| Formulary Chapter 12: Ear, nose and oropharynx - Full Chapter
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| Details... |
| 12.01 |
Drugs acting on the ear |
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| 12.01.01 |
Otitis externa |
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| 12.01.01 |
Astringent preparations |
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Acetic Acid 2% (Earcalm ®)
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Formulary
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First line in Acute Otitis Externa, as per antimicrobial guidelines
guidelines
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| 12.01.01 |
Anti-inflammatory preparations |
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Flumetasone 0.02% with Clioquinol 1% (Locorten-Vioform®)
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First Choice
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Dexamethasone with neomycin and glacial acetic acid (Otomize®)
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Second Choice
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Betamethasone 0.1% with Neomycin 0.5% ear drops
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Formulary
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Betamethasone ear drops
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Formulary
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Hydrocortisone Acetate 1% with Gentamicin 0.3% (Gentisone® HC)
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Formulary
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Only with positive culture/sensitivity data
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Dexamethasone with Antibacterial (Sofradex®)
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Formulary
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| 12.01.01 |
Anti-infective preparations |
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Chloramphenicol ear drops
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Formulary
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Only with positive culture/sensitivity data.
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Ciprofloxacin 2mg/ml ear drops (Cetraxal®)
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Formulary
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Ciprofloxacin 0.3% drops
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Formulary
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Off label use of eye drops
Specialist Recommendation
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Clotrimazole (Canesten®)
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Formulary
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Only with positive culture/sensitivity data.
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Gentamicin ear drops (Genticin®)
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Formulary
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Only with positive culture/sensitivity data.
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| 12.01.01 |
Other aural preparations |
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| 12.01.02 |
Otitis media |
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Please refer to antimicrobial guidelines. |
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| 12.01.03 |
Removal of ear wax |
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Cerumol®
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Formulary
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Olive Oil Ear Drops
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Formulary
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Sodium Bicarbonate 5% ear drops
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Formulary
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| 12.02 |
Drugs acting on the nose |
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| 12.02.01 |
Drugs used in nasal allergy |
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Azelastine and fluticasone (Dymista)
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Formulary
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Third line option for adults and children over 12 years with moderate to severe allergic rhinitis who have failed to respond to a steroid nasal spray with the addition of an oral antihistamine.
Follow treatment algorithm
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 BSSE APC: Allergic Rhinitis Treatment Pathway
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| 12.02.01 |
Antihistamines |
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| 12.02.01 |
Corticosteroids |
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Beclometasone Dipropionate nasal preparations
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First Choice
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Mometasone Furoate nasal spray
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Second Choice
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Betamethasone Sodium Phosphate nasal preparations
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Formulary
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Fluticasone furoate (Avamys®)
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Formulary
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previous APC decision reviewed in December 2015.
Approved for use in children and adults.
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Fluticasone Propionate (Flixonase Nasule®)
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Formulary
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Specialist Recommendations for Nasal Polyps.
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| 12.02.01 |
Cromoglicate |
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| 12.02.02 |
Topical nasal decongestants |
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| 12.02.02 |
Sympathomimetics |
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Ephedrine nose drops
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Formulary
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Short Term Use Only
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Sodium Chloride Nose drops 10ml
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Formulary
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Xylometazoline nose drops/spray
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Formulary
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Short term use only
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| 12.02.02 |
Antimuscarinic |
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| 12.02.03 |
Nasal preparations for infection |
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| 12.02.03 |
Nasal Staphylococci |
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Chlorhexidine Hydrochloride 0.1%, Neomycin Suphate 0.5% (Naseptin®)
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Formulary
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Contains arachis (peanut) oil, not suitable for patients with allergy to peanuts.
Patients with soya allergy should also avoid Naseptin®
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Mupirocin 2% in White Soft Paraffin (Bactroban Nasal®)
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Formulary
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Long term disruption to supply until second or third quarter of 2018.
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UKMi Memo re shortage of supply and alternative agents/ management options
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Octenidine hydrochloride (Octenisan® md Nasal gel )
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Formulary
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Classed as a medical device
Listed in drug tariff- 6ml tube
Added to formulary as alternative to Bactroban® nasal ointment in view of supply issues.
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| 12.03 |
Drugs acting on the oropharynx |
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| 12.03.01 |
Drugs for oral ulceration and inflammation |
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Benzydamine 0.15% oral rinse
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Formulary
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Benzydamine 0.15% oral spray
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Formulary
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Bonjela Junior Dental Gel (Bonjela® Junior)
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Formulary
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From 3 months of age
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Caphosol®
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Formulary
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Oncology and haematology use
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Choline Salicylate dental gel
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Formulary
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For patients over 16 years
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Gelclair®
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Formulary
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Oncology and haematology use only
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Hydrocortisone 2.5mg buccal tablets
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Formulary
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Specialist Recommendation
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Lidocaine 10% mouth spray
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 Restricted
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Hospital only
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Orabase Protective Paste
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Formulary
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Orahesive Powder
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Formulary
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| 12.03.02 |
Oropharyngeal anti-infective drugs |
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| 12.03.02 |
Oropharyngeal Fungal infections |
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Miconazole oral gel
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Formulary
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MHRA Alert: Topical miconazole, including oral gel: reminder of potential for serious interactions with warfarin
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Nystatin 100,000units/ml suspension
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Formulary
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Do not Prescribe as Sugar Free (SF)
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| 12.03.02 |
Oropharyngeal Viral infections |
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| 12.03.03 |
Lozenges and sprays |
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| 12.03.04 |
Mouthwashes, gargles, and dentifrices |
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Chlorhexidine gluconate 0.2% mouthwash
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Formulary
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Chlorhexidine gluconate 1% dental gel
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Formulary
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Hydrogen Peroxide mouthwash BP
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Formulary
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| 12.03.05 |
Treatment of dry mouth |
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| 12.03.05 |
Local Treatment |
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Biotene Oralbalance® (Saliva replacement gel)
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Formulary
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Approved for
ACBS conditions i.e. patients suffering from xerostomia (dry mouth) as a result of having or having undergone radiotherapy or sicca syndrome.
Palliative Care
Dental practitioners
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Saliveze® Oral spray
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Formulary
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Approved for
ACBS conditions i.e. patients suffering from xerostomia (dry mouth) as a result of having or having undergone radiotherapy or sicca syndrome.
Palliative Care
Dental practitioners
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Salivix® pastilles
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Formulary
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Approved for
ACBS conditions i.e. patients suffering from xerostomia (dry mouth) as a result of having or having undergone radiotherapy or sicca syndrome.
Palliative Care
Dental practitioners
only useful in patients who have residual salivary gland function.
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| 12.03.05 |
Systemic treatment |
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pilocarpine Hydrochloride tablets (Salagen®)
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Formulary
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Licensed for treatment of xerostomia following irradiation for head and neck cancer; dry mouth and dry eyes in Sjögren's syndrome.
Effective only in patients who have residual salivary gland function.
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| 12.04 |
Other preparations |
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Bismuth Iodine Paraffin Paste (BIPP ® )
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Formulary
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Bismuth Subnitrate and Iodoform Paste for Gauze
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Formulary
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Human papilloma virus vaccine (Gardasil® )
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Formulary
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For use by ENT Specialists in recurrent respiratory papillomatosis (RRP)
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| Non Formulary Items |
ACETIC ACID 5% solution in IMS
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Non Formulary
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Aciclovir
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Non Formulary
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Almond Oil
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Non Formulary
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Antacid with Oxetacaine
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Non Formulary
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AS saliva Orthana®
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Non Formulary
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contains porcine derived gastric mucin |
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Azelastine Hydrochloride (Rhinolast®)
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Non Formulary
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Benzocaine
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Non Formulary
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Betamethasone Sodium Phosphate 0.1% with Neomycin Sulphate 0.5%
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Non Formulary
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BioXtra®
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Non Formulary
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Budesonide
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Non Formulary
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Budesonide (Rhinocort Aqua®)
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Non Formulary
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Cetylpyridinium, Chlrocresol, Lidocaine (Anbesol®)
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Non Formulary
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Chlorhexidine & Chlorobutanol (Eludril®)
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Non Formulary
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Chlorhexidine mouthwash
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Non Formulary
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Docusate Sodium 0.5% (Waxsol®)
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Non Formulary
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Doxycycline
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Non Formulary
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Doxycycline
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Non Formulary
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Doxycycline (Periostat®)
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Non Formulary
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Exterol®
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Non Formulary
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Flunisolide (Syntaris®)
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Non Formulary
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Flurbiprofen lozenge
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Non Formulary
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Fluticasone Propionate Aqueous Nasal spray (Flixonase®)
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Non Formulary
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Fluticasone Propionate Aqueous Nasal spray (Nasofan®)
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Non Formulary
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Glandosane®
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Non Formulary
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Should not be prescribed to patients with their own teeth due to acidic pH. |
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Ipratropium Bromide (Rinatec®)
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Non Formulary
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 UKMI Q&A: Drug induced hypersalivation
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Lidocaine 5% ointment
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Non Formulary
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Lidocaine and Cetylpyridinium (Dentinox® Teething Gel)
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Non Formulary
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Lidocaine and Chlorhexidine (Instillagel®)
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Non Formulary
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Lidocaine and Phenylephrine (Cophenalcaine®)
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Non Formulary
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Luborant®
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Non Formulary
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Miconazole (Loramyc®)
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Non Formulary
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Molcer®
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Non Formulary
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Mouth Swabs
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Non Formulary
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Otex®
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Non Formulary
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Povidone Iodine (Betadine®)
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Non Formulary
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Prednisolone ear drops (Predsol®)
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Non Formulary
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Salicylates - Salicylic acid (Pyralvex®)
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Non Formulary
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Salinum®
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Non Formulary
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Sodium Chloride Mouthwash, Compound, BP
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Non Formulary
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Sodium Cromoglicate (Rynacrom®)
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Non Formulary
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Sodium Cromoglicate (Vividrin®)
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Non Formulary
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SST
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Non Formulary
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Thymol
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Non Formulary
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Tranexamic Acid Mouthwash
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Non Formulary
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Triamcinolone Acetonide (Nasacort®)
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Non Formulary
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Xerotin(r) (Xerotin®)
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Non Formulary
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Key |
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Cytotoxic Drug
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Controlled Drug
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High Cost Medicine
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Cancer Drugs Fund
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NHS England |
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Homecare |
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CCG |
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Traffic Light Status Information
| Status |
Description |
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Medicines which are suitable for initiation and maintenance prescribing by primary and secondary care clinicians. These medicines should be initiated and prescribed within their licensed indications. |
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Initiation and maintenance of prescribing by Specialists and transfer to Primary Care prescribing when appropriate, or initiation and maintenance of prescribing in Primary Care following recommendation from a Specialist.
Some amber medicines require agreement with the local (internal) medicines committee prior to initiation; others may require a framework to support safe transfer and maintenance of care such as a RICaD or ESCA. The Formulary will be annotated to reflect these requirements. |
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Medicines for initiation and maintenance prescribing by Specialists only |
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Non-formulary medicines- medicines not recommended for routine primary care prescribing. |
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Positive NICE TA and /or awaiting local clarification on place in therapy ; Please contact your Medicines Optimisation team for more information. |
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