Sore throat
ICD-10 R07.06 drugs
Drugs used for this condition
- BBenzydamineSecond line · Non-steroidal anti-inflammatory agent for topical use in the mouth and throatBenzydamine is a topical anti-inflammatory for the throat. The AEMPS ficha técnica gives it a single indication: symptomatic treatment of acute sore throat in adults and children over 6 years, for no longer than 7 days and one lozenge three times a day. The effect is local: the substance accumulates in inflamed mucosa and removes pain and redness while the viral infection runs its course. A 2018 meta-analysis in Anaesthesia confirms the same mechanism from the operating room side: benzydamine gargling before intubation reduced the rate of sore throat after anesthesia. Spanish pharmacies sell it as Propalgar, Fodonal, Juanolgar and Tantum Verde. Three limits from the ficha are worth knowing in advance: benzydamine is unsuitable with salicylate or NSAID allergy, bronchospasm is possible in people with asthma, and if pain lasts beyond 3 days or high fever appears, the situation needs reassessment.
- BFlurbiprofenSecond line · Non-steroidal anti-inflammatory drug, propionic acid derivative, for topical throat treatmentFlurbiprofen 8.75 mg is the best studied throat lozenge. The randomized trial by Watson and colleagues (Int J Clin Pract 2000) showed that the lozenge relieved sore throat markedly better than placebo, with the effect starting in the first minutes of sucking. The AEMPS ficha técnica allows the product for adults and adolescents from 12 years in short courses: the spray up to 5 applications a day at 3 to 6 hour intervals. In Spain these are Strefen and Bucopro. Flurbiprofen is a full NSAID and the systemic cautions remain: it is not used in peptic ulcer disease, severe heart failure or the third trimester of pregnancy, and bronchospasm is possible in asthma. The ficha also warns about something rare but important: if signs of bacterial infection appear or worsen during treatment, urgent assessment is needed – cases of necrotizing fasciitis have been reported.
- CAmbroxolCase-by-case decision · Mucolytic agentAmbroxol 20 mg lozenges are used for symptomatic pain relief in acute sore throat. Ambroxol has a local anaesthetic action: it blocks sodium channels in sensory nerves (preclinical proof of concept, Schutz 2002). Placebo-controlled RCTs (Fischer 2002; de Mey 2008) showed a modest reduction in pain, but the independent Prescrire 2009 review judged the effect no better than sucking a plain hard candy, and the positive RCTs were manufacturer-funded. The evidence is in genuine equipoise, so the decision to use it is individual. The formulation and mechanism differ from the mucolytic action in productive cough, and this is a separate question. In Spain, Lizipaina Ambroxol 20 mg lozenges are registered (AEMPS). Risks include the rare severe allergic and cutaneous reactions of the ambroxol class (EMA 2015).
- CBenzocaineAdd-on therapy · Local anesthetic, aminobenzoic acid esterBenzocaine lozenges – Angileptol, Deratin Complex, Garydol – sit by the till in a Spanish pharmacy, and people reach for them at the first sore throat. The benzocaine in them gives brief numbness of the pharyngeal lining while the lozenge dissolves. That is pain relief, not treatment: viral pharyngitis clears in 5 to 7 days on its own, and no ingredient of the lozenge shortens that. In combinations benzocaine comes with chlorhexidine and enoxolone, and the ficha técnica describes each contribution: antiseptic, anti-inflammatory, anesthetic. The dose must not be exceeded – the ficha states plainly that children, older people and debilitated patients are more sensitive to systemic benzocaine toxicity. If the sore throat lasts beyond three days or fever appears, the situation is reassessed: streptococcus may be behind it, and lozenges do not touch it.
- CCetylpyridiniumAdd-on therapy · Cationic quaternary ammonium antiseptic for topical use in the mouth and throatCetylpyridinium is the antiseptic in throat lozenges, and in Spain that means Septolete first of all, where it comes with benzydamine. The AEMPS ficha técnica describes the indication as short-term local anti-inflammatory, analgesic and antiseptic treatment of throat, mouth and gum irritation in adults, adolescents and children over 6 years, for up to 7 days. The analgesic part of the effect rests on benzydamine, the antiseptic part on cetylpyridinium. The lozenge is dissolved slowly every 3 to 6 hours, no more than 3 to 4 a day. One limit from the ficha matters: if there is no noticeable improvement within 3 days or fever appears, the situation is reassessed. Prolonged use of topical antiseptics causes sensitization, and treatment is then stopped.
- CEnoxoloneAdd-on therapy · Plant-derived anti-inflammatory agent, a liquorice root derivativeIn a Spanish pharmacy enoxolone exists only inside combinations: Angileptol and Deratin Complex are lozenges where it sits next to chlorhexidine and benzocaine. The AEMPS ficha técnica assigns the roles directly: chlorhexidine provides the antiseptic action, enoxolone the anti-inflammatory one, benzocaine the local anesthesia. Adults and adolescents from 12 years dissolve one lozenge every 2 to 3 hours, at most 8 a day, children from 6 years less often. Separate clinical trials of enoxolone in sore throat are few, and the contribution of this particular component cannot be isolated from the combination – so this card promises no more than symptom relief for a few days. The ficha asks people to stop if nothing improves within 3 to 5 days.
How to read tiers A–F
Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit