What medications can cause throat pain?

Medications That Cause Throat Pain

Multiple commonly prescribed medications can directly injure the esophagus and throat, causing pain through direct mucosal damage, with antibiotics (particularly doxycycline, tetracycline, and clindamycin) accounting for over 50% of cases.

High-Risk Medications for Throat/Esophageal Pain

Antibiotics (Most Common Culprits)

• Doxycycline, tetracycline, and clindamycin are the offending agents in more than 50% of all drug-induced esophageal injury cases 1
• These antibiotics cause direct caustic injury when tablets or capsules remain in contact with esophageal mucosa 1, 2

Anti-inflammatory Medications

• Aspirin (acetylsalicylic acid) and various NSAIDs commonly cause esophageal injury and throat pain 1
• Ibuprofen can cause throat irritation, though it is paradoxically also used to treat throat pain 3
• The FDA label for ibuprofen notes that throat irritation and dryness can occur as adverse effects 3

Cardiovascular Medications

• Potassium chloride is a frequent cause of severe esophageal injury, with serious sequelae including death reported 1, 2
• Quinidine accounts for a significant proportion of medication-induced esophageal complaints 1, 2
• Alprenolol has been reported to induce esophageal disorders 1

Other Common Offenders

• Alendronate (bisphosphonate) is identified as a risk factor for GERD and esophageal injury 4
• Ferrous sulfate (iron supplements) commonly causes esophageal irritation 1
• Oral corticosteroids are risk factors for GERD-related throat symptoms 4

Respiratory Medications

• Inhaled corticosteroids (such as fluticasone) can cause throat irritation, dryness, and sore throat as direct adverse effects 5
• The FDA label for fluticasone specifically lists "sore throat, throat irritation and dryness" as postmarketing adverse events 5
• Bronchodilators including inhaled β-adrenergic agonists and theophylline are risk factors for GERD, which can cause throat pain 4

Additional Medications

• Anticholinergic agents, calcium channel blockers, morphine, and meperidine increase risk of GERD-related throat symptoms 4
• More than 70 different drugs have been reported to induce esophageal disorders to date 1

Mechanism of Injury

Direct Caustic Damage

• Capsules or tablets commonly delay in their passage through the esophagus 1
• Highly caustic coatings and direct medication injury combined with poor esophageal clearance lead to acute inflammation 1
• Esophageal damage occurs when caustic drug contents remain in contact with mucosa long enough to produce lesions 1, 2

Clinical Presentation

• Retrosternal pain, odynophagia (painful swallowing), and dysphagia are the most commonly reported symptoms 2
• Most cases are self-limited with 7-10 days of symptomatic therapy 2
• Occasionally, severe symptoms necessitate hospitalization 2

Critical Risk Factors for Medication-Induced Throat Pain

High-Risk Behaviors

• Taking medications at bedtime or without adequate fluids is the most common preventable cause 1
• Lying down immediately after taking medications increases esophageal contact time 1, 2

Patient Factors

• Pre-existing esophageal motility disorders increase risk 1
• Anatomical abnormalities that delay pill transit 1

Diagnostic Approach

When to Suspect Drug-Induced Injury

• The possibility of drug-related damage should be suspected in ALL cases of esophagitis, chest pain, and dysphagia 1
• Temporal relationship between medication initiation and symptom onset is key 1, 2

Confirmation

• History alone may be sufficient in uncomplicated cases 2
• Endoscopy is the diagnostic study of choice for suspected medication-induced esophageal injury 2
• Air contrast barium swallow may detect subtle mucosal abnormalities 2

Prevention Strategies

Medication Administration

• Concurrent ingestion of adequate amounts of fluid (at least 8 ounces of water) with all oral medications 2
• Avoidance of unnecessary bedtime medications 2
• Remain upright for at least 30 minutes after taking high-risk medications 1

Clinical Awareness

• Many physicians and most patients are unaware of this problem 1
• Proactive counseling about proper medication administration is essential 1

Common Pitfalls

• Assuming all throat pain is infectious in origin without considering medication history 1
• Failing to ask specifically about timing of medication administration relative to symptoms 2
• Not recognizing that even commonly prescribed "safe" medications can cause significant esophageal injury 1
• Overlooking that antibiotics prescribed to treat throat infections can paradoxically worsen throat pain through direct mucosal injury 1, 2