Can Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) cause throat irritation?

Can NSAIDs Cause Throat Irritation?

Yes, NSAIDs can cause throat irritation, though this is not a primary or common adverse effect documented in major guidelines. The most clinically relevant throat-related symptom associated with NSAIDs occurs as part of hypersensitivity reactions, where throat irritation may signal a serious allergic response requiring immediate attention.

Direct Mucosal Effects

• NSAIDs can cause pill-induced esophagitis, which may present with throat discomfort, particularly when tablets are taken without adequate water or in patients with preexisting acid reflux 1.
• The mechanism involves direct mucosal contact injury rather than systemic pharmacologic effects, and this risk extends throughout the gastrointestinal tract from esophagus to rectum 2.
• Esophageal complications are more common in elderly patients and those with preexisting gastroesophageal reflux disease, though NSAIDs themselves do not typically provoke new-onset reflux in healthy individuals 1.

Throat Irritation as a Hypersensitivity Warning Sign

• Throat irritation occurring during NSAID use may indicate a serious hypersensitivity reaction, as documented in a case where a patient developed urticaria and throat irritation during aspirin challenge, requiring two doses of intramuscular epinephrine 3.
• This presentation represents a potentially severe "blended reaction" that can progress to anaphylaxis, particularly when accompanied by other symptoms like urticaria, lip swelling, or dyspnea 3.
• The 2022 practice parameter from the Journal of Allergy and Clinical Immunology notes that mucosal involvement (including throat symptoms) can be a prodromal sign of Stevens-Johnson syndrome/toxic epidermal necrolysis, though NSAIDs may be falsely implicated when started for fever accompanying these conditions 4.

Clinical Context and Risk Assessment

• For common cold symptoms, NSAIDs do not significantly improve throat irritation according to European rhinosinusitis guidelines, which found that while NSAIDs benefit headache and muscle pain, "throat irritation is not improved" 4.
• The FDA label for naproxen lists stomatitis (mouth inflammation) among adverse reactions occurring in 1-10% of patients, but does not specifically highlight throat irritation as a common complaint 5.
• Respiratory symptoms including throat involvement are more concerning in asthmatics, where 8-20% of adults may experience bronchospasm and associated upper airway symptoms within 20 minutes to 3 hours of NSAID ingestion 6.

Critical Clinical Pitfalls

• Never dismiss throat irritation that occurs acutely after NSAID ingestion, especially if accompanied by urticaria, angioedema, dyspnea, or other systemic symptoms, as this may represent evolving anaphylaxis requiring epinephrine 3.
• Patients with asthma and nasal polyps are at particularly high risk for severe respiratory reactions, and throat symptoms in this population warrant immediate cessation of the NSAID 6, 2.
• To minimize pill-induced esophageal injury, counsel patients to take NSAIDs with adequate water and avoid lying down immediately after ingestion, particularly in elderly patients or those with known reflux 1.

Safe Alternative Approaches

• If throat irritation occurs with one NSAID and hypersensitivity is suspected, selective COX-2 inhibitors like celecoxib show lower cross-reactivity rates and may be better tolerated, though this should only be attempted under medical supervision 7, 8.
• Acetaminophen remains the safest first-line alternative for patients with any NSAID-related throat or mucosal symptoms, as it is chemically distinct and does not trigger COX-1 mediated reactions 8.
• For topical pain relief needs, non-NSAID options like capsaicin or lidocaine preparations avoid systemic absorption and associated mucosal effects 7.