Do lozenges help relieve symptoms in an otherwise healthy adult with a sore throat?

Lozenges for Sore Throat Relief

Yes, lozenges provide effective temporary symptomatic relief for sore throat pain in otherwise healthy adults and should be recommended as part of symptomatic management.

Evidence-Based Recommendation

Lozenges containing topical anesthetics or NSAIDs are appropriate first-line symptomatic therapy for adults with acute sore throat, providing meaningful pain relief that lasts 3-4 hours per dose. 1, 2

• The American College of Physicians and CDC recommend offering analgesic therapy including throat lozenges to help reduce pain in adults with sore throat 3
• Lozenges containing topical anesthetics (ambroxol, lidocaine, benzocaine) provide effective temporary symptomatic relief through local numbing effects 1, 4
• The Infectious Diseases Society of America supports topical agents containing anesthetics for temporary symptom relief 4

Clinical Evidence for Efficacy

NSAID-containing lozenges demonstrate superior efficacy:

• Flurbiprofen 8.75 mg lozenges provided 79.8% greater relief of sore throat pain, 99.6% greater relief of difficulty swallowing, and 69.3% greater relief of swollen throat compared to placebo over 24 hours (all P ≤ 0.01) 2
• A single flurbiprofen lozenge provides significant relief lasting 3-4 hours in patients both with and without streptococcal infection 5
• Benefits are even more substantial in patients with relatively severe symptoms 2

Anesthetic-containing lozenges also show consistent benefit:

• Ambroxol 20 mg lozenges demonstrated statistically significant superiority over placebo in reducing sore throat pain intensity across five randomized controlled trials involving 1,713 evaluable patients 6
• Pain relief has early onset and lasts up to at least 3 hours after a single lozenge 6

Practical Implementation Algorithm

Use lozenges as adjunctive therapy alongside systemic analgesics:

1. First-line approach: Recommend NSAIDs (ibuprofen) or acetaminophen as primary analgesic therapy, as they provide more consistent pain relief than lozenges alone 1, 4
2. Add lozenges: Use lozenges containing topical anesthetics or NSAIDs for additional local relief between systemic analgesic doses 1, 4
3. Dosing: Allow up to 5 lozenges per 24 hours, spaced every 3-6 hours as needed 2
4. Duration: Continue as needed for symptom relief, typically less than one week 3

Important Caveats and Safety Considerations

Lozenges provide only symptomatic relief—they do not alter disease course:

• Lozenges do not shorten the duration of illness or prevent complications 1
• The benefit is purely symptomatic through temporary local effects 1
• Most sore throats resolve within one week without specific treatment 3

Choking hazard in young children:

• Lozenges represent a choking hazard for young children and should be avoided in this population 1
• Reserve for adults and older children capable of safely dissolving lozenges 1

Avoid aspirin-containing lozenges in children:

• Aspirin must be avoided in children due to the risk of Reye syndrome 4

What Does NOT Work

Zinc lozenges lack consistent evidence:

• Evidence for zinc-containing lozenges remains conflicting and inconsistent 1
• The American College of Chest Physicians does not recommend zinc preparations for acute cough due to common cold 1

Antiviral claims are not clinically validated:

• While some in vitro studies suggest virucidal effects of certain lozenge ingredients, these laboratory findings have not translated to clinically meaningful antiviral effects in patients 7, 8
• The primary benefit remains symptomatic pain relief, not viral eradication 1

When to Test for Streptococcal Infection

Clinical features alone cannot reliably diagnose streptococcal pharyngitis:

• Test patients with symptoms suggestive of group A streptococcal pharyngitis: persistent fevers, anterior cervical adenitis, tonsillopharyngeal exudates, and absence of viral features (cough, rhinorrhea, hoarseness) 3, 4
• Clinicians correctly diagnosed Strep A in only 27.5% of cases based on clinical assessment alone (sensitivity 27.5%, specificity 79.7%) 5
• Prescribe antibiotics only if streptococcal pharyngitis is confirmed by rapid antigen detection test or culture 3, 4

Complementary Symptomatic Measures

Additional non-pharmacologic approaches:

• Warm salt water gargles provide symptom relief for patients old enough to gargle safely 4, 9
• Simple home remedies like honey and lemon mixtures are reasonable first-line approaches 1
• Adequate hydration independently reduces pain and may provide additional benefit 9