| 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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| 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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 BSOL CCG: Conditions for which over the counter items (OTC) should not routinely be prescribed in primary care
 Conditions for which over the counter items should not routinely be prescribed in primary care: Guidance for CCGs
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Olive Oil Ear Drops
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Formulary
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BSOL CCG: Conditions for which over the counter items (OTC) should not routinely be prescribed in primary care
Conditions for which over the counter items should not routinely be prescribed in primary care: Guidance for CCGs
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Sodium Bicarbonate 5% ear drops
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Formulary
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BSOL CCG: Conditions for which over the counter items (OTC) should not routinely be prescribed in primary care
Conditions for which over the counter items should not routinely be prescribed in primary care: Guidance for CCGs
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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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Primary care antimicrobial guidelines 2017
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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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BSOL CCG: Conditions for which over the counter items (OTC) should not routinely be prescribed in primary care
Conditions for which over the counter items should not routinely be prescribed in primary care: Guidance for CCGs
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Sodium Chloride Nose drops 10ml
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Formulary
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BSOL CCG: Conditions for which over the counter items (OTC) should not routinely be prescribed in primary care
Conditions for which over the counter items should not routinely be prescribed in primary care: Guidance for CCGs
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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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BSOL CCG: Conditions for which over the counter items (OTC) should not routinely be prescribed in primary care
Conditions for which over the counter items should not routinely be prescribed in primary care: Guidance for CCGs
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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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BSOL CCG: Conditions for which over the counter items (OTC) should not routinely be prescribed in primary care
Conditions for which over the counter items should not routinely be prescribed in primary care: Guidance for CCGs
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Benzydamine 0.15% oral spray
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Formulary
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BSOL CCG: Conditions for which over the counter items (OTC) should not routinely be prescribed in primary care
Conditions for which over the counter items should not routinely be prescribed in primary care: Guidance for CCGs
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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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BSOL CCG: Conditions for which over the counter items (OTC) should not routinely be prescribed in primary care
Conditions for which over the counter items should not routinely be prescribed in primary care: Guidance for CCGs
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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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BSOL CCG: Conditions for which over the counter items (OTC) should not routinely be prescribed in primary care
Conditions for which over the counter items should not routinely be prescribed in primary care: Guidance for CCGs
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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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Primary care antimicrobial guidelines 2017
BSOL CCG: Conditions for which over the counter items (OTC) should not routinely be prescribed in primary care
Conditions for which over the counter items should not routinely be prescribed in primary care: Guidance for CCGs
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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BSOL CCG: Conditions for which over the counter items (OTC) should not routinely be prescribed in primary care
Conditions for which over the counter items should not routinely be prescribed in primary care: Guidance for CCGs
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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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Tranexamic Acid Mouthwash
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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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Prescribing in children
The APC notes that the informed use of unlicensed medicines or of licensed medicines for unlicensed applications (‘off-label’ use) is often necessary in paediatric practice.
The APC advises GPs to consider specialist prescribing recommendations for Green and Amber medicines that are not subject to ESCAs or RICaDs in combination with the information provided in the BNFC which goes beyond that of marketing authorisations. The BNFC has been designed for rapid reference and the information presented has been carefully selected to aid decisions on prescribing.
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Medicines suitable for routine use within primary care. Initiation and maintenance of prescribing by Specialists, GPs and other qualified clinicians. |
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Amber Specialist Initiation: Initiation and maintenance of prescribing by Specialists and transfer to Primary Care prescribing when appropriate. This may be supported by a RICaD, annotated within the formulary entry. |
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Amber Specialist Recommendation: Initiation and maintenance of prescribing in Primary Care following recommendation from a Specialist. |
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Amber Shared Care: Initiation and maintenance of prescribing by Specialists and transfer to Primary Care prescribing, in accordance with an ESCA, annotated within the formulary entry. |
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Medicines for initiation and maintenance prescribing by Specialists only. |
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Non-formulary Medicines which APC/Trust DTC has actively reviewed and do not recommend for use. |
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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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The term 'Specialist' refers to Consultants, General Practitioners and Independant Prescribers with a Specialist Interest. |
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