Sore throat tablets: what can help?

A sore throat is most often a symptom of acute pharyngitis or tonsillitis, an inflammation of the pharyngeal mucosa and tonsils. In the vast majority of cases, the cause is viruses, not bacteria, so the illness resolves on its own in about 5-7 days, even without antibiotics. Antibacterial therapy is only necessary for a proven bacterial infection, such as streptococcal pharyngitis, and not for any throat discomfort. [1]

Typical symptoms of acute sore throat include pain and irritation, increased pain when swallowing, a dry or wet cough, hoarseness, sometimes a moderate fever, and general malaise. Warning signs include severe shortness of breath, difficulty opening the mouth, severe asymmetrical pain on one side, drooling, high fever, and severe weakness. In such situations, sore throat lozenges are not a substitute for urgent medical attention. [2]

Sore throat lozenges can be roughly divided into two large groups. The first group includes topical lozenges and pastilles, which act directly on the mucous membrane of the pharynx and tonsils. The second group includes systemic lozenges for oral administration, primarily conventional painkillers and antipyretics. International recommendations emphasize that systemic painkillers are the mainstay of symptomatic therapy, while lozenges can be used in addition. [3]

It's important to separate treatment of the underlying cause from symptom management. Oral lozenges and regular painkillers reduce pain, irritation, and difficulty swallowing, and improve well-being, but they have virtually no effect on the duration of the illness or prevent rare complications. Oral antibiotics are only necessary for confirmed bacterial infections and are not a self-administered remedy for any sore throat. [4]

The goal of modern therapy for acute sore throat is to provide maximum symptomatic relief without overloading the body with unnecessary medications or worsening the situation with antibiotic resistance. Clinical guidelines for sore throat and streptococcal pharyngitis emphasize the need for rational choice: using simple analgesics and topical agents for pain control and prescribing antibiotics only to those patients who truly need them. [5]

Table 1. Main types of tablets for sore throat

Type of tablets	Example of action	The main purpose of application
Lozenges with analgesic	Local anesthesia	Reducing pain and irritation in the throat
Lozenges with antiseptic	Local reduction of microbial numbers	Relief of symptoms in mild inflammation
Tablets with a local non-steroidal anti-inflammatory drug	Reduction of inflammation and pain locally	More pronounced pain relief
Regular painkillers	Systemic analgesia and antipyretic effect	Pain and temperature control
Antibacterial tablets	Destruction of the bacterial pathogen	Treatment of confirmed bacterial pharyngitis

Why does my throat hurt and when do pills help and when don't they?

The causes of a sore throat are varied. Most commonly, it's a viral respiratory infection, which causes inflammation of the lining of the pharynx, tonsils, and upper respiratory tract. Less common causes include bacteria, including group A beta-hemolytic streptococcus, allergic reactions, irritation from dry or cold air, exposure to tobacco smoke, gastric reflux, mucosal trauma, or vocal cord strain. [6]

Classic signs of bacterial pharyngitis caused by streptococci include sudden onset of severe sore throat, high fever, absence of cough, tender and enlarged cervical lymph nodes, and typical tonsil plaque. However, even with this presentation, the diagnosis is confirmed by laboratory testing to avoid over-prescribing antibiotics. Clinical scoring systems are used to assess the likelihood of bacterial infection, but the final diagnosis is made based on an examination and, if necessary, a throat swab. [7]

Viral throat infections are usually milder. Fever is either absent or moderate, there is no significant intoxication, and pain gradually subsides over 5-7 days. Recommendations emphasize that for a typical acute viral illness, rest, plenty of fluids, painkillers, and topical treatments are sufficient. Antibiotics do not speed recovery or prevent complications in the vast majority of patients with uncomplicated acute pharyngitis. [8]

In these situations, sore throat lozenges play a supportive role. Systemic analgesics reduce pain and aches, while lozenges, due to their local action and increased salivation, facilitate swallowing and relieve dryness. However, no lozenges replace rest, adequate fluid intake, and mucosal care. The patient should not be under the illusion that the absence of pain means a complete recovery, even if the infection is still ongoing. [9]

It's essential to see a doctor if a sore throat is accompanied by one or more "red flags." These include difficulty breathing or swallowing, a feeling of shortness of breath, drooling due to inability to swallow, a sharp, one-sided sore throat, severe swelling of the neck, high fever, skin rash, severe weakness, and impaired speech, consciousness, or movement. These symptoms may indicate severe purulent complications, damage to the epiglottis, or a widespread bacterial infection, and require immediate medical attention rather than medication. [10]

Table 2. Main causes of sore throat and the role of tablets

Cause	Characteristics of symptoms	The role of pills
Viral pharyngitis or tonsillitis	Gradual onset, mild fever, runny nose, cough	Symptomatic pain relief and local agents
Streptococcal pharyngitis	Sudden severe pain, high fever, no cough	Painkillers are needed; if confirmed, antibiotics are prescribed.
Allergic irritation	Itching, irritation, watery eyes, runny nose	Antihistamines and allergen avoidance
Irritation from dry air, smoke	Sore throat, dryness, slight cough	Local tablets, air humidification
Reflux and mucosal trauma	Burning sensation behind the breastbone, associated with food intake, mechanical damage	The pills are secondary, correcting the underlying cause is important.

Oral lozenges: what they are and how they work

Oral lozenges and pastilles for sore throats provide prolonged contact of the active ingredients with the mucous membrane. Gradual dissolution releases the medication, stimulates salivation, moistens the mucous membrane, and reduces pain and irritation. Clinical guidelines note that in adults, there is moderate evidence to support the use of medicated orally dissolving lozenges, but the expected effect is usually modest and short-lived. [11]

A separate group consists of lozenges containing the topical nonsteroidal anti-inflammatory drug flurbiprofen. Several randomized trials have shown that the drug, at a dose of 8.75 mg in lozenge form, can significantly reduce sore throat, difficulty swallowing, and swelling in the first 24 hours compared to placebo. Moreover, at standard doses, the drug is well tolerated and does not produce significant systemic effects, as it acts primarily locally. [12]

Oral lozenges containing local anesthetics, such as those containing benzocaine or lidocaine, are used for rapid pain relief. Randomized trials show that these lozenges are more effective than placebo in reducing pain when swallowing, especially in the first hours after administration. However, they have some caveats: they can numb the tongue and mucous membranes, impair taste, and, in rare cases, methemoglobinemia has been reported with benzocaine overdose, especially in young children. Therefore, these lozenges are not recommended for young children or individuals with known hypersensitivity. [13]

Lozenges containing topical antiseptics, including quaternary ammonium compounds, alcohols, iodine compounds, and other molecules, as well as combinations thereof, such as amylmetacresol with dichlorobenzyl alcohol, are widely used. Clinical studies show that such lozenges can reduce sore throat and discomfort due to a combination of mild antiseptic and local irritant effects, but the effect is usually moderate and short-lived. International reviews emphasize that these agents should be considered symptomatic rather than a full-fledged alternative to systemic therapy for severe bacterial infections. [14]

A separate class of medications consists of benzydamine tablets, which have anti-inflammatory and local anesthetic effects. International expert consensus notes that most specialists consider benzydamine in the form of lozenges, sprays, or solutions to be an appropriate option for the short-term symptomatic treatment of acute sore throat. When used correctly, the drug is well tolerated but may cause a short-term burning sensation or numbness. [15]

There are also non-medicinal lozenges and drops, whose primary effect is related to increased salivation, mucosal hydration, and a mild, distracting taste. The evidence base for these products is limited, and guidelines emphasize that their benefit in reducing pain is modest. They can be used as a supplement, especially for dry throat, but a significant therapeutic effect should not be expected. [16]

When using any lozenges, it's important to follow the instructions. Generally, it's not recommended to take more than a certain number of lozenges per day, and it's advisable to abstain from eating or drinking for 20-30 minutes after dissolving the lozenge to allow the medication to take effect. Lozenges are not suitable for small children due to the risk of choking, so other dosage forms are preferred. [17]

Table 3. Main types of lozenges for sore throat

Tablet type	Main action	Pros	Restrictions
With a local nonsteroidal anti-inflammatory drug	Anti-inflammatory and analgesic	Significant reduction in pain	Not for people with contraindications to these products
With local anesthetic	Fast pain relief	Quick start of action	Risk of numbness, allergies, restrictions in children
With antiseptic	Reducing the number of microbes locally	Ease of use	Moderate effectiveness, possible irritation
With benzydamine	Anti-inflammatory and analgesic	Well tolerated with short-term use	Possible burning or bitterness
Non-medicated lozenges	Moisturizing and stimulating saliva	Minimum systemic effects	Limited evidence base for effect

Tablets for oral administration: painkillers, anti-inflammatory and other drugs

Systemic analgesics and antipyretics are considered the mainstay of symptomatic therapy for acute sore throat. Treatment guidelines for acute pharyngitis and sore throat recommend using paracetamol or, if there are no contraindications, nonsteroidal anti-inflammatory drugs such as ibuprofen to control pain and fever. These medications reduce the body's overall inflammatory response and often have a greater impact on well-being than topical treatments. [18]

Paracetamol has analgesic and antipyretic effects and is generally well tolerated when taken at recommended doses. It is particularly useful in patients with contraindications to nonsteroidal anti-inflammatory drugs, such as gastric ulcers or an increased risk of gastrointestinal bleeding. The main risk is associated with overdose and possible liver toxicity, so it is important not to exceed the daily dose and to consider other medications that may contain paracetamol. [19]

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, have potent analgesic and anti-inflammatory effects and can be particularly useful for severe sore throat and fever. However, they increase the risk of gastric irritation and gastrointestinal bleeding and can affect kidney function and the cardiovascular system, especially with long-term use. Guidelines recommend using the lowest effective dose and for limited durations, especially in elderly patients and those with chronic diseases. [20]

Combination cold medications often contain a combination of an analgesic, a decongestant, an antihistamine, and sometimes caffeine. Their usefulness for sore throats is limited, as the key role is played by paracetamol or a nonsteroidal anti-inflammatory drug. Antihistamine components can reduce swelling, but often cause drowsiness and dry mucous membranes, while vasoconstrictors increase the risk of cardiovascular side effects. Most recommendations emphasize that the use of such combinations should be short-term and well-founded. [21]

Oral antibacterial tablets occupy a special place. For confirmed streptococcal pharyngitis, penicillin and amoxicillin remain the drugs of choice, while in cases of allergy, cephalosporins, macrolides, or clindamycin are considered. However, broad-spectrum antibiotics do not improve outcomes and should not be used for mild acute pharyngitis unless there is evidence of a bacterial origin of the infection. Antibiotics should not be viewed as "just strong throat pills," much less self-prescribed. [22]

Systemic glucocorticosteroids are sometimes used as an adjunct for severe sore throat or severe swelling, but most guidelines do not recommend them for routine use in simple acute pharyngitis due to potential side effects. Such medications should only be considered by a physician, for clear indications, and for a short course when the expected benefit outweighs the risk. Self-medication with hormonal tablets for sore throat is strictly prohibited. [23]

Table 4. Main systemic drugs for sore throat

Group of drugs	Example of action	When appropriate
Paracetamol	Pain relief and fever reduction	Most mild to moderate cases
Nonsteroidal anti-inflammatory drugs	Pain relief and anti-inflammatory effect	For severe pain and fever, without serious contraindications
Combination cold remedies	Combined action on several symptoms	Short-term, with severe runny nose and headache
Antibiotics	Treatment of bacterial infection	Only if bacterial pharyngitis is confirmed
Systemic glucocorticosteroids	Powerful anti-inflammatory action	Only by doctor's decision for special indications

Throat Lozenge Safety and How to Choose Wisely

Local lozenges are generally considered safe for short-term use, but they do have their own side effects. Patients often report numbness or tingling in the mouth, taste changes, and a mild burning sensation. Local anesthetic medications can impair mucosal sensitivity, increasing the risk of ingesting extremely hot foods or drinks. In rare cases, allergic reactions are possible, including swelling or a generalized rash. [24]

Systemic painkillers also require safety considerations. Paracetamol, when taken in excess of the daily dose or in combination with alcohol and other hepatotoxic substances, can cause severe liver damage. Nonsteroidal anti-inflammatory drugs increase the risk of gastrointestinal bleeding, exacerbation of peptic ulcers, deterioration of renal function, and certain cardiovascular events, especially with long-term use and in elderly patients. Therefore, drug selection and dosage should take into account age and comorbidities. [25]

Particular attention should be paid to drug interactions. Many patients are already taking medications for hypertension, diabetes, and heart rhythm disorders, and adding painkillers or combination cold medications may alter their effectiveness. Pregnant and breastfeeding women, people with severe liver, kidney, or blood diseases, and those with bronchial asthma should always discuss their medication choice with a doctor or pharmacist. [26]

The principles of choosing wise throat lozenges are simple. First, it's best to use the minimum amount of medication needed. Second, avoid duplicating the same active ingredient in multiple medications, such as pure paracetamol and a combination product. Third, choose simple, well-studied medications over multi-component combinations with questionable added benefits. [27]

A particular danger is self-administration of antibiotics under the guise of "antibacterial throat lozenges," without a doctor's examination or a swab test. The widespread and uncontrolled use of antibacterial lozenges for common viral pharyngitis not only fails to speed recovery but also contributes to the growth of bacterial resistance. As a result, in truly severe infections, conventional antibiotics may prove less effective in the future. This is why international guidelines emphasize the strictest selection of patients for antibacterial therapy. [28]

Finally, it's important to carefully read the instructions for any medication, even if it's a throat lozenge. They'll list the dosage, maximum number of tablets per day, recommended course length, and a list of contraindications. Failure to follow these instructions, especially combining several medications, can result in an attempt to relieve a sore throat resulting in an allergic reaction, ulcer exacerbation, or liver problems. [29]

Table 5. Who should be especially careful with throat lozenges

Patient group	Possible problems	What to look out for
People with liver disease	Risk of toxicity when taking paracetamol	Dose limitation, choice of alternatives
Patients with gastric or intestinal ulcers	Risk of bleeding when taking nonsteroidal drugs	Preference for paracetamol, protection of the mucous membrane
Patients with impaired renal function	Hypersensitivity to non-steroidal drugs	Monitoring of renal function, dose limitation
Pregnant and lactating women	Potential effects on the fetus and child	Selecting safe medications and consulting a doctor
Young children	Risk of choking, metabolic features	Oral lozenges and many topical remedies are limited

Special situations, non-drug measures and patient algorithm

Non-drug measures remain an important part of sore throat care. Recommendations include drinking plenty of warm fluids, resting, humidifying the air, avoiding tobacco smoke and other irritants, and using warm drinks, honey for adults and children over 1 year old, and saline solutions for gargling. These measures do not eliminate the infection, but they help reduce irritation of the mucous membrane, speed up its recovery, and, when combined with oral medications, make the illness more comfortable. [30]

For children, the choice of tablets is particularly limited. Lozenges are only acceptable for those who can consciously dissolve the tablet and avoid swallowing it whole, typically those over 5-6 years of age. Local anesthetics and some antiseptics can cause more pronounced side effects in young children, so syrups, solutions, sprays, and systemic pain relievers in pediatric dosages are preferable. Any medications containing benzocaine should be used with extreme caution or not recommended at all in young children. [31]

During pregnancy and breastfeeding, the choice of throat lozenges should be discussed with a doctor. Typically, paracetamol is considered the first-line pain reliever at recommended doses, while nonsteroidal anti-inflammatory drugs (NSAIDs) are limited, especially in late pregnancy. Lozenges containing antiseptics and benzydamine are often acceptable for short-term use, but there are few high-quality studies on safety for the fetus and infant, so any long-term or combination treatment should be discussed with a specialist. [32]

For patients with chronic conditions such as asthma, severe cardiovascular disease, diabetes, kidney disease, and liver disease, the choice of systemic painkillers is particularly important. Nonsteroidal anti-inflammatory drugs can worsen asthma, increase blood pressure, and increase the risk of complications. In such cases, paracetamol in safe doses is often preferred, and any additional throat medications should be prescribed based on benefit and risk. [33]

A practical algorithm for a person with a sore throat can be described as follows. First, the symptoms and the presence of warning signs are assessed. For typical mild to moderate acute pharyngitis without red flags, a combination of non-drug measures, systemic painkillers, and, if necessary, lozenges are used. If the pain does not subside within several days, intensifies, a high fever occurs, swallowing becomes difficult, or shortness of breath develops, an urgent visit to the doctor is necessary. Antibiotics and complex treatment regimens are prescribed only after assessing the likelihood of a bacterial infection. [34]

Ultimately, sore throat lozenges are a symptom management tool, not a cure-all for all throat problems. Topical lozenges help relieve discomfort, systemic painkillers improve well-being, and oral antibiotics are only needed for confirmed bacterial infections. Using these remedies judiciously, along with simple throat care measures, allows you to get through the acute phase safely and with minimal risk to your future health. [35]

Table 6. Algorithm for selecting and using tablets for sore throat

Situation	Recommended actions
Mild sore throat without fever	Warm drinks, rest, and, if necessary, simple lozenges without active medications
Moderate pain and discomfort when swallowing	Paracetamol or non-steroidal antiseptic tablets with an analgesic or antiseptic
Severe pain, fever, but no red flags	Painkillers in adequate doses, medicated lozenges, consult a doctor if there is no improvement
Suspected bacterial pharyngitis	A specialist examination will be performed, and if confirmed, antibiotics and symptomatic medications will be prescribed.
Presence of red flags	Urgent medical attention is required; self-selection of tablets is not permitted.