ANTISEPTIC BLUE MINT MOUTHWASH- methyl salicylate, menthol, unspecified form, eucalyptol, and thymol liquid 
Fore Supply, Inc

Disclaimer: Most OTC drugs are not reviewed and approved by FDA, however they may be marketed if they comply with applicable regulations and policies. FDA has not evaluated whether this product complies.

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Antiseptic Blue Mint Mouthwash

Active IngredientsPurpose
Eucalyptol 0.092% , Menthol 0.04%Antigingivitis , Antiplaque
Methyl Salicylate0.060%,Thymol,0.064%Antigingivitis , Antiplaque

Use

Helps control plaque that leads to gingivitis

WARNINGS

DO NOT USE if you have painful or swollen gums, pus from the gum line,loose teeth or increased spacing between the teeth, see your dentist immediately, these may be a sign of periodontitis, as serious form of gum disease

Stop use and ask a dentist if gingivitis, bleeding or redness persists for more than 2 weeks.

Keep out of reach of children, If more than used for rinsing is accidentally swallowed, get medical help or contact a Poison Control Center right away.

Directions

Adults and children 12 years of age and older….vigously swish 20 ml between teeth for 30 seconds then spit out; do not swallow.

Children under 12 years of age…. Consult a dentist or doctor

*Rinse is not intended to replace brushing or flossing

Other Information

cold weather may cloud this product. Its antiseptic properties are not affected. Store at room temperature (59 °– 77 °F)

Inactive Ingredients

Water, Alcohol 21.6%, Polysorbate 80,Sorbitol,Flavor, Benzoic Acid, Sodium Saccharin, Sodium Benzoate, Blue 1, Yellow 5

antiseptic-01

ANTISEPTIC BLUE MINT MOUTHWASH 
methyl salicylate, menthol, unspecified form, eucalyptol, and thymol liquid
Product Information
Product TypeHUMAN OTC DRUGItem Code (Source)NDC:71627-128
Route of AdministrationORAL
Active Ingredient/Active Moiety
Ingredient NameBasis of StrengthStrength
Methyl Salicylate (UNII: LAV5U5022Y) (SALICYLIC ACID - UNII:O414PZ4LPZ) Methyl Salicylate0.6 mg  in 1 mL
MENTHOL, UNSPECIFIED FORM (UNII: L7T10EIP3A) (MENTHOL, UNSPECIFIED FORM - UNII:L7T10EIP3A) MENTHOL, UNSPECIFIED FORM0.42 mg  in 1 mL
Eucalyptol (UNII: RV6J6604TK) (Eucalyptol - UNII:RV6J6604TK) Eucalyptol0.92 mg  in 1 mL
Thymol (UNII: 3J50XA376E) (Thymol - UNII:3J50XA376E) Thymol0.64 mg  in 1 mL
Inactive Ingredients
Ingredient NameStrength
Water (UNII: 059QF0KO0R)  
alcohol (UNII: 3K9958V90M) 216 mg  in 1 mL
SORBITOL (UNII: 506T60A25R)  
Benzoic Acid (UNII: 8SKN0B0MIM)  
SACCHARIN SODIUM (UNII: SB8ZUX40TY)  
Sodium Benzoate (UNII: OJ245FE5EU)  
Polysorbate 80 (UNII: 6OZP39ZG8H)  
FD&C BLUE NO. 1 (UNII: H3R47K3TBD)  
FD&C YELLOW NO. 5 (UNII: I753WB2F1M)  
Product Characteristics
ColorBLUEScore    
ShapeSize
FlavorMINTImprint Code
Contains    
Packaging
#Item CodePackage DescriptionMarketing Start DateMarketing End Date
1NDC:71627-128-013785 mL in 1 JUG; Type 0: Not a Combination Product06/05/2017
Marketing Information
Marketing CategoryApplication Number or Monograph CitationMarketing Start DateMarketing End Date
OTC MONOGRAPH NOT FINALpart35606/05/2017
Labeler - Fore Supply, Inc (025126459)
Registrant - Fore Supply, Inc (025126459)
Establishment
NameAddressID/FEIBusiness Operations
HealthSpecialty794053863MANUFACTURE(71627-128)

Revised: 2/2020
Document Id: d1ba236e-a5b0-42ac-ae9e-65e048c8170b
Set id: 50521f23-c81e-4073-b33c-393619db81fb
Version: 3
Effective Time: 20200203
 
Fore Supply, Inc