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 Formulary Chapter 12: Ear, nose and oropharynx - Full Chapter
Notes:
 
 Details...
12.01  Expand sub section  Drugs acting on the ear
12.01.01  Expand sub section  Otitis externa
12.01.01  Expand sub section  Astringent preparations
Acetic Acid 2% (Earcalm ®)
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Formulary
Green
  • First line in Acute Otitis Externa, as per antimicrobial guidelines
    guidelines


     
  •    
    12.01.01  Expand sub section  Anti-inflammatory preparations
    Flumetasone 0.02% with Clioquinol 1% (Locorten-Vioform®)
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    First Choice
    Green
     
    Dexamethasone with neomycin and glacial acetic acid  (Otomize®)
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    Second Choice
    Green
     
       
    Betamethasone 0.1% with Neomycin 0.5% ear drops
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    Formulary
    Green
     
       
    Betamethasone ear drops
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    Formulary
    Green
     
       
    Hydrocortisone Acetate 1% with Gentamicin 0.3% (Gentisone® HC)
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    Formulary
    Green
  • Only with positive culture/sensitivity data 
  •    
    Dexamethasone with Antibacterial (Sofradex®)
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    Formulary
    Red
     
       
    12.01.01  Expand sub section  Anti-infective preparations to top
    Chloramphenicol ear drops
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    Formulary
    Green
  • Only with positive culture/sensitivity data. 
  •    
    Ciprofloxacin 2mg/ml ear drops (Cetraxal®)
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    Formulary
    Amber
     
       
    Ciprofloxacin 0.3% drops
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    Formulary
    Amber
  • Off label use of eye drops
  • Specialist Recommendation 
  •    
    Clotrimazole (Canesten®)
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    Formulary
    Green
  • Only with positive culture/sensitivity data. 
  •    
    Gentamicin ear drops (Genticin®)
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    Formulary
    Green
  • Only with positive culture/sensitivity data. 
  •    
    12.01.01  Expand sub section  Other aural preparations
    12.01.02  Expand sub section  Otitis media
     note  Please refer to antimicrobial guidelines.
    12.01.03  Expand sub section  Removal of ear wax
    Cerumol®
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    Formulary
    Green
     
       
    Olive Oil Ear Drops
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    Formulary
    Green
     
       
    Sodium Bicarbonate 5% ear drops
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    Formulary
    Green
     
       
    12.02  Expand sub section  Drugs acting on the nose
    12.02.01  Expand sub section  Drugs used in nasal allergy to top
    Azelastine and fluticasone (Dymista)
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    Formulary
    Green
  • 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
     
  • Link  BSSE APC: Allergic Rhinitis Treatment Pathway
       
    12.02.01  Expand sub section  Antihistamines
    12.02.01  Expand sub section  Corticosteroids
    Beclometasone Dipropionate nasal preparations
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    First Choice
    Green
     
    Mometasone Furoate nasal spray
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    Second Choice
    Green
     
       
    Betamethasone Sodium Phosphate nasal preparations
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    Formulary
    Green
     
       
    Fluticasone furoate (Avamys®)
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    Formulary
    Green
  • previous APC decision reviewed in December 2015.
  • Approved for use in children and adults. 
  •    
    Fluticasone Propionate (Flixonase Nasule®)
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    Formulary
    Amber
  • Specialist Recommendations for Nasal Polyps. 
  •    
    12.02.01  Expand sub section  Cromoglicate
    12.02.02  Expand sub section  Topical nasal decongestants
    12.02.02  Expand sub section  Sympathomimetics to top
    Ephedrine nose drops
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    Formulary
    Green
  • Short Term Use Only 
  •    
    Sodium Chloride Nose drops 10ml
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    Formulary
    Green
     
       
    Xylometazoline nose drops/spray
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    Formulary
    Green
  • Short term use only 
  •    
    12.02.02  Expand sub section  Antimuscarinic
    12.02.03  Expand sub section  Nasal preparations for infection
    12.02.03  Expand sub section  Nasal Staphylococci
    Chlorhexidine Hydrochloride 0.1%, Neomycin Suphate 0.5% (Naseptin®)
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    Formulary
    Green
  • Contains arachis (peanut) oil, not suitable for patients with allergy to peanuts.
  • Patients with soya allergy should also avoid Naseptin® 
  •    
    Mupirocin 2% in White Soft Paraffin (Bactroban Nasal®)
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    Formulary
    Green
  • Long term disruption to supply until second or third quarter of 2018.  
  • Link  UKMi Memo re shortage of supply and alternative agents/ management options
       
    Octenidine hydrochloride (Octenisan® md Nasal gel )
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    Formulary
    Green
  • 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.  
  •    
    12.03  Expand sub section  Drugs acting on the oropharynx
    12.03.01  Expand sub section  Drugs for oral ulceration and inflammation to top
    Benzydamine 0.15% oral rinse
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    Formulary
    Green
     
       
    Benzydamine 0.15% oral spray
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    Formulary
    Green
     
       
    Bonjela Junior Dental Gel (Bonjela® Junior)
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    Formulary
    Green
  • From 3 months of age 
  •    
    Caphosol®
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    Formulary
    Red
  • Oncology and haematology use 
  •    
    Choline Salicylate dental gel
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    Formulary
    Green
  • For patients over 16 years 
  •    
    Gelclair®
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    Formulary
    Red
  • Oncology and haematology use only 
  •    
    Hydrocortisone 2.5mg buccal tablets
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    Formulary
    Amber
  • Specialist Recommendation 
  •    
    Lidocaine 10% mouth spray
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    Restricted Drug Restricted
    Red
  • Hospital only 
  •    
    Orabase Protective Paste
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    Formulary
    Green
     
       
    Orahesive Powder
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    Formulary
    Green
     
       
    12.03.02  Expand sub section  Oropharyngeal anti-infective drugs
    12.03.02  Expand sub section  Oropharyngeal Fungal infections
    Miconazole oral gel
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    Formulary
    Green
     
    Link  MHRA Alert: Topical miconazole, including oral gel: reminder of potential for serious interactions with warfarin
       
    Nystatin 100,000units/ml suspension
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    Formulary
    Green
  • Do not Prescribe as Sugar Free (SF) 
  •    
    12.03.02  Expand sub section  Oropharyngeal Viral infections
    12.03.03  Expand sub section  Lozenges and sprays
    12.03.04  Expand sub section  Mouthwashes, gargles, and dentifrices to top
    Chlorhexidine gluconate 0.2% mouthwash
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    Formulary
    Green
     
       
    Chlorhexidine gluconate 1% dental gel
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    Formulary
    Red
     
       
    Hydrogen Peroxide mouthwash BP
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    Formulary
    Green
     
       
    12.03.05  Expand sub section  Treatment of dry mouth
    12.03.05  Expand sub section  Local Treatment
    Biotene Oralbalance® (Saliva replacement gel)
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    Formulary
    Green
    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 
  •    
    Saliveze® Oral spray
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    Formulary
    Green
    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


     
  •    
    Salivix® pastilles
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    Formulary
    Green
    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.  
  •    
    12.03.05  Expand sub section  Systemic treatment
    pilocarpine Hydrochloride tablets (Salagen®)
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    Formulary
    Green
  • 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.  
  •    
    12.04  Expand sub section  Other preparations
    Bismuth Iodine Paraffin Paste (BIPP ® )
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    Formulary
    Red
     
       
    Bismuth Subnitrate and Iodoform Paste for Gauze
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    Formulary
    Red
     
       
    Human papilloma virus vaccine (Gardasil® )
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    Formulary
    Red
  • For use by ENT Specialists in recurrent respiratory papillomatosis (RRP) 
  •    
     ....
     Non Formulary Items
    ACETIC ACID 5% solution in IMS

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    Non Formulary
     
    Aciclovir

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    Non Formulary
     
    Almond Oil

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    Non Formulary
     
    Antacid with Oxetacaine

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    Non Formulary
     
    AS saliva Orthana®

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    Non Formulary
    Black
  • contains porcine derived gastric mucin
  •  
    Azelastine Hydrochloride  (Rhinolast®)

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    Non Formulary
     
    Benzocaine

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    Non Formulary
     
    Betamethasone Sodium Phosphate 0.1% with Neomycin Sulphate 0.5%

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    Non Formulary
     
    BioXtra®

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    Non Formulary
     
    Budesonide

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    Non Formulary
    Black
     
    Budesonide  (Rhinocort Aqua®)

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    Non Formulary
    Black
     
    Cetylpyridinium, Chlrocresol, Lidocaine  (Anbesol®)

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    Non Formulary
     
    Chlorhexidine & Chlorobutanol  (Eludril®)

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    Non Formulary
     
    Chlorhexidine mouthwash

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    Non Formulary
     
    Docusate Sodium 0.5%  (Waxsol®)

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    Non Formulary
     
    Doxycycline

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    Non Formulary
     
    Doxycycline

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    Non Formulary
     
    Doxycycline  (Periostat®)

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    Non Formulary
     
    Exterol®

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    Non Formulary
     
    Flunisolide  (Syntaris®)

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    Non Formulary
     
    Flurbiprofen lozenge

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    Non Formulary
     
    Fluticasone Propionate Aqueous Nasal spray  (Flixonase®)

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    Non Formulary
    Black
     
    Fluticasone Propionate Aqueous Nasal spray  (Nasofan®)

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    Non Formulary
    Black
     
    Glandosane®

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    Non Formulary
    Black
  • Should not be prescribed to patients with their own teeth due to acidic pH.
  •  
    Ipratropium Bromide  (Rinatec®)

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    Non Formulary
    Black
    Link  UKMI Q&A: Drug induced hypersalivation
     
    Lidocaine 5% ointment

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    Non Formulary
     
    Lidocaine and Cetylpyridinium  (Dentinox® Teething Gel)

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    Non Formulary
     
    Lidocaine and Chlorhexidine  (Instillagel®)

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    Non Formulary
     
    Lidocaine and Phenylephrine  (Cophenalcaine®)

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    Non Formulary
     
    Luborant®

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    Non Formulary
     
    Miconazole  (Loramyc®)

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    Non Formulary
     
    Molcer®

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    Non Formulary
     
    Mouth Swabs

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    Non Formulary
     
    Otex®

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    Non Formulary
     
    Povidone Iodine  (Betadine®)

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    Non Formulary
     
    Prednisolone ear drops  (Predsol®)

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    Non Formulary
    Black
     
    Salicylates - Salicylic acid  (Pyralvex®)

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    Non Formulary
     
    Salinum®

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    Non Formulary
     
    Sodium Chloride Mouthwash, Compound, BP

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    Non Formulary
    Black
     
    Sodium Cromoglicate  (Rynacrom®)

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    Non Formulary
     
    Sodium Cromoglicate  (Vividrin®)

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    Non Formulary
     
    SST

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    Non Formulary
     
    Thymol

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    Non Formulary
     
    Tranexamic Acid Mouthwash

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    Non Formulary
     
    Triamcinolone Acetonide  (Nasacort®)

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    Non Formulary
     
    Xerotin(r)  (Xerotin®)

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    Non Formulary
     
      
    Key
    note Notes
    Section Title Section Title (top level)
    Section Title Section Title (sub level)
    First Choice Item First Choice item
    Non Formulary Item Non Formulary section
    Restricted Drug
    Restricted Drug
    Unlicensed Drug
    Unlicensed
    Track Changes
    Display tracking information
    click to search medicines.org.uk
    Link to adult BNF
    click to search medicines.org.uk
    Link to children's BNF
    click to search medicines.org.uk
    Link to SPCs
    Cytotoxic Drug
    Cytotoxic Drug
    CD
    Controlled Drug
    High Cost Medicine
    High Cost Medicine
    Cancer Drugs Fund
    Cancer Drugs Fund
    NHSE
    NHS England
    Homecare
    Homecare
    CCG
    CCG

    Traffic Light Status Information

    Status Description

    Green

    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.  

    Amber

    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.   

    Red

    Medicines for initiation and maintenance prescribing by Specialists only  

    Black

    Non-formulary medicines- medicines not recommended for routine primary care prescribing.  

    Grey

    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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