2,4-dichlorobenzyl alcohol + amylmetacresol: clinical use

Prescribing considerations

• Confirm the exact formulation, age restriction and excipients; products sharing the Strepsils name are not interchangeable.
• Consider sugar content in diabetes and carbohydrate-intolerance disorders. Strawberry Sugar Free contains polyols that may have a laxative effect.
• Persistent or worsening symptoms, high fever, headache, dehydration, immunosuppression, recurrent symptoms or airway signs require assessment.

Contraindications and cautions

• Hypersensitivity to either active ingredient or any formulation excipient.
• Do not use below the formulation-specific licensed age.
• Honey and Lemon and Menthol formulations should not be used in wheat allergy; their very low gluten content is considered unlikely to affect coeliac disease.
• Avoid relevant sugar-containing formulations in hereditary fructose intolerance, glucose-galactose malabsorption or sucrase-isomaltase deficiency.

Monitoring

• No routine laboratory monitoring is required for local use.
• Review symptom progression and check for oral irritation or hypersensitivity.

Clinical pharmacology

Both ingredients have local antiseptic properties and act principally in the oropharynx. In-vitro sodium-channel blockade may provide a local-anaesthetic-like effect, while formulation bases have a demulcent effect. Product-specific pharmacokinetic data are limited.

Formulation and product differences

• Strawberry Sugar Free uses isomalt and maltitol syrup and contains propylene glycol and benzyl alcohol in its flavouring.
• Honey and Lemon contains sucrose, glucose, honey, wheat-derived glucose, sulphites and fragrance allergens.
• Menthol contains sucrose, glucose, levomenthol, eucalyptus and mint flavourings, propylene glycol, wheat-derived glucose and sulphites; its licensed minimum age and pregnancy wording differ.
• Sulphites in Honey and Lemon and Menthol may rarely cause severe hypersensitivity reactions or bronchospasm.