Sore throat is a common condition usually caused by a viral infection, and less commonly by a bacterial infection. A sore throat usually lasts about one week. It is a self-limiting condition meaning it goes on its own without treatment. There is no treatment for a sore throat caused by a viral infection. Even when a sore throat is caused by a bacterial infection, in most cases, patients will get better without antibiotic treatment (NICE, 2018). Customers can choose from a wide range of products to manage the symptoms of the sore throat, such as pain and inflammation (swelling). Sore throat lozenges are one of the most popular products used for symptomatic management of sore throat. In this post, I will review the most common sore throat lozenges available in pharmacies and supermarkets.
Additionally, I dedicated a few paragraphs to Tyrozets alternative products. Tyrozets were one of the most popular lozenges for sore throat. Recently, Tyrozets were discontinued due to ”misuse” of antibiotic (one of the active ingredients) in the treatment of sore throats, which are mostly caused by viruses and not bacteria.
Sore throat: when to see GP
Very often there is no need to see a doctor when a sore throat is present unless other symptoms are present or sore throat last a long time (see list below for more details).
- Symptoms lasting more than seven days with no signs of improvement
- Severe symptoms (pain)
- Symptoms getting worse quickly
- Difficulty in swallowing or breathing
- Patient taking a drug which can lead to agranulocytosis (sudden lowering of white blood cells), for example, carbimazole, methotrexate.
- Recent episodes of throat infection (for instance tonsillitis)
Use of antibiotics for sore throat
Very often, episodes of sore throats are caused by viral infections. Sore throats caused by viral infection are self-limiting and do not require antibiotic treatment. Symptoms usually last around seven days.
Patients who decide to see their GP about a sore throat are usually assessed according to specific criteria, for example, FeverPAIN, which looks at different symptoms present. FeverPAIN standards for antibiotic use in sore throat episodes look at the following:
- Presence of fever in the last 24 hours
- Presence of pus on tonsils
- Rapid attendance (within three days of symptoms appearance)
- The severity of inflamed tonsil
- No cough or inflammation of the nose
A high score indicates more severe symptoms, with bacterial infection more likely causing the sore throat. A decision on antibiotic need is supported with results taken from the FeverPAIN assessment. Very often, GP may recommend issuing a ”stand by” prescriptions, with recommended use, only if symptoms do not resolve 3-5 days or get worse suddenly.
Unnecessary use of antibiotics contributes to antibiotic resistance – reduced effectiveness of antibiotics in treating bacterial infections.
How to treat a sore throat
The main recommendations in terms of management of sore throats are the use of self—care measures such as:
- Staying well hydrated
- Gargling with salty water or dissolvable aspirin
- Use of paracetamol or ibuprofen (painkillers)
- Use of lozenges/throat sweets
- Use of throat sprays containing a local anaesthetic
The National Institute for Health and Care Excellence (NICE) recommends the use of simple analgesics such as paracetamol or ibuprofen as firs-line treatment of pain caused by a sore throat. Patients may choose to use other products such as lozenges, although NICE describes the benefit of therapy as ”small” (NICE, 2018).
Which lozenges are the best for sore throats?
Most lozenges, which are used in the treatment of sore throat, contain a single or combination of the following ingredients:
- Essential Oils
- Local anaesthetics
- Antiseptic agents
- Non-steroidal anti-inflammatory drugs (NSAIDs)
Medicated lozenges containing NSAIDs (Strefen and Difflam lozenges) have some evidence to support their effectiveness in terms of pain reduction and anti-inflammatory properties. However, their use is associated with a higher possibility of side effects; for example, a common side effect for flurbiprofen lozenges (Strefen Honey and Lemon) includes dizziness, headaches, diarrhoea, nausea.
Lozenges containing hexylresorcinol (Strepsils Extra Triple Action) are associated with fewer side effects (ibid).
The soothing effect of throat sweets should not be undermined. Lozenges increase the production of saliva by sucking action as fast as 1 minute after individuals start to use them. Saliva soothes the inflammation associated with sore throats and provides lubrication (Oxford & Leuwer, 2011).
It is not clear whether combination lozenges (local anaesthetic & antiseptic) provide treatment benefits in the management of sore throats.
The mechanism of action of menthol (a component of many throat lozenges) has been described in many studies. Menthol helps mainly with respiratory discomfort by acting on ”cold” receptors which are found inside the nose and upper airways (Nishino et al., 2017).
Effectiveness of analgesics for sore throat (paracetamol & ibuprofen)
Simple painkillers such as paracetamol or ibuprofen are more effective in reducing fever (high temperature) and sore throat pain in adults who present symptoms of upper respiratory infections as compared to no treatment (NICE, 2018).
No need for antibiotics
Patients need to remember that most sore throats are caused by viral infections, often associated with colds. Most cases, sore throats are self-limiting and lasting about seven days. Antibiotics are not needed for the treatment of a sore throat.
Best Sore throat lozenges – Top 10 recommended products
1. Jakemans sore throat lozenges
Jakemans throat and chest lozenges are the best-selling product in category ”Sore Throat Remedies” on Amazon.co.uk with excellent reviews for the range. The reason for this is the simplicity of lozenges, which contain aniseed oil, eucalyptus oil and menthol giving not only refreshing taste, but also providing a soothing and sweet effect much needed for the management of painful and sore throats.
Jakemans lozenges come in four different flavours:
• The Original and Famous: Throat and Chest
• Blueberry Menthol
• Honey & Lemon Menthol
• Menthol & Eucalyptus with a hint of Lemon
Jakemans throat lozenges are relatively cheap, and overall provide the best value and quality of the product based on simple management of sore throats with a well-known ingredient such as menthol and eucalyptus oil.
Jakemans lozenges are stock by most supermarkets and pharmacies including online websites.
2. Strefen Honey and Lemon lozenges
Strefen sore throat lozenges are a pharmacy-only product, which is available only from pharmacies including online chemists.
Strefen lozenges contain flurbiprofen, a Non -Steroidal-Anti-inflammatory-Drug (NSAID). NSAIDs are used to reduce pain and inflammation. Strefen are used for short-term management (up to 3 days), of sore throat in children and adults over 12 years of age.
Flurbiprofen has shown to reduce swollen and inflamed sore throats, when used locally as a throat lozenge, with multiple-doses which demonstrated to reduce pain, swelling of the throat in the first 24 hours as well as during three days.
Since flurbiprofen is an NSAID, some restrictions apply to who can use Strefen.
Strefen lozenges: caution on the use
- Patients who shown hypersensitivity reactions to NSAIDs (for example asthmatic patients)
- Patients who had or currently have ulcers
- History of gastrointestinal bleeding
- Last trimester of pregnancy
Additionally, patients who already take another NSAID such as ibuprofen or naproxen should avoid taking Strefen, to minimise the risk of side effects. The second group of patients who should avoid taking Strefen are patient on a low dose of aspirin 75mg (baby aspirin) unless advised by a doctor.
As compared to non-medicated lozenges or lozenges containing menthol and other essential oils, the use of Strefen is associated with some common side effects, including:
- diarrhoea and
For more details, read the product information leaflet.
Effectiveness of Strefen sore throat lozenges
Some evidence exists to support the effectiveness of Flurbiprofen lozenges in the management of sore throat. When used locally (in the form of lozenges), flurbiprofen reduced symptoms of the sore throat including soreness, a sensation of a swollen throat, difficulty in swallowing (de Looze et al., 2019) and significant reduction of pain (Aspley et al., 2013).
3. Vocalzones throat lozenges (not only) for singers
Vocalzones Throat Pastilles are marketed as throat lozenges ”specifically” designed for singers, actor and other people who rely on their voice. Similarly to previously discussed Jakemans, Vocalzones contain essential oils such as peppermint oil, menthol, and myrrh and aromatic gum resin from the plant.
Myrrh has been used in Western -traditional medicine since ancient times for its anti-inflammatory (reduces swelling), analgesic (reduce pain) and antibacterial properties (Cao, et al, 2019). The benefits of menthol were discussed at the beginning of this post (cooling effect & clearance of sinuses).
Although Vocalzones are marketed for a specific group of people, this product tick many boxes in terms of a product which can be used for the management of sore throat.
Key advantages of Vocalzones:
• Unique combination of ingredients
• Choice of three flavours
– blackcurrant, Vocalzone Throat Pastilles Sugar Free Blackcurrant 24
– honey & lemon Vocalzone Throat Pastilles Honey & Lemon 24 , and
– original: menthol, peppermint oil and myrrh Vocalzone Throat Pastilles 24
• Sugar-free option (Blackcurrant)
• Vegan lozenges (Certified vegan by the Vegan Society)
• Lactose and gluten-free
• On the market since 1912 with impressive sales worldwide
Children under the age of 12 should not use Vocalzones.
4. Dequadin lozenges for sore throat
Dequadin lozenges are commonly requested lozenges indicated for sore throats and mouth infections. Dequadin contains dequalinium chloride as an active ingredient, which has antiseptic and topical bacteriostatic (kills bacteria on the surface) and possibly antifungal properties.
Dequadin lozenges are generally available from pharmacies only. Customers may need to ask at the pharmacy counter about the availability of this product. Dequadin lozenges can be used by adults and children over ten years of age.
As I write this post, Dequadin lozenges are out of stock in most online chemists, possibly due to increased demand caused by discontinuation of Tyrozets lozenges. At the moment there is no information on possible discontinuation of Dequadin lozenges.
Looking at the withdrawal of Tyrozets from the market, MHRA may question the licensed use of Dequadin lozenge in the management of sore throats.
Dequalinium chloride is available as prescription-only medication if a form of vaginal tablets (brand name: Fluomizin 10 mg vaginal tablet), which are used for the treatment of bacterial vaginosis.
5. Difflam lozenges
Difflam range is mostly known for Difflam mouth spray containing benzydamine hydrochloride. The newest addition, Difflam lozenges, which also contain benzydamine hydrochloride as the main ingredient, are licensed for the management of pain and irritation of throat and mouth.
Difflam throat lozenges are pharmacy-only product, which means they can only be purchased from pharmacies and online chemists. Each Difflam lozenge contains 3mg of benzydamine hydrochloride.
The main active ingredient, benzydamine hydrochloride, is a Non-Steroidal Anti-inflammatory drug (NSAID), which reduce inflammation (swelling), act as a local anaesthetic and help with the pain. Leaving asideDifflam’s local anaesthetic properties, two other main effects are similar to commonly available NSAIDs such as ibuprofen, or in fact, discussed earlier Strefen lozenges.
Treatment with Difflam lozenge should be limited to a maximum of 7 days.
Who should not use Difflam lozenges?
Main cautions on the use come around the use by patients who are typically advised not to use NSAIDs due to underlying condition for example. The following patients should use Difflam lozenges with caution:
- Patients who are sensitive to NSAIDs or salicylic acid (use not advisable)
- Asthmatic patients due to possible increased risk of bronchospasm (narrowing of the airways)
- people with phenylketonuria
- patients with rare problems of fructose intolerance
- pregnant and breastfeeding women
- children under six years of age should not use Difflam lozenges.
Difflam lozenges come in different flavours:
- Lemon flavour
- Orange and honey
- Eucalyptus Flavour
- Mint flavour
Overall, this is a great addition to sore throat lozenges and the only product used for throat and mouth irritation which contains benzydamine hydrochloride. This main active ingredient was shown to be effective in reducing inflammation and pain.
6. Strepsils Extra Triple Action
Streptils is a well-known brand of throat lozenges available in supermarkets, stores and pharmacies. Streptils Extra Triple Action are advertised as lozenges which help with main symptoms caused by sore throats including pain, soreness and infection.
The main active ingredient found in Streptils Extra Triple Action lozenges is hexylresorcinol, which has properties of a local anaesthetic (numbs the area) and antiseptic agent (not antibacterial) which acts on the surface of the membranes to prevent bacteria growth.
Streptils range of sore throat lozenges includes Strepsils Honey & Lemon Lozenges Strepsils Honey & Lemon Lozenges, Pack of 36 , the best selling product in Streptils range. Strepsils Honey & Lemon contains two active antiseptics – 2,4-dichlorobenzyl alcohol and 1.2mg amylmetacresol.
The main advantages of Steptils range:
- the widespread availability of lozenges (supermarkets and pharmacies)
- relatively low price
- range of flavours
- can be used in adults and children over six years of age
- not known interaction with other drugs
- can be used in pregnancy with ”care”
- Contains active ingredient Hexylresorcinol for use in throat medications
- Relieves pain
- Fights infection
7. Olbas Pastilles
Olbas Pastilles take advantage of essential oils to help with symptomatic relief of colds, catarrh, sore throats and cold and flu symptoms. Olbas Pastilles contain various active ingredients, including:
- Eucalyptus Oil
- Peppermint Oil
- Juniper Oil
- Methyl Salicylate and
- Clove Oil
Essential oils are mainly used to improve respiratory symptoms of colds, such as congestion. Methyl salicylate adds a sweet and fruity smell to the pastilles. Methyl salicylate can be used to help manage the pain, however unlikely with the amounts present in Olbas Pastilles.
8. Covonia Medicated Sore Throat Lozenges
Covonia Medicated Sore Throat lozenges (lemon flavour) are pharmacy-only product containing two active ingredients – chlorhexidine dihydrochloride (disinfectant) and lidocaine hydrochloride (a local anaesthetic).
Lidocaine is a local anaesthetic, which numbs the area quickly to reduce pain, whereas chlorhexidine acts an antiseptic agent. It is not clear if products containing a combination of an antiseptic and local anaesthetic help with sore throat symptoms (NICE, 2018).
Covonia Medicated can be used by children and adults over 12 years of age.
9. Covonia Non-Medicated Double Impact Lozenges
Non-medicated Covonia lozenges are also available over the counter (available on the high street and online) as Covonia Double Impact Lozenges. Each Double Impact lozenge is designed as ”split” into two halves. One side of the lozenge works to clear the airways (brown side, which contain menthol) and white side to warm the mouth and throat.
Other features of Covonia range:
- All Covonia products are suitable for vegetarians, some also for vegans
- All Covonia products are gluten-free
- Some Covonia lozenges are sugar-free
- Warming flavour Powerful menthol vapour Gluten free Covonia lozenges are hand made the traditional way in Yorkshire Suitable for vegetarians
- The recipe for Covonia Lozenges has been specially created with really powerful flavours. The lozenges are formed in two halves, the brown side contains a warming flavour, while the white side is mentholated
10. Tyrozets throat lozenges
Although discontinued, I wanted to include Tyrozets on the list of most popular/best lozenges as maybe at some point in the future we will see re-launch of Tyrozets, most likely with a combination of different active ingredients.
Discontinuation of Tyrozets
Tyrozets were discontinued in 2020, following concerns from Medicines and Healthcare products Regulatory Agency (MHRA) about the overuse of an antibiotic, Tyrothricin, which is one of the active ingredients found in Tyrozets.
MHRA quite rightly challenged the sale of Tyrozets, which contain Tyrothricin. Although not available in any other form, Tyrothricin is a combination of two different antibiotic compounds – gramicidin and tyrocidine.
Tyrozets contain two active ingredients: tyrothricin, an antibiotic and benzocaine, a local anaesthetic.
There are no other throat lozenges or products available over the counter which contain tyrothricin. Tyrozets alternative products which may be considered in the treatment of sore throat may include some lozenges reviewed in this post, for example:
- Dequadin (contain dequalinium chloride as an active ingredient, which has antiseptic and topical bacteriostatic properties)
- Covonia Medicated Sore Throat Lozenges (contain a local anaesthetic and antiseptic agent)
- Strefen and Difflam lozenges (both contain non-steroidal anti-inflammatory drugs)
I presented 10 common lozenges available from high street pharmacies, supermarkets and online used in the management of sore throats. Except for NSAIDs containing lozenges, there is little evidence to support their use; however, the soothing effect of throat sweets is almost immediately evident when used to help with the discomfort of the throat.
Overall, simple lozenges such as Jakemans together with analgesic drugs, such as paracetamol or/and ibuprofen are sufficient to help with pain, irritation and discomfort associated with sore throats.
What is your favourite brand of sore throat lozenges? Please leave comments.
Which lozenges are best for sore throat?
There is no data to suggest a particular brand of lozenges are the best, however lozenges containing NSAIDs (Strefan and Difflam lozenges for example) reduce pain and inflammation caused by a sore throat. Simple throat sweets combined with analgesics, such as paracetamol may offer the best treatment option.
Do throat lozenges really help a sore throat?
Sore throat lozenges (medicated and non-medicated) offer soothing effect and lubrication which ease the symptoms of a sore throat. Most sore throats will resolve on its own within a week.
Do Strepsils kill viruses?
Strepsils which contain an antiseptic (disinfectant) agent may kill viruses on the surface of membranes however their overall benefit in the treatment of infection will be modest.
How long does viral sore throat last?
Viral sore throat is a self-limiting condition which lasts about 7 days.
Does ibuprofen help with sore throat?
Simple analgesics (painkillers) such as ibuprofen are recommended as first-line treatment of sore throat. Ibuprofen, an anti-inflammatory drug will help with sore throat by reducing the pain and swelling.
Aspley S.,B. Schachtel, P. Berry, A. Shephard, T. Shea, G. Smith,E. Schachtel (2013). Flurbiprofen lozenges in patients with a “bad sore throat”. Available at: https://doi.org/10.1016/j.jpain.2013.01.574 Accessed on 26/08/2020
Cao B, Wei XC, Xu XR, et al. Seeing the Unseen of the Combination of Two Natural Resins, Frankincense and Myrrh: Changes in Chemical Constituents and Pharmacological Activities. Molecules. 2019;24(17):3076. Published 2019 Aug 24. doi:10.3390/molecules24173076 Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6749531/ Accessed on 26/08/2020
de Looze F, Shephard A, Smith AB. Locally Delivered Flurbiprofen 8.75 mg for Treatment and Prevention of Sore Throat: A Narrative Review of Clinical Studies. J Pain Res. 2019;12:3477-3509. Published 2019 Dec 27. doi:10.2147/JPR.S221706 Available at: https://dx.doi.org/10.2147%2FJPR.S221706 Accessed on 26/08/2020
NICE (2018). Sore throat (acute): antimicrobial prescribing. Available at: https://www.nice.org.uk/guidance/ng84/chapter/recommendations Accessed on 24/08/2020
Nishino T, Tagaito Y, Sakurai Y. (1997). Nasal inhalation of l-menthol reduces respiratory discomfort associated with loaded breathing. Available at: https://www.atsjournals.org/doi/full/10.1164/ajrccm.156.1.9609059 Accessed on 06/04/19
Oxford, J.S. and Leuwer, M. (2011), Acute sore throat revisited: clinical and experimental evidence for the efficacy of over‐the‐counter AMC/DCBA throat lozenges. International Journal of Clinical Practice, 65: 524-530. doi:10.1111/j.1742-1241.2011.02644.x Available at: https://doi.org/10.1111/j.1742-1241.2011.02644.x Accessed on 21/01/2020