeast growth by altering cell membrane permeability, causing death of fungal cells. Reevaluate the diagnosis if no clinical improvement is seen after 4 weeks.

Fluconazole (Diflucan)

Fluconazole is a synthetic oral antifungal (broad-spectrum bistriazole) that selectively inhibits fungal cytochrome P450 and sterol C-14 alpha-demethylation.

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