There are wide varieties of throat lozenges in the market, claiming to kill germs and bring relief to throat itchiness and pain. The popularity of these products is evident from their availability in a wide range of retail outlets, including drugstores, supermarkets and department stores. Amongst the 41 throat lozenge samples in a survey conducted by the Consumer Council, some were found to be registered drugs or registered proprietary Chinese medicine. Some of the samples had no clear instructions on daily intake limit and direction for use, nor have comprehensive warnings about improper use. Even if a user follows the recommended consumption quantity, the intake of sugar can reach nearly 50% of the daily limit of sugar intake.
The Council stresses that access to accurate product information is a fundamental right of consumers, and is particularly important for medications. Although the pharmaceutical products content in throat lozenges is minimal, given its ready availability at many retail stores, consumers may not realise that excessive consumption may be detrimental to the health of children, pregnant women and breastfeeding mothers. Manufacturers are urged to ensure accuracy and comprehensiveness in the product labels to enable consumers to make informed choices.
Throat lozenges are solid preparations that dissolve in mouth or throat, with sugar, flavourings or sweeteners as base material and combined with one or more drugs to treat throat discomfort or infection. The survey covered 41 samples, focusing on label information, including ingredients, product claims, sugar or other sweetener content, and recommended dosage. According to the information on the labels, 10 of the 41 samples were registered drugs, and 1 was a registered proprietary Chinese medicine, while the remaining 30 samples were ordinary food products.
Among the 10 registered pharmaceutical products, 9 samples contained antiseptic ingredients, such as quaternary ammonium compound, 2,4-dichlorobenzyl alcohol or amylmetacresol, used to treat mouth or throat infection. In 1 lozenge sample with 0.25g of dequalinium chloride, its product label did not specify its maximum daily intake. With reference to the label of medicine containing such ingredient in UK, the daily dosage should not exceed 2mg or a maximum of 8 lozenges per day and consumption exceeding this limit could develop tongue or mouth pain. According to expert opinion, children under 6 or even 10 years old should refrain from taking dequalinium chloride.
4 samples were labelled to contain 2,4-dichlorobenzyl alcohol and amylmetacresol to help relieve mouth and throat symptoms. However, excessive intake of 2,4-dichlorobenzyl alcohol may cause stomach discomfort or irritation to the central nervous system, and amylmetacresol may also induce facial swelling and breathing difficulty.
In addition to their antiseptic function, some throat lozenges of registered pharmaceutical products can also help relieve pain and allergy. 4 samples were found to have an analgesic ingredient with 1 of them containing ambroxol hydrochloride, which also has local anaesthesia, anti-inflammatory and phlegm-clearing functions. However, this ingredient can be released from breast milk and therefore breastfeeding mothers should avoid taking this type of throat lozenge. Another sample with benzydamine hydrochloride, a non-steroidal anti-inflammatory drug, may result in side-effects such as mouth burn, mouth pain, nausea, vomiting, vertigo and headache. People who are allergic to non-steroidal anti-inflammatory drugs may develop a skin rash or throat ulceration, so they should seek advice from pharmacists or other healthcare professionals before purchase.
With regard to the 30 lozenge samples listed as ordinary food, although they are not required like registered drugs to list the ingredients, dosage recommendations and usage instructions, the samples should provide nutrition labels, particularly on the sugar content to which consumers should pay attention. The survey found 22 samples labelled with various sugar ingredients, including sucrose, syrup and honey, ranging from 0.02g to 3.8g per lozenge. Nearly half of them (14 samples) had sugar content up to 70% or more of the total content, with 3 samples containing over 3g of sugar per lozenge.
According to the recommendations of the World Health Organization and the UN Food and Agriculture Organization, the consumption of free sugar should be less than 10% of a person’s daily energy intake. So based on a daily intake of 2,000 Kcal, the intake of free sugar should be less than 50g a day. Consuming 2 lozenges at a time of the sample with the highest sugar content of 3.8g for 3 times a day would have consumed 22g of sugar in total, equivalent to 45% of the recommended daily intake limit.
In the survey, 7 samples claimed to contain no sugar and 1 sample claimed a mere 0.02g sugar content per lozenge. However, samples with low sugar content usually contain artificial sweeteners or sugar alcohol, such as isomalt, xylitol or sorbitol. According to the website of the International Chemical Safety Regulation Agency, high isomalt consumption of 20g to 30g per day may induce a laxative effect.
The survey also found discrepancy in 2 samples between their nutrition labels and ingredients lists. 1 sample was labelled as zero sugar content but on the ingredients list, the top 2 rankings were sugar and syrup, raising doubt about the accuracy of its label. The Council has referred the sample in question to the Centre for Food Safety for follow-up.
Ingredients lists of 13 throat lozenge samples contained honey that serves as a demulcent to soothe throat irritation but honey can be contaminated with clostridium botulinum (botox) spores, so while it may pose a low heath risk for older children and adults, it may pose a higher health risk for infants. Only 2 samples were labelled with the warning not suitable for children under 2 years old. 1 sample was labelled as not suitable for children under 3 years old while another sample was labelled as recommended for children over 6-year-old, and parents should pay attention to such warning.
The cause of throat itchiness and pain is complicated and taking throat lozenges can only relieve the symptoms. Without proper treatment specific to the cause of the sore throat, taking lozenges may result in delay of treatment. Before purchasing and consuming throat lozenges, consumers should clearly check and understand the ingredients and heed to a number of key points as follows:
- Look for the Hong Kong registration number of pharmaceutical products or the proprietary Chinese medicine on the packaging, and read the ingredients lists to ensure they are suitable for your own use. For pregnant women and breastfeeding mothers or in case of doubt, consult a pharmacist or medical professional before use;
- When taking throat lozenges with drug ingredients, strictly follow the dosage recommendations. Exercise due caution to avoid unsuitable or excessive use which will pose a health risk;
- Remember that throat lozenges can only help relieve the symptoms but cannot cure the sickness. If symptoms of throat pain persist, do not hesitate or delay to consult doctor or a Chinese medicine practitioner for proper treatments;
- Most throat lozenges use sugar as their main ingredients, so frequent consumption in large quantity can lead to health problems, such as tooth decay and obesity.
The Consumer Council reserves all its right (including copyright) in respect of CHOICE magazine and Online CHOICE.