How often should Cepacol (benzocaine) lozenges be taken for short‑term sore‑throat relief?

Cepacol Dosing for Sore Throat Relief

Cepacol (benzocaine) lozenges should be taken every 2 hours as needed, with a maximum of 8 lozenges per 24 hours for short-term symptomatic relief of sore throat pain.

Standard Dosing Regimen

• Benzocaine lozenges provide rapid pain relief starting within 1-20 minutes after administration, with demonstrated superiority over placebo in reducing throat soreness 1, 2
• The typical dose is one 8 mg benzocaine lozenge dissolved slowly in the mouth every 2 hours as needed, not to exceed 8 lozenges in 24 hours 1
• Treatment duration should be limited to short-term use (typically 2-7 days), as most sore throats resolve within one week regardless of treatment 3, 4

Clinical Context and First-Line Recommendations

While benzocaine lozenges are effective for symptomatic relief, guidelines prioritize systemic analgesics as first-line therapy:

• Ibuprofen or paracetamol (acetaminophen) are recommended as first-line treatments for acute sore throat, with ibuprofen showing slightly better efficacy for pain relief 3, 5
• Benzocaine lozenges serve as an adjunctive or alternative option when systemic analgesics are contraindicated or when patients prefer topical therapy 1
• The combination of systemic analgesics with topical lozenges may provide additive benefit, though this approach lacks specific guideline recommendations 3, 5

Evidence for Efficacy

• Benzocaine 8 mg lozenges significantly reduce pain intensity over 2 hours compared to placebo (p = 0.001), with median time to worthwhile pain relief of 20 minutes versus >45 minutes for placebo 1
• The number needed to treat (NNT) for symptom relief with any analgesic at day 3 is less than 6, demonstrating clinically meaningful benefit 4
• Lozenges containing local anesthetics provide rapid onset of numbness and pain relief within 1-15 minutes, making them useful for immediate symptom control 2

Important Limitations and Cautions

• Do not exceed the maximum daily dose of 8 lozenges, as excessive benzocaine use can lead to methemoglobinemia, particularly in children
• Benzocaine lozenges should not be used in children under 2 years of age due to choking risk and increased susceptibility to adverse effects
• Avoid continuous use beyond 7 days without medical evaluation, as persistent symptoms may indicate bacterial infection requiring antibiotic therapy or other complications 3, 5
• Benzocaine does not treat the underlying cause of sore throat and should not delay appropriate evaluation for Group A Streptococcus if clinical features suggest bacterial pharyngitis 3, 5

When to Consider Alternative or Additional Treatment

• If symptoms persist beyond 3-5 days or worsen, clinical re-evaluation is necessary to assess for bacterial infection or complications 6
• For patients with severe presentations (high Centor scores), testing for Group A Streptococcus is indicated before relying solely on symptomatic treatment 3, 5
• Corticosteroids may be considered in conjunction with antibiotics for severe adult presentations, but are not recommended for routine use or in children 3, 5, 7