In our latest question and answer, our pharmacist discusses potential therapies for treating a persistent sore throat.
Right after Thanksgiving got sick with an upper respiratory infection that came with a nasty sore throat. A steroid pack and 10 days of antibiotics later, respirator stuff mostly gone but throat is still VERY sore (seemingly like strep but doc says throat doesn't present as strep and urgent care actually tested me for that in the first few days I was sick and it came back negative). I have been taking Motrin but don't think it's good to take that long term. What is safe to take that would help with the pain but not damage liver, etc.??
There are several over the counter options for your sore throat pain. A few options that we will discuss include cough drops and throat sprays, non-steroidal anti-inflammatory drugs (NSAIDs), and Tylenol (acetaminophen). Each option has pros and cons depending on your situation.
Cough drops and throat sprays contain active ingredients such as menthol, phenol, and benzocaine. They work by providing a numbing or cooling sensation that provides pain relief in the mouth and throat. These products do not have much systemic absorption which means less risk for side effects and drug interactions. Cough drops are well tolerated, inexpensive, and have a localized effect directly in the throat. The downside with cough drops is that the effect is short-lasting and usually need to be taken every 2 hours to be effective (check the specific product information for dosing).
Medications such as Motrin (ibuprofen) and Aleve (naproxen) fall into a medication class known as NSAIDs. These are commonly used over the counter medications that can be taken for a variety of ailments including arthritis, cramping related to menstruation, general aches and pains, fever, and headache. While there isn’t much data on taking NSAIDs for sore throat, one study shows that ibuprofen seemed to work better than Tylenol (acetaminophen). Naproxen lasts longer than ibuprofen and usually only has to be taken twice daily.
Reasons to avoid NSAIDs would include preexisting GI conditions, heart or blood pressure conditions, and while taking with blood thinners like warfarin, apixaban (Eliquis), clopidogrel (Plavix), or heparin products. The FDA has also recently warned that NSAIDs can increase the risk of heart attacks and stroke even during the first week of use.
NSAIDs don’t necessarily have an inherent risk of causing liver damage (<1% of patients develop liver damage), but may cause an increase in liver enzymes. It is more likely that NSAIDs can cause a decrease in kidney function, but this mostly occurs in patients with kidney conditions.
Tylenol (acetaminophen) is another option for treating sore throat related pain. Acetaminophen can be taken for a variety of acute and chronic pain ailments. Benefits for acetaminophen over NSAIDs include less likelihood to cause GI issues, bleeding, and kidney dysfunction. Acetaminophen can have negative impacts on the liver, especially at higher doses for an extended period of time. The max daily dose of acetaminophen is recommended to be 4000 mg due to the potential for liver damage. This is caused by a build-up of the toxic metabolite N-acetyl-para-benzoquinoneimine (NAPQI). It is rare for liver damage to occur in healthy patients at recommended doses.
As always when fighting an illness, get plenty of rest, drink enough fluids, and follow-up with your physician if your condition worsens.