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Topical NSAID — Throat / Mouth Pregnancy: Use with caution — limited data; minimal systemic absorption; topical use generally considered acceptable

Benzydamine Hydrochloride

Brand names: Difflam, Difflam Forte

Adult dose

Dose: Mouth rinse (0.15%): 15 mL gargled or rinsed every 1.5–3 hours. Spray (0.15%): 4–8 sprays every 1.5–3 hours
Route: Topical (oropharyngeal)
Frequency: Every 1.5–3 hours
Max: Mouth rinse: 15 mL per use; Spray: 8 sprays per use
Topical NSAID and local anaesthetic for painful inflammatory conditions of the oropharynx: tonsillitis, pharyngitis, post-tonsillectomy pain, aphthous ulcers, oral mucositis (chemotherapy/radiotherapy). Difflam Forte (0.15%) is the standard; dilute if causes stinging.

Paediatric dose

Dose: Age-based spray/kg
Route: Topical
Frequency: Every 1.5–3 hours
Max: 4 sprays per use in children
BNFc: spray — 6–12 years 4 sprays every 1.5–3h; ≥12 years adult dose. Mouth rinse — not recommended under 12 years (swallowing risk). Do not use in infants.

Dose adjustments

Renal

No dose adjustment required (minimal systemic absorption)

Hepatic

No dose adjustment required

Paediatric weight-based calculator

BNFc: spray — 6–12 years 4 sprays every 1.5–3h; ≥12 years adult dose. Mouth rinse — not recommended under 12 years (swallowing risk). Do not use in infants.

Clinical pearls

  • Useful adjunct in post-tonsillectomy pain — reduces analgesic requirement; does not increase bleeding risk at topical doses
  • Oral mucositis from chemotherapy/head and neck radiotherapy: benzydamine 0.15% mouthwash reduces severity and duration (Cochrane 2014)
  • Dilute 1:1 with water if burning or stinging on initial use — maintains efficacy; reduces discomfort
  • Available OTC — patients can self-purchase; useful to recommend specifically for tonsillitis pending antibiotic decision
  • Unlike systemic NSAIDs, topical benzydamine has no significant cardiovascular, renal, or GI systemic effects

Contraindications

  • Hypersensitivity to benzydamine or NSAIDs
  • Infants (choking risk with spray)

Side effects

  • Oral numbness/tingling (expected — local anaesthetic effect)
  • Burning sensation (dilute if occurs)
  • Nausea (if swallowed)
  • Photosensitivity (prolonged use — rare)

Interactions

  • Minimal — negligible systemic absorption at topical doses

Monitoring

  • Symptom response
  • Signs of hypersensitivity

Reference: BNFc; BNF 90; BNFc; Cochrane Review (Clarkson et al. 2014) Oral Mucositis; NICE NG84. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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