Medication for Self-Administered Sore Throat Relief
For sore throat related to coughing, analgesic throat lozenges containing local anesthetics (such as benzocaine 8mg, lidocaine 8mg, or ambroxol 20mg) or systemic analgesics (ibuprofen, acetaminophen, or naproxen) can be safely left at bedside for patient self-administration after initial assessment, with appropriate screening for contraindications.
Initial Assessment Requirements
Before allowing bedside self-administration, perform a one-time assessment to:
- Rule out group A streptococcal pharyngitis if the patient has persistent fever, anterior cervical adenitis, or tonsillopharyngeal exudates, as antibiotics may be needed rather than symptomatic therapy alone 1
- Screen for contraindications to NSAIDs, including history of gastrointestinal ulcers, bleeding disorders, kidney disease, liver disease, pregnancy (especially after 20 weeks), or concurrent use of anticoagulants, corticosteroids, SSRIs, or SNRIs 2
- Verify the cough is not due to pneumonia by checking for absence of tachycardia (>100 bpm), tachypnea (>24 breaths/min), fever (>38°C), and abnormal chest findings 1
Recommended Self-Administration Options
Systemic Analgesics (Preferred for Moderate-Severe Pain)
- Ibuprofen 200-400mg every 4-6 hours shows the best benefit-risk profile for sore throat pain relief 3, 4
- Acetaminophen 650mg every 4-6 hours is an alternative with fewer gastrointestinal risks 1, 5
- Naproxen is also effective for symptomatic treatment 1, 4
Key contraindications for NSAIDs: Do not use if patient has active ulcers, severe kidney/liver disease, heart failure, is pregnant beyond 20 weeks, or takes anticoagulants 2
Local Anesthetic Throat Lozenges (Preferred for Mild-Moderate Pain)
- Benzocaine 8mg lozenges have confirmed efficacy in clinical trials 3
- Lidocaine 8mg lozenges provide effective local anesthesia 3
- Ambroxol 20mg lozenges have the best documented benefit-risk profile among local anesthetics 3
These lozenges provide rapid relief within 5 minutes that persists for up to 2 hours 6
Self-Administration Protocol
Dosing Instructions for Patient
- Lozenges: Allow to dissolve slowly in mouth every 2-3 hours as needed, maximum 8 lozenges per 24 hours 6
- Systemic analgesics: Take at scheduled intervals (ibuprofen every 4-6 hours, acetaminophen every 4-6 hours) rather than waiting for severe pain 1
- Do not exceed maximum daily doses: Ibuprofen 1200mg/day (OTC use), acetaminophen 3000mg/day 2
When to Notify Healthcare Provider
Instruct patient to alert staff if:
- Symptoms worsen or persist beyond 7 days (typical self-limited course) 1
- New fever develops or fever persists beyond 3 days 1
- Difficulty swallowing worsens or breathing becomes difficult 1
- Signs of NSAID complications develop: black/tarry stools, vomit that looks like coffee grounds, severe stomach pain, unusual bleeding 2
Additional Supportive Measures
- Salt water gargling can be offered, though evidence is limited 1
- Adequate hydration should be encouraged 1
- Cough suppressants (dextromethorphan or codeine) may help if cough is contributing to throat irritation, though evidence for benefit in acute bronchitis is limited 1
What NOT to Do
- Do not provide antibiotics for symptomatic relief, as most sore throats are viral and antibiotics do little to alleviate symptoms 1
- Avoid topical antibiotics or antiseptics due to lack of efficiency data 3
- Do not use newer-generation antihistamines (cetirizine, loratadine) for acute sore throat, as they are ineffective 7
Special Populations
Patients with Kidney Disease
- Avoid NSAIDs entirely; use acetaminophen instead 2
- Reduce acetaminophen dose if severe liver disease present 5
Patients with Allergies
- Screen for NSAID/aspirin allergy history (asthma attacks, hives, allergic reactions) 2
- Local anesthetic lozenges are generally safe alternatives if systemic analgesics contraindicated 3