Sore throat medicine in Japan: tablets, powders, lozenges and sprays, and how they differ

The short version

• If your throat is the only problem, you don't have to buy a combination cold medicine. Japanese drugstores have a separate throat section (のどの薬).
• There are four kinds on the shelf: tablets you swallow, herbal powders taken without water, lozenges, and sprays.
• Most are Class 3 or Class 2 medicines on open shelves, and most contain no antihistamine, so they are not labeled as causing drowsiness.
• Two things to check: iodine sprays are not for people with thyroid disease, and several throat products contain licorice, so don't stack them.
• A sore throat with trouble swallowing saliva, trouble breathing, or trouble opening your mouth is not a drugstore problem. See the last section.
• Everything below is as of October 2026. The box and its leaflet are the final word.

Why not just buy cold medicine?

Most Japanese cold medicines are combinations: a pain reliever, a cough suppressant, a sedating antihistamine, a decongestant and caffeine in one tablet. That is useful when you have all of those symptoms. When you only have a sore throat, it means taking four ingredients you don't need, and the label tells you not to drive.

For how the combination products work, see Cold medicine in Japan.

The products named below are examples of each type. I am describing what the manufacturers label them for, not ranking them.

Tablets: tranexamic acid

Pelack T (ペラックT錠) from Daiichi Sankyo Healthcare is one example. It is a Class 3 medicine.

• Labeled for: pharyngitis and tonsillitis (throat pain, throat swelling), and mouth ulcers.
• Contains: tranexamic acid (750 mg in the adult daily amount), licorice extract, and vitamins B2, B6 and C. No antihistamine.
• Age: 7 and over, with a reduced amount under 15.
• Ask first if you have ever had a blood clot (stroke, heart attack, thrombophlebitis) or have been told you are at risk of one. Tranexamic acid affects how clots break down, and the leaflet lists this under "consult before use".

Tranexamic acid is also inside some combination cold medicines, including the "throat" versions of Lulu Attack and Benza Block. Don't take Pelack T together with one of those.

Herbal powder: Ryukakusan Direct

Ryukakusan Direct (龍角散ダイレクト) is a Class 3 medicine in single-dose stick packs, in mint or peach.

• Labeled for: cough, phlegm, and hoarseness, roughness or discomfort from throat inflammation.
• Contains: powdered platycodon root, senega, licorice, apricot kernel, ginseng and gambir.
• Age: 3 and over, with a reduced amount under 15.
• How to take it: without water. The maker's instructions say it works by contact with the throat, and that washing it down with water weakens the effect. Leave at least two hours between doses.

Kampo lozenge: kikyoto

Kikyoto (桔梗湯) is a two-herb Kampo formula, platycodon root and licorice. Tsumura sells it as a lozenge (ツムラ漢方トローチ桔梗湯) and as granules that are dissolved slowly in the mouth. Both are Class 2 medicines.

• Labeled for: a throat that is swollen and painful, sometimes with a cough; tonsillitis and peritonsillitis. The label says it can be used regardless of constitution.
• Age: differs between the lozenge and the granules. Check the box.
• Ask first if you have high blood pressure, heart disease or kidney disease, or are under a doctor's care. It contains licorice.

It is a medicine with a leaflet, not a throat candy. For what Kampo is and how it is regulated here, see What is Kampo?.

Lozenges and throat candy are not the same thing

Sprays: iodine or azulene

Throat sprays come in two types, and the difference matters.

Iodine sprays (brown liquid). One example is Nodonuru Spray (のどぬ〜るスプレー) from Kobayashi, a Class 3 medicine labeled for disinfecting the throat.

• Do not use if you have thyroid disease, have ever reacted to iodine, or for a child under 2. This is on the label as "do not use", not "ask first".
• Ask first if you are pregnant or breastfeeding. Some iodine sprays exclude this outright.
• Not for long-term or heavy use. It stains fabric.

Azulene sprays (blue liquid, アズレン). These contain sodium azulene sulfonate and are labeled for throat inflammation: soreness, swelling, roughness. Azulene is a different ingredient from iodine. If you have a thyroid condition, tell the pharmacist before choosing any spray, and check the ingredient panel of the exact product.

Gargles (うがい薬) come in the same two types, brown and blue, and the same iodine cautions apply.

One thing to check: licorice

Pelack T, Ryukakusan Direct and kikyoto all contain licorice (甘草, kanzo). So do many Kampo formulas and some cold medicines. Taken together or for a long time, licorice can cause fluid retention, raised blood pressure and low potassium. Pick one throat product, and tell the pharmacist what else you take, especially if you have high blood pressure, heart or kidney disease.

At the counter

You can show these on your phone. More are on the scripts page.

When a sore throat needs a doctor

Go the same day, or call 119, if:

• you can't swallow your own saliva, or you are drooling
• breathing is difficult or noisy
• you can't open your mouth fully, or your voice has become muffled
• the swelling is clearly on one side

See a doctor soon if:

• you have a high fever with the sore throat
• you can see white patches on your tonsils
• you have used a throat medicine as directed for five or six days without improvement (this is the limit the leaflets give)

Antibiotics are prescription-only in Japan. For a throat problem you can go directly to an ear, nose and throat clinic (耳鼻咽喉科, jibi-inkoka) without a referral, or to an internal medicine clinic (内科, naika). The Japan National Tourism Organization keeps a searchable list of medical institutions and runs a 24-hour visitor hotline: 050-3816-2787.

Official sources

• PMDA: search for over-the-counter medicine leaflets (Japanese) — the package inserts for every product named above
• Daiichi Sankyo Healthcare: Pelack T (Japanese)
• Ryukakusan: Ryukakusan Direct Stick Mint (English)
• Kobayashi Pharmaceutical: Nodonuru Spray (Japanese)
• Japan National Tourism Organization: guide for when you are feeling ill

Not sure what to ask at the counter about your own medicines?

If you already take prescription medicines and aren't sure what to ask at the counter, you can write in English to a pharmacist licensed in Japan and get a written explanation of what the labels and leaflets say.

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