Benzydamine mouthwash, spray and lozenges (Difflam): uses and cautions

Benzydamine is an NSAID, a medicine that reduces pain and inflammation, formulated as a mouthwash, mouth spray or lozenge so that it acts locally. It does not help pain anywhere else in the body. The NHS lists mouth ulcers, sore throats, sore tongue or gums and teething in babies, and it may also be used for pain from dentures or dental surgery. The NHS says it is not used for ulcers caused by chemotherapy; people having chemotherapy should ask their cancer nurse.

The NHS sets out age limits. From 1 month to 5 years only the spray is used, from 6 to 12 years the spray or lozenges, and from 13 years upwards mouthwash, lozenges or spray. Benzydamine mouthwash contains more alcohol than the spray and must not be given to children aged 12 and under.

For the mouthwash, adults and children from 13 use 15ml every 1.5 to 3 hours as needed. Gargle or rinse for 20 to 30 seconds, then spit it out, using the measuring cup, and do not swallow it. Leave at least 1 hour and 30 minutes between doses.

For the spray, adults and children from 12 use 4 to 8 sprays of the 0.15% spray, or 2 to 4 of the 0.3% spray, every 1.5 to 3 hours. Children aged 6 to 11 use 4 sprays of 0.15% or 2 sprays of 0.3%. For children aged 5 and under the dose is worked out from weight by a doctor or pharmacist. Prime a new spray away from your face, aim the spray arm at the sore area, wipe the arm afterwards so it does not block and keep it away from your eyes.

For lozenges, adults and children from 6 can have 1 lozenge, 3 times a day, letting it dissolve slowly without chewing or swallowing whole, and no more than 3 lozenges in a day.

You can usually use benzydamine for up to 7 days. If symptoms do not improve after 7 days, speak to a doctor, dentist or pharmacist and stop after 7 days unless they say it is fine. If you are treating mouth ulcers, get advice if there is no improvement within 3 days or they are getting worse.

A missed mouthwash or spray dose can be used when you remember, then carry on every 1.5 to 3 hours. Skip a missed lozenge, and never take an extra to make up. Using more than recommended without swallowing it is very unlikely to cause serious effects, but contact 111 if you have used or swallowed more than the recommended dose.

Some people get a stinging feeling or numbness in the mouth, which with the spray may last a few minutes. With the mouthwash the NHS suggests diluting a dose with up to 15ml of water. Swelling of the lips, mouth, throat or tongue could signal a serious allergic reaction and needs 999. Suspected side effects can be reported through the Yellow Card scheme.

You can drive or ride a bike while using benzydamine and eat and drink normally, remembering that the mouthwash and spray contain alcohol. It is usually fine to drink alcohol, and contraception is unaffected.

Most adults can use benzydamine. Tell your doctor or pharmacist if you have ever had an allergic reaction to it or other medicines, if you have had an allergic reaction to NSAIDs including aspirin, ibuprofen or naproxen, if you have ever had asthma, or if you are pregnant, trying to get pregnant or breastfeeding. Other medicines are unlikely to affect how it works, but tell your doctor, dentist or pharmacist about everything you take.

If you are pregnant, talk to a doctor or pharmacist. Only small amounts reach the body because most stays in the throat, so it may be acceptable, but only for a few days. It is OK to use while breastfeeding for as short a time as possible, and there is no evidence of an effect on fertility.

The NHS suggests other self-help for a sore throat or mouth ulcer: paracetamol for pain, gargling with warm salty water for adults (not recommended for children) and medicated lozenges containing a local anaesthetic or antiseptic. See a doctor if a sore throat has not improved after a week.