Strefen Honey & Lemon (Flurbiprofen Throat Spray)
NSAID oromucosal spray for short-term relief of sore throat pain and inflammation in adults
Quick Facts: Strefen Honey & Lemon
Key Takeaways
- Targeted throat relief: Flurbiprofen spray delivers anti-inflammatory and analgesic action directly to the site of pain in the throat, with onset within 15-30 minutes
- Short-term use only: Do not use for more than 3 days unless directed by a doctor. Seek medical advice if symptoms persist or worsen
- Adults only: Not suitable for children or adolescents under 18 years of age
- Avoid with other NSAIDs: Do not combine with ibuprofen, aspirin, naproxen or other anti-inflammatory medicines to prevent increased risk of side effects
- Not in late pregnancy: Must not be used during the last 3 months of pregnancy. Avoid throughout pregnancy unless medically advised
What Is Strefen Honey & Lemon and What Is It Used For?
Strefen Honey & Lemon is an oromucosal spray containing flurbiprofen 8.75 mg per dose. It belongs to the NSAID class of medicines and is used for short-term symptomatic relief of sore throat, including pain, swelling and difficulty swallowing, in adults aged 18 and over.
Flurbiprofen, the active ingredient in Strefen Honey & Lemon, is a non-steroidal anti-inflammatory drug (NSAID). NSAIDs work by inhibiting cyclooxygenase (COX) enzymes, specifically both COX-1 and COX-2. These enzymes are responsible for the production of prostaglandins, which are chemical mediators that play a central role in the inflammatory response. By reducing prostaglandin synthesis at the site of application in the throat, flurbiprofen decreases inflammation, pain and local swelling.
When sprayed to the back of the throat, flurbiprofen provides topical anti-inflammatory and analgesic effects in the oropharynx. Clinical studies have demonstrated that a single 8.75 mg dose of flurbiprofen delivered as a throat spray provides significant pain relief within approximately 15 to 30 minutes, with the effects lasting between 3 and 6 hours. This makes it particularly effective for the acute phase of sore throat where pain and swelling are most troublesome.
Sore throat is one of the most common reasons for seeking medical advice and purchasing over-the-counter remedies. While most sore throats are caused by viral infections and resolve within 5 to 7 days, the pain and discomfort can significantly impact quality of life, making it difficult to eat, drink and sleep. Strefen Honey & Lemon is designed to provide relief from these symptoms while the underlying cause resolves naturally.
Strefen Honey & Lemon treats the symptoms of sore throat (pain, swelling, difficulty swallowing) but does not treat the underlying cause. If you suspect a bacterial throat infection (such as strep throat), you may need antibiotics. Consult your doctor if symptoms persist beyond 3 days, worsen, or if you develop fever, difficulty breathing, or a rash.
The spray formulation offers several advantages over traditional lozenges and oral tablets. The fine mist allows for direct application to the inflamed area at the back of the throat, providing more rapid and targeted relief. Each bottle contains 15 ml of solution, which is sufficient for approximately 83 individual sprays, or roughly 27 doses. The honey and lemon flavouring provides a pleasant taste that is well-tolerated by most users.
What Should You Know Before Using Strefen Honey & Lemon?
Strefen Honey & Lemon should not be used if you are allergic to flurbiprofen, aspirin or other NSAIDs, if you have a history of peptic ulcers or gastrointestinal bleeding, if you are in the last three months of pregnancy, or if you have severe heart, kidney or liver failure. It is not suitable for anyone under 18 years of age.
Contraindications
There are several important contraindications to using Strefen Honey & Lemon. Understanding these is essential for safe use. Do not use this medicine if any of the following apply to you:
- Allergy to flurbiprofen or other NSAIDs: If you have ever had an allergic reaction to flurbiprofen, aspirin, ibuprofen, naproxen, diclofenac or any other NSAID, you must not use this product. Allergic reactions to NSAIDs can include asthma, wheezing, itching, runny nose, skin rash or swelling
- Peptic ulcer disease: If you have or have previously had stomach ulcers, duodenal ulcers, or bleeding or perforation of the gastrointestinal tract on at least two occasions
- Severe ulcerative colitis: If you have had severe inflammation of the bowel (colitis)
- Bleeding disorders: If you have ever experienced problems with blood clotting or bleeding after taking NSAIDs
- Late pregnancy: Must not be used during the last three months (third trimester) of pregnancy due to risk of premature closure of the ductus arteriosus and other complications
- Severe organ failure: If you have severe heart failure, severe kidney failure, or severe liver failure
- Under 18 years of age: This product is not intended for use in children or adolescents
Warnings and Precautions
Even if none of the contraindications above apply to you, there are situations where extra caution is required. Speak to your doctor or pharmacist before using Strefen Honey & Lemon if any of the following apply:
- You are already taking another NSAID or aspirin
- You have tonsillitis or suspect a bacterial throat infection, as you may need antibiotics
- You have an active infection (NSAIDs can mask signs of infection such as fever and pain, which may delay appropriate treatment and increase the risk of complications)
- You are elderly, as you may be at greater risk of side effects
- You have or have ever had asthma or allergies
- You suffer from systemic lupus erythematosus (SLE) or mixed connective tissue disease
- You have high blood pressure
- You have a history of inflammatory bowel disease (ulcerative colitis or Crohn's disease)
- You have heart, kidney or liver problems
- You have had a stroke
- You are in the first 6 months of pregnancy or breastfeeding
Any skin reaction such as rash, blistering, peeling or flaking skin. Signs of severe allergic reaction including swelling of the face, tongue or throat, difficulty breathing, rapid heartbeat or a drop in blood pressure. These can occur even on first use of the medicine.
Medicines like flurbiprofen may be associated with a small increased risk of heart attack or stroke. Any risk is more likely with high doses and prolonged treatment. Do not exceed the recommended dose or duration of treatment. If you have heart problems, a history of stroke, or risk factors for cardiovascular disease (such as high blood pressure, diabetes, high cholesterol or smoking), discuss with your doctor before use.
Pregnancy and Breastfeeding
If you are pregnant, breastfeeding, think you may be pregnant, or are planning to have a baby, consult your doctor or pharmacist before using this medicine. The following restrictions apply:
- Third trimester (months 7-9): Strefen must NOT be used. NSAIDs during late pregnancy can cause premature closure of the ductus arteriosus in the foetus, delay labour, and increase the risk of maternal and foetal bleeding
- First and second trimester (months 1-6): Use should be avoided unless considered essential by a doctor, as NSAIDs may affect foetal development
- Breastfeeding: Flurbiprofen passes into breast milk in small amounts. Consult your doctor before use
- Fertility: Flurbiprofen belongs to a group of medicines (NSAIDs) that may impair female fertility. This effect is reversible when treatment is stopped
Driving and Using Machines
Strefen Honey & Lemon should not affect your ability to drive or operate machinery under normal circumstances. However, dizziness and visual disturbances are possible side effects of NSAIDs. If you experience these, do not drive or use machines until the effects have resolved.
Important Information About Ingredients
Strefen Honey & Lemon contains several excipients that may cause reactions in sensitive individuals:
- Methyl parahydroxybenzoate (E218) and propyl parahydroxybenzoate (E216): May cause allergic reactions, possibly delayed
- Fragrance allergens: Contains anisyl alcohol, citral, citronellol, d-limonene, geraniol and linalool, which may cause allergic reactions
- Sodium: Contains less than 1 mmol (23 mg) sodium per dose, essentially sodium-free
How Does Strefen Honey & Lemon Interact with Other Drugs?
Strefen Honey & Lemon can interact with many commonly used medicines. The most clinically significant interactions are with other NSAIDs, anticoagulants (blood thinners), antihypertensive medicines, methotrexate, lithium and SSRIs. Always tell your doctor or pharmacist about all medicines you are taking.
Drug interactions with flurbiprofen are an important consideration, even when used as a topical throat spray. Although the systemic absorption from the spray is lower than from oral tablets, flurbiprofen is still absorbed into the bloodstream and can interact with other medicines. The following table summarises the most important drug interactions.
Major Interactions
| Medicine / Class | Interaction Effect | Clinical Advice |
|---|---|---|
| Other NSAIDs (ibuprofen, naproxen, diclofenac, COX-2 inhibitors) | Increased risk of gastrointestinal ulceration, bleeding and perforation | Do not use Strefen together with any other NSAID |
| Warfarin, heparin and other anticoagulants | Enhanced anticoagulant effect; increased bleeding risk | Avoid concomitant use or seek medical advice |
| Aspirin (acetylsalicylic acid) | Increased GI bleeding risk; may reduce cardioprotective effect of low-dose aspirin | Avoid unless directed by a doctor |
| Methotrexate | Reduced renal clearance of methotrexate; increased toxicity risk | Avoid, especially within 24 hours of methotrexate dosing |
| Lithium | Reduced renal excretion; increased lithium plasma levels and toxicity risk | Monitor lithium levels; seek medical advice |
| Mifepristone | NSAIDs may reduce the effectiveness of mifepristone | Do not use NSAIDs for 8-12 days after taking mifepristone |
Other Important Interactions
| Medicine / Class | Interaction Effect | Clinical Advice |
|---|---|---|
| ACE inhibitors, ARBs (blood pressure medicines) | Reduced antihypertensive effect; risk of renal impairment | Monitor blood pressure; ensure adequate hydration |
| Diuretics (including potassium-sparing) | Reduced diuretic effect; risk of hyperkalaemia with potassium-sparing diuretics | Monitor kidney function and potassium levels |
| SSRIs (antidepressants) | Increased risk of gastrointestinal bleeding | Use with caution; be aware of bleeding signs |
| Corticosteroids | Increased risk of GI ulceration and bleeding | Use with caution; seek medical advice |
| Digoxin (cardiac glycosides) | Increased plasma digoxin levels | Monitor digoxin levels |
| Ciclosporin, tacrolimus | Increased risk of nephrotoxicity | Monitor kidney function closely |
| Quinolone antibiotics (ciprofloxacin, levofloxacin) | Possible increased risk of seizures | Use with caution |
| Oral antidiabetic medicines | Possible alteration of blood glucose levels | Monitor blood glucose more frequently |
| Phenytoin | Possible increased phenytoin plasma levels | Monitor phenytoin levels |
| Probenecid, sulfinpyrazone | May delay excretion of flurbiprofen; reduced uricosuric effect | Seek medical advice before combining |
| Zidovudine | Increased risk of haematological toxicity | Monitor blood counts; seek medical advice |
Alcohol
You should avoid drinking alcohol while using Strefen Honey & Lemon. Alcohol increases the risk of gastrointestinal bleeding when combined with NSAIDs, even with short-term topical use. This risk is further elevated in individuals who regularly consume alcohol or who have a history of stomach ulcers.
What Is the Correct Dosage of Strefen Honey & Lemon?
For adults aged 18 and over: spray 3 times (one dose = 8.75 mg flurbiprofen) to the back of the throat every 3 to 6 hours as needed. Do not exceed 5 doses (15 sprays total) in 24 hours. Do not use for more than 3 days without medical advice.
Always use this medicine exactly as described in the patient information leaflet or as directed by your doctor or pharmacist. Use the lowest effective dose for the shortest time needed to relieve your symptoms. If you have an infection and symptoms (such as fever and pain) persist or worsen, contact your doctor or pharmacist promptly.
Adults (18 years and over)
Standard Dosage
- Single dose: 3 sprays to the back of the throat (delivers 8.75 mg flurbiprofen)
- Dosing interval: Every 3 to 6 hours as needed
- Maximum daily dose: 5 doses (15 sprays = 43.75 mg flurbiprofen) in 24 hours
- Maximum duration: 3 days without medical supervision
- Route: Oromucosal (spray to the back of the throat only)
Children and Adolescents
Strefen Honey & Lemon must not be used by children or adolescents under 18 years of age. The safety and efficacy of flurbiprofen throat spray has not been established in this age group. If your child has a sore throat, consult a doctor or pharmacist for appropriate treatment options.
Elderly Patients
Elderly patients are at increased risk of side effects from NSAIDs, particularly gastrointestinal bleeding, ulceration and renal impairment. While no specific dose adjustment is required, elderly patients should use the lowest effective dose for the shortest possible duration. Extra vigilance is recommended, and medical advice should be sought if symptoms do not improve within 3 days.
How to Use the Spray
Correct use of the spray pump ensures effective delivery of the medicine to the back of the throat. Follow these steps:
- Priming (first use): When using the pump for the first time, or after it has been stored without use for an extended period, point the nozzle away from yourself and spray at least 4 times until a fine, even mist is produced. The pump is now ready to use
- Re-priming: If you have not used the product for a prolonged period, point the nozzle away and spray at least once to verify a fine mist is produced before applying to the throat
- Application: Point the nozzle towards the back of your throat. Press the pump 3 times with quick, even motions. Make sure to press the pump fully down each time and lift your finger between each spray
- Do not inhale: Do not breathe in while spraying
Missed Dose
Strefen Honey & Lemon is used as needed for symptom relief, so there is no fixed dosing schedule. Simply use it when you experience sore throat symptoms, maintaining at least 3 hours between doses. Do not take a double dose to make up for a missed one.
Overdose
If you have used too much Strefen Honey & Lemon, or if a child has accidentally ingested the medicine, contact your doctor, hospital or poison control centre immediately for assessment and advice.
Symptoms of flurbiprofen overdose may include nausea, vomiting, abdominal pain, and less commonly diarrhoea. Tinnitus (ringing in the ears), headache and gastrointestinal bleeding are also possible. In severe cases, central nervous system effects such as drowsiness, dizziness and, rarely, seizures may occur.
If you experience irritation in the mouth during use, discontinue treatment with flurbiprofen and consult your pharmacist or doctor for alternative options.
What Are the Side Effects of Strefen Honey & Lemon?
Like all medicines, Strefen Honey & Lemon can cause side effects, although not everyone experiences them. The most common side effects include dizziness, headache, throat irritation, mouth ulcers and a burning or tingling sensation in the mouth. Stop using the medicine and seek immediate medical attention if you experience signs of a severe allergic reaction or serious skin reaction.
Side effects are classified by how frequently they occur in clinical studies and post-marketing surveillance. The frequency categories used below follow the internationally standardised system used by regulatory authorities including the European Medicines Agency (EMA) and the World Health Organization (WHO).
- Any serious skin reaction such as blistering (including Stevens-Johnson syndrome and toxic epidermal necrolysis)
- Signs of anaphylaxis: swelling of the face, tongue or throat, difficulty breathing, rapid heartbeat, drop in blood pressure leading to shock
- Signs of hypersensitivity: redness, swelling, scaling, blistering, peeling skin, or sores on skin and mucous membranes
- Allergic reactions such as asthma, unexplained wheezing or breathlessness, itching, runny nose or skin rash
Common
May affect up to 1 in 10 users
- Dizziness, headache
- Throat irritation
- Mouth ulcers, pain or numbness in the mouth
- Sore throat (pharyngeal discomfort)
- Warm, burning or tingling sensation in the mouth
- Nausea or diarrhoea
- Tingling and itching of the skin (paraesthesia, pruritus)
Uncommon
May affect up to 1 in 100 users
- Drowsiness
- Blisters in the mouth or throat, numbness of the throat
- Bloating, abdominal pain, flatulence, constipation, indigestion, vomiting
- Dry mouth
- Burning sensation in the mouth, altered taste
- Fever, pain
- Feeling of sleepiness or difficulty sleeping
- Worsening of asthma, wheezing, breathlessness
- Reduced sensation in the throat (hypoaesthesia)
Rare
May affect up to 1 in 1,000 users
- Anaphylactic shock (severe allergic reaction with breathing difficulty, rapid heart rate and dangerously low blood pressure)
Not Known
Frequency cannot be estimated from available data
- Anaemia (low red blood cell count)
- Thrombocytopenia (low platelet count leading to easy bruising and bleeding)
- Oedema (swelling), high blood pressure
- Heart failure or heart attack (with prolonged NSAID use)
- Hepatitis (inflammation of the liver)
- Severe skin reactions such as Stevens-Johnson syndrome and toxic epidermal necrolysis
The gastrointestinal side effects associated with NSAIDs, such as stomach ulcers, bleeding and perforation, are generally more common with prolonged systemic use at higher doses. However, even short-term topical use can carry some risk, particularly in elderly patients, those with a history of GI problems, or those taking other medicines that increase bleeding risk.
If you experience any side effect not listed above, or if any of the side effects become serious, please report them to your doctor, pharmacist or nurse. Reporting side effects helps improve the safety information available for all medicines.
How Should You Store Strefen Honey & Lemon?
Store Strefen Honey & Lemon at room temperature, away from cold and frost. Do not freeze. An opened bottle can be used for up to 6 months. Keep out of sight and reach of children. Do not use after the expiry date printed on the bottle and carton.
Proper storage of medicines is essential to maintain their effectiveness and safety throughout their shelf life. For Strefen Honey & Lemon, the following storage conditions apply:
- Temperature: Store at room temperature. Protect from cold. Do not freeze
- After opening: An opened bottle may be used for up to 6 months. Discard any remaining solution after this period
- Expiry date: Do not use after the expiry date (EXP) printed on the bottle and outer carton. The expiry date refers to the last day of that month
- Safety: Keep out of sight and reach of children at all times
- Disposal: Do not dispose of unused medicine via household waste or wastewater. Return unused or expired medicine to a pharmacy for safe disposal. This helps protect the environment
The spray solution is a clear, colourless to slightly yellow liquid with a honey and lemon flavour. The product is supplied in a white, opaque HDPE bottle with a multi-component pump and polypropylene cap. If the solution appears cloudy, discoloured or contains particles, do not use it and return it to the pharmacy.
What Does Strefen Honey & Lemon Contain?
Each dose (3 sprays) contains 8.75 mg of flurbiprofen as the active ingredient, corresponding to a concentration of 16.2 mg/ml. The solution also contains betadex, buffering agents, preservatives (E218, E216), sweeteners and honey-lemon flavouring.
Active Ingredient
The active substance is flurbiprofen. Each dose of 3 sprays delivers 8.75 mg of flurbiprofen. The solution concentration is 16.2 mg/ml. Flurbiprofen is a propionic acid derivative NSAID that has been used in clinical practice since the 1970s, with a well-established safety and efficacy profile for both systemic and topical use.
Inactive Ingredients (Excipients)
The following excipients are included in the formulation to ensure stability, delivery, preservation and palatability of the solution:
- Betadex (beta-cyclodextrin): Solubilising agent that improves the dissolution and stability of flurbiprofen
- Disodium phosphate dodecahydrate: Buffering agent to maintain pH
- Citric acid monohydrate: Buffering agent and preservative
- Methyl parahydroxybenzoate (E218): Preservative (may cause allergic reactions)
- Propyl parahydroxybenzoate (E216): Preservative (may cause allergic reactions)
- Sodium hydroxide: pH adjustment
- Honey flavour: Contains flavouring agents and propylene glycol (E1520)
- Lemon flavour: Contains flavouring agents and propylene glycol (E1520)
- N,2,3-trimethyl-2-isopropylbutanamide: Cooling agent
- Saccharin sodium: Sweetener
- Hydroxypropyl betadex: Solubilising agent
- Purified water: Solvent base
Frequently Asked Questions
Strefen Honey & Lemon is used for short-term symptomatic relief of sore throat in adults aged 18 and over. It contains flurbiprofen, an NSAID that reduces inflammation, pain and swelling at the back of the throat. It is particularly helpful for relieving pain when swallowing, throat swelling and general throat discomfort associated with pharyngitis. It treats symptoms only and does not address the underlying cause of sore throat.
Clinical studies show that flurbiprofen throat spray begins to provide pain relief within approximately 15 to 30 minutes of application. The analgesic and anti-inflammatory effects typically last for 3 to 6 hours. Because the spray delivers the medicine directly to the site of inflammation in the throat, it can provide faster targeted relief compared to oral tablets that must first be absorbed through the digestive system.
Paracetamol (acetaminophen) is not an NSAID and works through a different mechanism, so it can generally be used alongside Strefen Honey & Lemon for additional pain relief. However, you should not combine Strefen with other NSAIDs such as ibuprofen, naproxen, aspirin or diclofenac, as this significantly increases the risk of gastrointestinal side effects. If in doubt, always check with your pharmacist or doctor.
No, although both flurbiprofen and ibuprofen are NSAIDs that work by inhibiting COX enzymes, they are different medicines with different chemical structures. Flurbiprofen is a more potent COX inhibitor on a milligram-for-milligram basis than ibuprofen. In the Strefen throat spray, flurbiprofen is delivered topically to the throat, providing targeted local action at the site of pain and inflammation, whereas ibuprofen tablets work systemically throughout the body.
You should consult a doctor if your sore throat does not improve within 3 days, if it gets worse, or if you develop new symptoms such as high fever (above 38.5°C / 101.3°F), difficulty breathing, a rash, swollen lymph nodes, white patches on the tonsils, or severe difficulty swallowing. These may indicate a bacterial infection requiring antibiotics or another condition that needs medical evaluation. Also see a doctor if you experience any side effects from the medicine.
Flurbiprofen passes into breast milk in small amounts. While the risk to the nursing infant is considered low with short-term topical use, you should consult your doctor or pharmacist before using Strefen Honey & Lemon while breastfeeding. They can help you weigh the benefits of treatment against any potential risks and may suggest alternative options if appropriate.
References
All information in this article is based on the following peer-reviewed sources, regulatory documents and international clinical guidelines:
- European Medicines Agency (EMA). Flurbiprofen Summary of Product Characteristics. Available at: www.ema.europa.eu
- British National Formulary (BNF). Flurbiprofen. National Institute for Health and Care Excellence (NICE). Available at: bnf.nice.org.uk
- World Health Organization (WHO). WHO Model List of Essential Medicines, 23rd List, 2023. Available at: www.who.int
- Benrimoj SI, et al. Efficacy and tolerability of the anti-inflammatory throat lozenge flurbiprofen 8.75 mg in the treatment of sore throat. Clinical Drug Investigation. 2001;21(3):183-193.
- Shephard A, et al. Flurbiprofen 8.75 mg spray for the relief of sore throat: a randomised, double-blind, placebo-controlled, dose-ranging study. BMC Ear, Nose and Throat Disorders. 2013;13(1):13.
- Russo M, et al. Pharmacokinetics and local tolerability of a flurbiprofen 8.75 mg oromucosal spray compared with lozenges and oral rinse solution. Clinical Drug Investigation. 2018;38(5):463-472.
- National Institute for Health and Care Excellence (NICE). Sore throat (acute): antimicrobial prescribing. NICE Guideline NG84. 2018. Available at: www.nice.org.uk/guidance/ng84
- Wonnemann M, et al. Comparison of the efficacy of flurbiprofen 8.75 mg lozenges and sprays in patients with sore throat: a randomised, non-inferiority trial. Advances in Therapy. 2020;37(5):2384-2397.
Editorial Team
This article was written and reviewed by the iMedic Medical Editorial Team, comprising licensed physicians and clinical pharmacologists with expertise in pharmacology, ENT medicine and clinical therapeutics.
Content reviewed by iMedic Medical Review Board following EMA, BNF and WHO guidelines. Evidence level: 1A based on systematic reviews and randomised controlled trials.
All content follows the GRADE evidence framework. No commercial funding or pharmaceutical company sponsorship. Independent medical editorial content reviewed according to international standards.