Aerosols for sore throats

One of the most popular and quite effective means of local treatment of inflammatory diseases of the throat and larynx is aerosol for sore throat.

In addition to the anesthetic effect, all drugs in this category have anti-inflammatory and antiseptic properties (bacteriostatic and bactericidal), and some also help against fungal infections.

Indications for the use of throat aerosols include: acute tonsillitis (sore throat), chronic tonsillitis, acute and chronic pharyngitis, glossitis, chronic laryngitis, tracheitis, laryngotracheitis, as well as stomatitis (including aphthous) and gingivitis.

[ 1 ], [ 2 ]

Pharmacodynamics

The pharmacological action of the aerosol Angilex (Givalex) is based on its composition, which includes local antiseptics hexetidine and chlorobutanol hemihydrate, as well as a derivative of salicylic acid (non-steroidal anti-inflammatory drug) choline salicylate.

Hexetidine (5-methyl-hexahydropyrimidineamine) acts bacteriostatically on pathogenic microorganisms, disrupting their metabolism. Chlorobutanol hemihydrate (1-trichloro-2-methyl propan-2-ol) is a chlorinated butyl alcohol used as a chemical preservative, sedative and mild local anesthetic. And choline salicylate, like any NSAID, relieves inflammation by reducing cyclooxygenase activity and, thereby, reducing the production of prostaglandins (inflammatory mediators).

The aerosol for sore throat Geksoral also contains hexetidine. And the drug Stopangin, in addition to hexetidine, contains a derivative of salicylic acid methyl salicylate (has anti-inflammatory properties) and essential oils: eucalyptus, menthol, clove and sassafras. There is no detailed information about the latter oil in the official instructions, so it is worth saying a few words about it. Oil from the roots of the Sassafras officinale tree contains safrole - a phenylpropanoid, which is a precursor of psychotropic and narcotic drugs.

The pharmacodynamics of Septolete Plus aerosol is based on two components: a cationic surface-active ammonium derivative – cetylpyridinium chloride and a local anesthetic agent, benzocaine (there is 5 times more benzocaine in the preparation than antiseptic). The antiseptic is cetylpyridinium chloride, which, by binding to the bacterial cell membrane, disrupts its integrity and enters the cytoplasm of bacteria, causing their death. And benzocaine relieves pain by blocking the passage of pain impulses along axons.

The anti-inflammatory and analgesic effect of Tantum Verde is provided by the NSAID for local use - benzydamine hydrochloride, which reduces the permeability of mucous membrane capillaries, helps stabilize the cell membranes of epithelial cells, and also reduces the production of tissue inflammation mediators (Pg). The analgesic effect of this drug occurs due to a decrease in the synthesis of neurotransmitters at the site of inflammation.

The mechanism of pharmacological action of the TeraFlu Lar aerosol is similar to the drug Septolet Plus, since its active substance - the antiseptic benzoxonium chloride - also belongs to the ammonium derivatives, and the anesthetic lidocaine hydrochloride suppresses the occurrence and conduction of pain impulses.

The throat aerosol with antibiotic Bioparox contains the antibiotic fusafungin - a cyclohexadepsipeptide obtained from the hyphomycete fungus of the genus Fusarium (Fusarium lateritium or Gibberella baccata). The drug acts bacteriostatically on bacteria, integrating into the protein membranes of microbial cells, disrupting the water-electrolyte balance and the ability of microorganisms to divide cells that cause the inflammatory process.

Another throat spray with an antibiotic, Anginovag, contains four active substances at once. Firstly, it is a polypeptide antibiotic for local use, tyrothricin (obtained from gram-positive spore-forming bacteria of the genus Brevibacillus). The ammonium antiseptic dequalinium chloride, which also relieves inflammation, has antibacterial, antiviral and antifungal (Candida albicans) properties. The active substance enoxolone, which is a complex of triterpene glycosides of glycyrrhizic acid from licorice roots, also helps reduce inflammatory processes (including herpesvirus etiology). Enoxolone not only prevents viruses from penetrating into the cells of the mucous epithelium, but also stops the replication of their RNA.

Aerosol Anginovag contains glucocorticosteroid hydrocortisone, which suppresses all inflammation processes and inhibits oxidative processes in cells and the development of allergic reactions. So it can be used as an aerosol for allergies in the throat. Anesthesia occurs due to the presence of the above-mentioned lidocaine in this aerosol.

The pharmacodynamics of the throat aerosol Kameton are provided by the following components: camphor (stimulates blood circulation, disinfects the mucous membrane); eucalyptus oil (contains the monocyclic terpene cineole, which is a strong antiseptic); chlorobutanol (see above) and levomenthol. Levomenthol is an isomer of menthol, and its local anesthetic effect is caused by the expansion of the capillaries of the mucous membrane, which causes a sensation of "mint cold".

Pharmacokinetics

As noted in the official instructions, the throat pain aerosol Angilex (Givalex) is well absorbed by the mucous membranes after spraying and continues to act for some time. But the manufacturers do not provide any more information, although chlorobutanol enters the bloodstream (in small quantities).

The therapeutic effect of Hexoral aerosol after one spray lasts more than 10 hours, although, as noted, this drug is almost not absorbed. Nevertheless, traces of hexetidine are quite firmly "settled" in tissue structures, but the process of biotransformation of this substance is not explained.

The pharmacokinetics of the drugs TeraFlu Lar and Anginovag are not presented by the manufacturers.

The active ingredients of the Stopangin aerosol do not enter the blood, but enter the saliva. The further path of its components (hexetidine, methyl salicylate and essential oils) is not traced.

Benzocaine, which is part of Septolete Plus, is absorbed into the blood in small quantities and is hydrolyzed there. Some of the metabolites are formed in the liver and excreted by the kidneys.

Benzydamine hydrochloride in the Tantum Verde aerosol is absorbed by the mucous membranes and gets into the underlying tissues. The instructions further inform that the elimination of biotransformation products is carried out through the kidneys and intestines.

After use, the throat aerosol with the antibiotic Bioparox remains on the mucous membrane of the mouth and throat, but does not enter the systemic bloodstream (since fusafungine is poorly soluble). The drug is excreted from the body during breathing - along with tracheobronchial secretions.

But chlorobutanol and camphor in the Kameton aerosol enter the blood, and their metabolites (glucuronides) leave the body with urine.

Names of aerosols for sore throat

The names of aerosols for sore throat from various manufacturers presented in this review are: Angilex (Ukraine) and its synonym Givalex (Norgine Pharma, France), Stopangin (Ivax Pharmaceuticals, Czech Republic), Hexoral (Famar Orleans, France), Septolete plus (KRKA, Slovenia), Tantum Verde (ACRAF SpA, Italy) and its synonym Tenflex (Turkey), TeraFlu Lar (Novartis, Switzerland), Bioparox (Egis Pharmaceuticals, Hungary), Anginovag (Ferrer Internacional, Spain), Kameton (Ukraine).

If the sore throat is caused not by rhinoviruses, but by a bacterial infection (staphylococci, streptococci, pneumococci, etc.), a throat aerosol with an antibiotic is needed. Of the above-mentioned products, such aerosols include Bioparox and Anginovag.

It should be noted that it is useless to look for a special throat spray for children: there is simply no such thing. Moreover, otolaryngologists warn that no aerosols should be used at all for a child under 2.5-3 years old due to the increased risk of laryngeal muscle spasm, which can lead to convulsions, fainting, and respiratory arrest. As noted by specialists from the American Academy of Pediatrics, aerosols (sprays) containing local anesthetics are no more effective than lozenges and throat lozenges, and are not recommended for children.

The throat pain aerosol Angilex should not be used to treat children under 2.5 years of age, and the instructions for the spray Givalex, which has an identical composition, indicate that it is only permitted to be used after 12 years of age.

According to the instructions, Bioparox is not prescribed to children under 2.5 years of age. Hexoral and Tantum Verde aerosols are contraindicated for children under three years of age. TeraFlu Lar spray can be used after 4 years; Kameton - after 5; Septolete Plus - after 6; Stopangin - after 8, and throat aerosol with antibiotic Anginovag - only after 13 years.

Method of application and dosage of aerosols for sore throat

Aerosol Angilex (Givalex) is recommended for use: for adults - one irrigation of the throat 4-5 times during the day (after meals); for children under 15 years old - no more than three times; the maximum duration of use is 5 days.

Doses of aerosols for sore throat Stopangin and Hexoral: spray the mucous membrane of the throat 2-3 times a day (2 seconds at a time), use for no more than a week.

Septolete: two sprays constitute a single dose for adults and one spray for children aged 6 to 12 years; can be used 7-8 times a day. The course of treatment is 7 days.

Tantum Verde: for adults, the minimum single dose is 4 presses on the sprayer, the maximum is 8 presses; for children, the maximum dose is 4 presses. The drug is used every 2-3 hours. For children under 6 years old, one press is allowed for every 4 kg of their weight.

TeraFlu Lar: 4 sprays (pressing the sprayer) up to 6 times a day for adults; half as much for children over 4 years old. The maximum duration of treatment is 5 days.

The throat spray with the antibiotic Bioparox should be used 4 sprays every 4 hours; for children, the dosage is reduced to one spray every 6 hours. This product should not be used for more than 5-6 days.

Anginovag throat aerosol with antibiotic is used 1-2 sprays up to 4 times a day for a week. The method of application and doses of Kameton aerosol are similar.

Using Sore Throat Sprays During Pregnancy

According to the information provided in the official instructions for the drugs Angilex, Hexoral, Tantum Verde, Anginovag and Kameton, the use of aerosols for sore throat during pregnancy and lactation is permitted: only according to the doctor's instructions, with the standard wording - "if the expected benefit to the mother is higher than the possible risks to the child."

With regard to the drugs Angilex (Givalex) and Hexoral, which contain hexetidine, you should know that, according to the decision of the European Agency for the Evaluation of Medicines (EAEMP), pregnant women should not use drugs that contain hexetidine.

By the way, hexetidine is also a part of Stopangin, but the manufacturers have limited the ban on its use by pregnant women to the first 14 weeks only. But methyl salicylate in this drug (according to the instructions for methyl salicylate itself) is contraindicated during pregnancy!

It is not recommended to use the sore throat aerosols Septolete Plus and Bioparox during pregnancy and breastfeeding, and the drug TeraFlu Lar is contraindicated.

The instructions for the drug Anginovag indicate that only a doctor can prescribe it during pregnancy. However, this drug contains the adrenal cortex hormone hydrocortisone, which is contraindicated for pregnant women.

Contraindications for use

The presented aerosols for sore throat have the following contraindications for use:

Angilex (Givalex), Hexoral, Tantum Verde, Bioparox and Anginovag – individual intolerance to the components of the drug.

Stopangin – individual sensitivity to the components of the drug, age under 8 years, atrophic pharyngitis, first trimester of pregnancy.

Septolete plus - individual hypersensitivity to local anesthetics, alcohol abuse, blood disease methemoglobinemia.

TeraFlu Lar – hypersensitivity to ammonia derivatives and compounds, pregnancy.

Cameton – bronchial asthma; due to the presence of camphor – epilepsy.

[ 3 ], [ 4 ], [ 5 ]

Side effects

The use of the considered aerosols for sore throat may cause the following side effects:

• Angilex - irritation of the mucous membranes in the mouth and throat.
• Hexoral – allergic reactions, taste disturbances and discoloration of tooth enamel.
• Stopangin - allergies, burning sensation in the throat, vomiting may occur if swallowed.
• Septolete plus – allergic reactions in the form of skin rash and swelling, as well as difficulty breathing.
• Tantum Verde – dryness and numbness in the mouth, urticaria and insomnia.
• TeraFlu Lar - irritation of mucous membranes, staining of tooth enamel and tongue (reversible), skin rashes, laryngeal edema. Due to lidocaine, a decrease in blood pressure and bradycardia are possible.
• Bioparox – irritation of the mucous membranes in the mouth and nasopharynx, cough, bronchospasm or laryngeal spasm, taste in the mouth, nausea, urticaria, development of superinfection, anaphylactic shock.

The throat spray with the antibiotic Anginovag can cause dryness and numbness in the mouth, allergic reactions, swelling of the face, shortness of breath. Similar side effects are noted in the instructions for the drug Kameton.

Overdose

There is currently no information about overdosage of the drugs Angilex, Stopangin, Bioparox and Anginovag.

An overdose of Hexoral spray occurs if the sprayed drug is swallowed, which can cause nausea and vomiting, since the ethyl alcohol contained in the aerosol promotes absorption.

Exceeding the recommended dosage of Septolete Plus, which contains benzocaine, may lead to the development of methemoglobinemia, which manifests itself as headache, cyanosis of the skin, shortness of breath, general weakness. In such situations, an oxygen pillow, gastric lavage and the use of methylene blue as an antidote are needed.

Overdose of Tantum Verde, which contains benzydamine hydrochloride, causes CNS stimulation and hallucinations.

In case of overdose of aerosol for sore throat TeraFlu Lar nausea and vomiting are observed. In addition, lidocaine inhibits electrical conductivity of the myocardium and reduces heart rate, but the manufacturers claim that its content in the aerosol is small.

An overdose of the drug Kameton results in an increase in its side effects (dryness and numbness in the mouth, allergic reactions, swelling of the face and shortness of breath).

Interactions with other drugs

No clinically significant interactions with other drugs have been identified for drugs such as Hexoral, Stopangin, Septolete Plus, Tantum Verde, Bioparox and Kameton.

The throat pain aerosol Angilex (Givalex) should not be used in combination with other antiseptics. TheraFlu Lar should not be used with alcohol-containing products, so as not to increase the absorption of benzoxonium chloride.

The throat spray with the antibiotic Anginovag is not used in combination with sedatives and painkillers.

Storage conditions and shelf life

Storage conditions for the listed drugs: in a shaded place at normal room temperature. The shelf life of aerosols Hexoral, Stopangin, Bioparox, Kameton is 2 years; Angilex (Givalex), Septolete plus - 3 years; Tantum Verde, Anginovag - 4 years; TeraFlu Lar - 5 years.