Topical NSAID (oropharyngeal)
Pregnancy: Considered safe — minimal systemic absorption from oromucosal use.
Benzydamine hydrochloride
Brand names: Difflam, Difflam-C (with chlorhexidine)
Adult dose
Dose: Mouthwash 0.15% (Difflam): 15 ml gargle/rinse every 1.5–3 hours; max 7 doses/day; dilute with equal volume of water if stinging. Spray 0.15%: 4–8 sprays every 1.5–3 hours. Cream 3%: apply BD–TDS to inflamed skin.
Route: Oromucosal / Topical
Frequency: Every 1.5–3 hours as required
Do NOT swallow mouthwash. Maximum 7 days of regular use unless under specialist (radiotherapy mucositis).
Paediatric dose
Route: Oromucosal
Frequency: Every 1.5–3 hours
Mouthwash: ≥12 yrs use as adult; 6–11 yrs spray 4 sprays every 1.5–3 hours. Not recommended <6 yrs (alcohol content, choking).
Clinical pearls
- First-line analgesic-antiseptic combination for radiation-induced oral mucositis (NCI guidance).
- Local anaesthetic effect within minutes — useful between meals during chemoradiotherapy or post-tonsillectomy.
- If stinging is severe at full strength, dilute 1:1 with water (NHS guidance) — efficacy preserved.
- Difflam-C (with chlorhexidine 0.12%) adds antiseptic activity — useful for ulcerative gingivitis.
- OTC and prescription — counsel that effect is symptomatic, not curative.
Contraindications
- Hypersensitivity to benzydamine or aspirin/NSAIDs (cross-reactivity rare but possible)
- Children under 6 (mouthwash; spray can be used 6–11 yrs)
Side effects
- Numbness, stinging, burning of oral mucosa (transient)
- Dry mouth
- Photosensitivity (rare)
- Bronchospasm in NSAID-sensitive individuals
- Hypersensitivity reactions
Interactions
- Minimal — topical/oromucosal use, very low systemic absorption
Monitoring
- Symptomatic relief; reassess if no benefit at 7 days
Reference: BNFc; BNF 90; SmPC Difflam; NICE CKS Mouth Ulcers; NCI/MASCC Mucositis Guidelines. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.