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Benzydamine hydrochloride (BNZ) is a familiar name in ENT and dental prescriptions, but recent data show it is more than “just a sore-throat spray.ˮ For dentists and general practitioners, it offers a practical, locally acting option for managing inflammatory, infectious and post‑procedural pain in the oral and oropharyngeal region.
BNZ is an indolic NSAID with predominantly topical action, exhibiting anti‑inflammatory, analgesic, local anaesthetic, antimicrobial, and antifungal effects. Unlike classic NSAIDs, its primary mechanism is not COX or LOX inhibition; instead, it reduces pro‑inflammatory cytokines (TNF‑α, IL‑1), interferes with leukocyte–endothelial interactions, stabilises membranes, and can block voltage‑gated sodium channels in sensitised nociceptors. This combination explains rapid symptom relief with relatively low systemic exposure when used as a spray, mouthwash, gargle or lozenge.
In acute sore throat and tonsillopharyngitis, BNZ sprays and lozenges provide rapid pain relief within minutes and maintain efficacy over several days, with good tolerability. It has also been tested around tonsillectomy and after intubation (post-operative sore throat), where several trials and meta‑analyses show reduced incidence and/or severity of symptoms when used as a spray on the tube cuff, gargle, or oral rinse, though not all studies are positive. For clinicians, this means BNZ can be considered as an adjunct to standard
systemic analgesia in peri‑operative airway‑related pain, particularly when minimising opioid or systemic NSAID use is desirable.
Oral mucositis in head‑and‑neck cancer remains a significant cause of treatment interruption and poor quality of life. International MASCC/ISOO guidelines recommend BNZ mouthwash for the prevention of radiation‑induced oral mucositis in head‑and‑neck patients receiving radiotherapy alone, and several trials (including more recent ones) support reduced severity and delayed onset, especially compared with simple rinses such as sodium bicarbonate. Evidence is more mixed when concurrent chemotherapy is added or when BNZ is compared with some herbal or lidocaine‑based mouthwashes, underlining the need to align expectations and dosing schedules.
In recurrent aphthous stomatitis, BNZ has not consistently reduced ulcer frequency. However, patients often report better pain relief due to its anaesthetic effect, making it a reasonable symptomatic adjunct alongside standard anti‑inflammatory or corticosteroid regimens. In plaque‑induced gingivitis, BNZ mouthwash has shown reductions in gingival inflammation comparable to chlorhexidine in some trials, with relatively low cytotoxicity to gingival fibroblasts; however, not all studies have reproduced these benefits when used as a spray formulation.
After periodontal surgery, including crown lengthening, BNZ mouthwash (0.15%) has provided pain control comparable to ibuprofen 400 mg and superior to diclofenac 50 mg in the short‑term post-operative period, with the advantages of topical delivery, fewer systemic adverse effects, and lower cost. This makes BNZ a practical option when systemic NSAIDs are contraindicated or need to be minimised, for example, in patients with GI risk, renal compromise or polypharmacy.
Across multiple phase IV studies and meta‑analyses, topical BNZ (sprays, mouthwashes, gargles, lozenges) shows a favourable safety profile, with adverse effects usually limited to transient oral numbness or tingling, consistent with its local anaesthetic action. There is no evidence of interference with oncologic treatments, and paediatric use in oropharyngeal conditions has been documented.
Emerging drug‑delivery approaches thermoresponsive in‑situ gels, mucoadhesive buccal films, nanosponges, chitosan‑based particles, and fast‑dissolving oral strips—aim to extend contact time on mucosa, provide sustained release, and potentially enhance local bioavailability for conditions such as mucositis and aphthous ulcers. For frontline clinicians, this pipeline suggests that BNZ is likely to remain a relevant tool in managing localised oral and pharyngeal pain, with progressively more patient‑friendly and targeted formulations on the horizon.
