Sore throat lozenges

As a local symptomatic treatment, you can use lozenges for sore throat, which gradually dissolve in the mouth, and the medicinal substances contained in them have an antiseptic, disinfectant and analgesic effect on the mucous membranes. Since they all belong to antiseptics, they have the ATC code - R02AA20.

Indications for the use of pain-relieving antimicrobial lozenges include: acute respiratory infections and acute respiratory viral infections with sore throat and hoarseness, acute and chronic tonsillitis (angina), laryngitis, pharyngitis, laryngotracheitis, as well as inflammation of the oral mucosa (stomatitis) and gums (gingivitis).

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Pharmacodynamics

The therapeutic effect of Septolete throat lozenges is based on the antiseptic benzalkonium chloride (2,4-dichlorobenzyl alcohol) they contain, which blocks the hydration process of pathogenic microbes, leading to their dehydration and death. The drug also contains thymol, an analgesic and antiseptic monoterpene phenol, levomenthol, and essential oils of peppermint and eucalyptus. Peppermint oil, thanks to menthol, blocks Ca2+ channels, dilates blood vessels, and relieves pain. And the monoterpene compound cineole in peppermint and eucalyptus oils is a strong antibacterial, antifungal, and antiviral substance.

The pharmacodynamics of Astrasept lozenges is due to the same dichlorobenzyl alcohol, as well as the phenolic antiseptic amylmetacresol, which stops the synthesis of proteins in microbial cells.

Active ingredients of Anti-Angin lozenges: halogen chlorhexidine, analgesic tetracaine hydrochloride and antioxidant vitamin C (ascorbic acid). The antiseptic component chlorhexidine destroys many bacteria, trichomonads, and also neutralizes the activity of the Candida fungus and herpes virus by binding phosphates of the cytoplasmic membranes of their cellular structures.

The analgesic and antibacterial effect of Angal lozenges is provided by lidocaine hydrochloride (by blocking Na+ channels in the cells of peripheral nerve fibers and stopping the conduction of nerve impulses by them) and the already mentioned chlorhexidine.

Hexadreps lozenges (Laboratoires Doms Adrian, France) exhibit bactericidal activity against streptococci and staphylococci, since the active antiseptic substance biclotymol (biphenol derivative of 6-chlorothymol) destroys the cell membranes of bacteria, coagulating mucopolysaccharides; it also has analgesic properties. In addition, these lozenges contain ioxaglic acid, which is an iodine-containing radiopaque substance. The manufacturer does not explain in the instructions how this substance works for a sore throat, although it is known that iodine is also an antiseptic and is absorbed by the mucous membrane.

Pharmacodynamics of Eucalyptus-M is based on the action of eucalyptus essential oil and levomenthol. The main active substance of Sage lozenges is the essential oil of sage, which contains such anti-inflammatory and antimicrobial compounds as cineole, borneol and thujone.

Isla-Mint (Isla-Moos) throat lozenges act as antiseptics due to the presence of an aqueous extract of Centraria islandica (Icelandic moss), which contains antimicrobial acids - usnic, lichesteric, etc.

Pharmacokinetics

Since throat lozenges are kept in the mouth, their active ingredients end up in the stomach in small quantities with saliva. Most manufacturers of these drugs do not provide information on their pharmacodynamics. Some note that "no studies of the drug's pharmacokinetics have been conducted."

It is known that benzalkonium chloride is not absorbed by mucous membranes. Chlorhexidine is almost not absorbed by the mucous membranes of the mouth, throat and gastrointestinal tract, and what is absorbed is 10% decomposed in the liver and excreted by the intestines.

Local anesthetics tetracaine hydrochloride and lidocaine are absorbed by the mucous membrane of the oropharynx. Tetracaine binds to plasma proteins, but after 60-90 minutes it is broken down by the hydrolytic enzyme cholinesterase in the liver; it is excreted in the urine and bile.

The pharmacokinetics of lidocaine hydrochloride is characterized by the formation of active metabolites in the liver, which are excreted from the body by the kidneys after 4-18 hours.

Biclotymol in the composition of Hexadreps lozenges is absorbed through the mucous membranes and is present in the oral cavity for quite a long time.

Names of lozenges for sore throat

Pharmacies have a fairly large selection of products for local symptomatic therapy of the above-mentioned respiratory diseases, and you can choose lozenges for sore throat depending on the severity of the symptom and the etiology of the disease - bacterial or viral.

Among them, the following names of lozenges for sore throat are noted: Septolete (Septolete D, Septolete Neo), Astrasept (Adzhisept, Gorpils, Suprimalor, Lorpils), Anti-Angin, Angal, Hexadreps, Eucalyptus-M, Sage, Isla-Mint (Isla-Moos), etc.

Dr. MOM lozenges, containing the menthol isomer levomenthol, extracts of licorice, ginger and emblica (amla), are an expectorant and are used for unproductive coughs that accompany colds.

In most cases, throat lozenges for children are contraindicated for use if the child is under 6 years old, and Eucalyptus M lozenges are not used until the age of 8. Throat lozenges Astrasept, Angal and Salfei are allowed for use by children from the age of 5, Septolete and Isla-Mint - after 4 years.

Throat lozenges with anesthetic tetracaine hydrochloride - Anti-Angin; with lidocaine hydrochloride - Angal. Septolete, Astrasept (Adzhisept), Eucalyptus-M contain menthol or levomenthol, which act on the receptors of the mucous membrane of the oropharynx, which provides the analgesic effect of these lozenges.

Throat lozenges with antibiotics are not produced, since antibacterial drugs for bacterial diseases of the upper respiratory tract and ENT organs are used systemically and must be prescribed by a doctor, and in what cases see - Antibiotics for sore throat, Antibiotics for laryngitis.

Cheap lozenges for sore throats - Adzhisept and Gorpils, made in India, their average price in pharmacies is almost half the cost of their synonyms (see above), as well as their analogue Septolete (Krka, Slovenia) or Anti-Angin lozenges (H.Ten Herkel, Netherlands).

If you need good lozenges for a sore throat (the definition of “good” is not entirely correct in relation to drugs), then pharmacists advise paying attention to their composition and mechanism of therapeutic action (pharmacodynamics), as well as their contraindications and possible side effects.

How to use lozenges for sore throat

The only way to use throat lozenges is to hold them in your mouth until they dissolve completely.

Septolete and Astrasept should be used by adults and children over 12 years of age one lozenge at least every three hours (maximum daily amount is 8 lozenges); children 4-10 years old – four lozenges during the day, 10-12 years old – six. Duration of use – no more than four days in a row.

Anti-Angin and Angal are recommended for adults, 6 lozenges per day (every 2-3 hours), children - three lozenges (at intervals of 4 hours).

Adults can take up to 6 Hexadreps lozenges (under the tongue) per day, children over 6 years old – half as much.

Eucalyptus-M can be used one lozenge up to 4 times a day - for adults, for children - no more than two lozenges per day. Duration of use - no more than five days. The maximum permissible daily number of Sage lozenges for adults and children over 15 years old is 6 (at intervals of 2.5 hours); children 10-15 years old - 4 lozenges per day, 5-10 years old - 3 lozenges (every 4 hours). Sage lozenges can be used for no longer than seven days.

The maximum daily dose of Isla-Mint (Isla-Moos) lozenges for adults and children over 12 pieces; for children 4-12 years old – 6 lozenges (one lozenge every 2-2.5 hours).

Using Sore Throat Lozenges During Pregnancy

Septolete may be used during pregnancy only on the recommendation of a physician; these lozenges should also be used for sore throats during lactation.

The instructions for Astrasept, Anti-Angin and Hexadreps do not contain any information regarding the possibility of their use during pregnancy.

During pregnancy and lactation, Angal lozenges can be used, but in the exact recommended dosage and for no longer than three days.

Eucalyptus-M lozenges, according to the instructions, require caution when used during pregnancy. And Sage lozenges (since both the plant and the essential oil contain plant estrogens) should not be used in this case.

The manufacturer (Engelhard Arzneimittel GmbH & Co, Germany) has not received any information regarding the negative impact of Isla-Mint lozenges on pregnant and lactating women.

Contraindications for use

The throat lozenges presented in the review have the following contraindications for use:

• Septolete - galactosemia, glucose malabsorption syndrome, hypersensitivity to the constituent substances (fructose), lactase or isomaltase deficiency; age under 4 years.
• Astrasept – hypersensitivity, children under 5 years of age.
• Anti-Angin - hypersensitivity to components; the instructions note the use of lozenges by children aged 5-10 years, however, the local anesthetic tetracaine hydrochloride is contraindicated for children under 10 years of age.
• Angal - hypersensitivity to the components, age under five years. It should be borne in mind that lidocaine hydrochloride (which is part of these lozenges) is contraindicated in atrioventricular block and heart failure of 2-3 degrees, in the presence of sinus node weakness syndrome; not recommended for severe bradycardia, low blood pressure, myasthenia, and for children under 12 years of age.
• Hexadreps - hypersensitivity, children under six years of age. There are no other contraindications in the instructions, but given the presence of biclotymol in Hexadreps lozenges
• ioxaglic acid, it should be borne in mind that the released iodine can accumulate in the thyroid gland in the form of metabolites, which is unacceptable in thyrotoxicosis.
• Eucalyptus-M – children under 8 years of age and hypersensitivity to essential oils, with caution – in the presence of diabetes.
• Sage - similar to Astrasept.
• Isla-Mint (Isla-Moos) – hypersensitivity to ingredients, including fructose intolerance, age up to 4 years.

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Side effects

Some lozenges for sore throat may have side effects. For example, using lozenges for sore throat Septolete, Astrasept (Adzhisept, Gorpils, Suprimalor, Lorpils), Eucalyptus-M or Sage may cause allergic reactions.

Anti-Angin, in addition to an allergic reaction, due to the presence of tetracaine hydrochloride, can lead to irritation of the oral mucosa, cyanosis and CNS excitation.

Possible side effects of Angal lozenges include diarrhea, irritation of the mucous membrane of the oropharynx, and in children, difficulty breathing. Side effects of Hexadreps and Isla-Mint have not been identified to date.

Overdose

Exceeding the recommended amounts of Septolete and Astrasept throat lozenges results in nausea, vomiting and diarrhea. The manufacturers report in the instructions for Eucalyptus-M and Isla-Mint that no cases of overdose have been reported. Abuse of Salvia lozenges contributes to the development of allergic reactions. There is no such information about Hexadreps lozenges.

An overdose of tertacaine, which is contained in Anti-Angin lozenges, can cause general weakness and dizziness, decreased blood pressure and vomiting, agitation and convulsions, respiratory failure and collapse.

And Angal lozenges containing lidocaine hydrochloride, in addition to the symptoms just listed, in case of overdose can cause depression, cardiac arrhythmia, decreased myocardial tone and systemic circulatory disorders.

Interactions with other drugs

The instructions for use of Astrasept, Anti-Angin, Hexadreps, and Eucalyptus-M lozenges do not provide any data regarding their interaction with other drugs.

No clinically significant drug interactions between Sage and Isla-Mint (Isla-Moos) lozenges have been identified.

All other throat lozenges discussed in the review should not be used simultaneously with other local antiseptic agents.

Storage conditions for throat lozenges: at a temperature not exceeding +25°C.

The shelf life of the lozenges Septolete, Astrasept, Anti-Angin, Eucalyptus-M, Sage is 3 years; Angal - 5 years; Hexadreps, Isla-Mint - 2 years.