Tyrozets review of throat lozenges

Tyrozets sore throat lozenges are pharmacy-only medication (P) licensed in the management of sore throats and throat irritations, for example, following a surgical procedure to remove tonsils or other mouth procedures. Tyrozets are advertised as a product with dual action, which comes from it’s two active ingredients. Firstly, Tyrozets quickly numbs the throat, helping with the management of the pain, and secondly, an antibiotic used in the formulation of lozenges ‘help to fight the throat infection’. Tyrozets review covers the following: 

• license use review of Tyrozets
• review of possible side effects
• discussion on the effectiveness in relation to its two main active ingredients
• discussion on the use of Tyrozets lozenges in pregnancy and when breastfeeding, and 
• availability of this product

Tyrozets: restrictions on age and duration of treatment

Tyrozets lozenges can be used by children and adults from 3 years of age. It is recommended that patients should consider stopping the use if the response is not sufficient. Tyrozets should not be used for longer than five days.  

Tyrozets review of dosage

For children aged 3-11 years: 

• the reduced dose is recommended
• maximum of 6 lozenges in 24 hours
• allow Tyrozets to be slowly dissolved, do not chew or swallow. 

Children and adults 12 years and above:

• one lozenged to be dissolved in the mouth every three hours
• maximum of 8 lozenges in 24 hours 
• allow Tyrozets to be slowly dissolved, do not chew or swallow.

Children under 3 years of age:

• do not use Tyrozets 

Tyrozets review of main active ingredients

Tyrozets contain two active ingredients: 

• Tyrothricin, an antibiotic and 
• Benzocaine, a local anaesthetic 

Tyrothricin is classified as an antibiotic, although not used in any other form in the treatment of bacterial infections in the UK. Tyrothricin is a mixture of two different antibiotics gramicidin and tyrocidine.

Interestingly, tyrothricin is produced and extracted from bacteria Bacillus brevis. Tyrothricin belongs to a group of antimicrobial peptides (AMPs). AMPs are produced by all organisms and play a role as the first-line defense against infections (Lang & Staiger, 2016).

Benzocaine is a local anaesthetic, which numbs the area to which it is applied and thus helps with the management of pain. Benzocaine can be found in other products used in conditions associated with pain, for example, oral gels (brand name: Orajel) to help with toothaches, or creams (brand name: Lanacane cream) for symptomatic relief of pain, irritation, and itching due to insect bites and other causes. Anaesthetic throat sprays containing benzocaine can also be purchased, for example, Ultra Chloraseptic throat spray. 

Tyrozets review of the effectiveness 

Tyrozets has been licensed since 2008. There is no information available publicly on the possible effectiveness of this product. Benzocaine produces numbness when Tyrozets are sucked. Local anaesthetics are effective in reducing pain with a number of studies confirming their benefits (Quaba et al, 2005)., hence their wide application in dental procedures, cannulation, skin grafting, and other procedures. Only properly set up clinical study could provide us with some useful information on Tyrozets effectiveness in terms of pain management and possible effect (if any) on the treatment of throat infections.

The majority of sore throats are caused by viral infections, often associated with colds. Most cases sore throats are self-limiting (no treatment is needed), lasting about 7 days. Antibiotic treatment is generally not recommended for acute episodes of sore throats unless patients have other symptoms, are very unwell, or have other underlying illness or condition (NICE, 2017). Patients should seek medical attention if (ibid):  

• symptoms get worse quickly or significantly
• when symptoms last more than 7 days or 
• an individual becomes very unwell 
• a patient takes immunosuppressive medication 

Limited information is available describing the effectiveness of tyrothricin in the management of sore throats. Nevertheless, some studies (in the lab) confirm its anti-bacterial as well as anti-viral and anti-fungal properties. As an antibiotic, tyrothricin has the best potential in treatments of skin infections (Lang & Staiger, 2016).

Lozenges, increase the production of saliva by sucking action as fast as 1 minute after individuals start to use them. Saliva soothes the inflammation associated with sore throats and provides lubrication (Oxford & Leuwer, 2011).  

Tyrozets review of possible side effects

Patients are advised that soreness or blackness of a tongue may happen when Tyrozets are used. This goes away after the treatment is stopped. 

Benzocaine can also cause skin rashes. Despite being safe and low-risk when used topically, benzocaine has the potential to cause methemoglobinemia, a life-threatening side effect. Methemoglobinemia rarely occurs in children or infants after benzocaine absorption. Methemoglobinemia is characterised by: 

• decreased amounts of oxygen reaching tissues 
• skin discoloration (going blue) due to lack of oxygen 
• difficulty / heavy breathing 

Tyrozets in pregnancy: can you use them?

There is no information on the effects of benzocaine or tyrothricin in pregnancy. Tyrozets should not be used in pregnancy unless benefits outweigh the possible risks. 

Tyrozets and breastfeeding: can you use them? 

It is not known if either of the active ingredients included in Tyrozets lozenges is excreted in the milk. Tyrozets should not be used when breastfeeding unless benefits outweigh the possible risks. 

Tyrozets: where to buy them from?

As previously mentioned, Tyrozets are pharmacy-only medication. P medicines can only be purchased from registered pharmacies with a pharmacist being present at the premises. Most pharmacies such as Boots, Lloyds, Asda or Tesco stock Tyrozets. Tyrozets can also be bought online from registered pharmacies. 

Acute sore throat: self-care advice 

Self-management of sore throats include: 

• Use of pain relief drugs such as paracetamol or ibuprofen (NSAIDs)
• Use of sore throat lozenges with a local anaesthetic, such as Tyrozets or other lozenges containing antiseptics or NSAIDs (Flurbiprofen, for example, Strefen honey & lemon lozenges)
• Use of throat sprays containing a local anaesthetic 
• Use of mouthwashes containing a local anaesthetic
• Gargle with warm, salty water
• Adequate fluid intake

Note: there is little evidence confirming the effectiveness of any over the counter medication in the treatment of sore throats. 

Conclusion 

Despite the lack of evidence on effectiveness, Tyrozets lozenges can be used in the management of sore throat. As local anaesthetic benzocaine is effective in numbing the throat, possibly providing for the some pain relief. Patients should consider other self-care suggestions. Paracetamol and ibuprofen are effective in reducing the pain associated with sore throats (Kenealy, 2011). 

FAQ

References:

Lang, C., Staiger C. (2016). Tyrothricin – An underrated agent for the treatment of bacterial skin infections and superficial wounds? Available at: https://www.researchgate.net/publication/304498355_Tyrothricin_-_An_underrated_agent_for_the_treatment_of_bacterial_skin_infections_and_superficial_wounds Accessed on 19/01/2020

Kenealy T. Sore throat. BMJ Clin Evid. 2011;2011:1509. Published 2011 Jan 13. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3275136/ Accessed on 21/01/2020

Oxford, J.S. and Leuwer, M. (2011), Acute sore throat revisited: clinical and experimental evidence for the efficacy of over‐the‐counter AMC/DCBA throat lozenges. International Journal of Clinical Practice, 65: 524-530. doi:10.1111/j.1742-1241.2011.02644.x Available at: https://doi.org/10.1111/j.1742-1241.2011.02644.x Accessed on 21/01/2020

Quaba O, Huntley JS, Bahia H, et al. (2005) A users guide for reducing the pain of local anaesthetic administration. Emergency Medicine Journal 2005;22:188-189. Available at: http://dx.doi.org/10.1136/emj.2003.012070 Accessed on 20/01/2020