What over-the-counter (OTC) sprays or lozenges, such as Chloraseptic (phenol) or Cepacol (menthol and eucalyptus), can provide relief for a patient experiencing a sore throat or mouth pain?

OTC Sprays and Lozenges for Sore Throat Relief

Phenol-based sprays (such as Chloraseptic at 1.4% concentration) and lozenges containing amylmetacresol/2,4-dichlorobenzyl alcohol (AMC/DCBA) or hexylresorcinol are effective OTC options for temporary relief of sore throat pain. 1, 2

Recommended OTC Spray Options

Phenol 1.4% oral spray (e.g., Chloraseptic) is FDA-approved for temporary relief of occasional minor irritation, pain, sore mouth, and sore throat. 1

• This formulation is approved for ages 2 years and older 1
• Available in various flavors including cherry 1
• Provides topical anesthetic/analgesic effects 1

Recommended OTC Lozenge Options

Hexylresorcinol Lozenges

Hexylresorcinol lozenges demonstrate superior efficacy with rapid onset of action beginning 1-5 minutes post-dose and peak numbness at 10 minutes. 2

• Showed statistically significant superiority over placebo for throat soreness, sore throat relief, and difficulty swallowing 2
• Provides antiviral activity against multiple respiratory viruses including parainfluenza virus type 3 3
• Well-tolerated with minimal side effects 2

AMC/DCBA Lozenges

Lozenges containing amylmetacresol and 2,4-dichlorobenzyl alcohol (available in multiple Strepsils formulations) provide rapid relief starting 1-10 minutes post-dose. 2

• Multiple formulations available: Original, Extra Strong, Warm, Orange with Vitamin C, Sugar-free Lemon, Children's Strawberry, and Soothing Honey and Lemon 4
• Demonstrate virucidal effects against parainfluenza virus type 3 and cytomegalovirus with peak effects at 1 minute of contact 3
• AMC/DCBA with added lidocaine provides enhanced numbing sensation beginning at 1 minute, peaking at 15 minutes 2

Carrageenan Lozenges

Iota-carrageenan lozenges show highly effective antiviral activity against all tested respiratory viruses, reducing viral titer by 85-91% during the residence time in the mouth. 4

• Superior broad-spectrum antiviral efficacy compared to AMC/DCBA or hexylresorcinol formulations 4
• Fast binding and inactivation of virus particles 4

Delivery Format Considerations

Lozenges and tablets are significantly more effective than sprays or gargles for delivering active ingredients to the throat. 5

• Solid dose forms (lozenges/tablets) show significantly greater initial deposition in mouth and throat combined compared to sprays or gargles 5
• Lozenges maintain significantly more of the dose at 10 and 20 minutes compared to tablets 5
• The mouth acts as a reservoir for continued clearance to the throat, providing prolonged delivery up to 2 hours 5

Important Caveats and Pitfalls

Avoid excessive menthol-containing cough drop use, as higher menthol consumption correlates with increased cough severity. 6

• Cough severity shows significant independent associations with average menthol dose per drop (R=0.19, P=0.007), number of drops consumed daily (R=0.2, P=0.002), and total daily menthol consumption (R=0.21, P=0.001) 6
• Clinicians should specifically inquire about cough drop use in patients with persistent cough 6

These products provide symptomatic relief only and should be used as part of appropriate management that includes NSAIDs (ibuprofen) or acetaminophen as first-line analgesics. 7

• Do not rely on OTC throat products alone for pain management 7
• Consider antibiotic therapy only when clinically indicated based on validated scoring systems (Centor, McIsaac, or FeverPAIN) 7