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 Formulary Chapter 12: Ear, nose and oropharynx - Full Chapter
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12.01  Expand sub section  Drugs acting on the ear
12.01.01  Expand sub section  Otitis externa
Boric acid (insufflation) 
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Formulary
Red
 
 
12.01.01  Expand sub section  Astringent preparations
Acetic Acid 2% spray (Earcalm ®)
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Formulary
Green
 
 
12.01.01  Expand sub section  Anti-inflammatory preparations
Betamethasone 0.1% ear/eye/nose drops
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Formulary
Green
  • First choice corticosteroid ear drops.
 
 
Betamethasone 0.1% with neomycin 0.5% ear drops (Betnesol N®)
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Formulary
Green
  • Alternative choice compound antibacterial/corticosteroid ear drop.
 
 
Chloramphenicol
(5% & 10% drops)
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Formulary
Green
 
 
Dexamethasone 0.05% with framycetin 0.5% ear drops (Sofradex®)
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Formulary
Green
  • Alternative choice compound antibacterial/corticosteroid ear drop.
 
 
Dexamethasone 0.1% with neomycin 0.5% spray (Otomize®)
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Formulary
Green
  • Alternative choice compound antibacterial/corticosteroid ear drop.
 
 
Flumetasone 0.02% with Clioquinol 1% ear drops
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Formulary
Green
  • Alternative choice compound antibacterial/corticosteroid ear drop.
 
 
Hydrocortisone 1% Neomycin 0.439% & Polymixin B sulphate 10,000iu/ml ear drops (Otosporin®)
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Formulary
Green
  • Alternative choice compound antibacterial/corticosteroid ear drop.
 
 
Hydrocortisone Acetate 1% with Gentamicin 0.3% (Gentisone® HC)
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Formulary
Green
  • First choice compound antibacterial/corticosteroid ear drop.
 
 
Prednisolone 0.5% ear/eye drops
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Formulary
Green
  • Second choice corticosteroid ear drops.
 
 
Triamcinolone with neomycin, gramicidin and nystatin  (Kenacomb Otic®)
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Formulary
Red
  • Triamcinolone acetonide 1mg,  neomycin sulphate 2.5mg,  gramicidin 0.25mg & nystatin 100,000iu/5g ointment unlicensed unlicensed
 
 
Betamethasone 0.1% (Betnovate® Scalp Application)
(As EAR DROPS for eczema)
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Restricted Drug Restricted
Green plus
  • unlicensed unlicensed
 
 
12.01.01  Expand sub section  Anti-infective preparations to top
Chloramphenicol 5% and 10% ear drops
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Formulary
Green
 
 
Ciprofloxacin 0.2% ear drops
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Formulary
Green
  •  2mg/ml (0.2%) ear drops (0.25ml unit dose)
 
 
Clotrimazole 1% solution
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Formulary
Green
 
 
Gentamicin 0.3% ear/eye drops
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Formulary
Green
 
 
12.01.01  Expand sub section  Other aural preparations
12.01.02  Expand sub section  Otitis media
Phenazone with lidocaine (Otigo®)
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Formulary
Green
  • Phenazone 40mg/1g & lidocaine hydrochloride 10mg/1g ear drops
    • Approved for the treatment of Acute otitis media & Barotraumatic otitis in line NICE


 

 
 
12.01.03  Expand sub section  Removal of ear wax
Olive Oil Ear Drops
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Formulary
Not Recomended
 
 
Sodium Bicarbonate ear drops
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
 
 
Betamethasone Sodium Phosphate 0.1% eye/ear/nose drops
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Formulary
Green
 
 
12.02.01  Expand sub section  Antihistamines
Azelastine Hydrochloride 140microgram nasal spray (Rhinolast®)
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Formulary
Green
 
 
12.02.01  Expand sub section  Corticosteroids
Beclometasone Dipropionate 50 microgram nasal spray
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First Choice
Green
 
Betamethasone 0.1% eye/ear/nose drops
(ear)
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Alternatives
Green
 
 
Fluticasone furoate 27.5microgram/dose nasal spray (Avamys®)
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Alternatives
Green
  • Note: take care to avoid confusion with fluticasone propionate.
 
 
Fluticasone Propionate 400microgram/dose nasal drops (Flixonase Nasule®)
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Alternatives
Green
  • Note: take care to avoid confusion with fluticasone furoate.
 
 
Fluticasone Propionate 50microgram/dose nasal spray (Nasofan®)
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Alternatives
Green
  • Note: take care to avoid confusion with fluticasone furoate.
 
 
Mometasone Furoate 50microgram/metered dose nasal spray
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Alternatives
Green
 
 
Triamcinolone Acetonide 55microgram metered dose nasal spray (Nasacort®)
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Alternatives
Green
 
 
12.02.01  Expand sub section  Cromoglicate
12.02.02  Expand sub section  Topical nasal decongestants
Sodium Chloride 0.9%
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Formulary
Green
  • Nasal drops and UDV's.
 
 
12.02.02  Expand sub section  Sympathomimetics to top
Xylometazoline (Otrivine®)
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First Choice
Green
  • 0.05% and 0.1% nasal drops.
  • 0.1% nasal spray.
 
Ephedrine
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Alternatives
Red
  • 0.5% and 1% nasal drops.
 
 
12.02.02  Expand sub section  Antimuscarinic
Ipratropium Bromide 21 microgram/puff nasal spray (Rinatec®)
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Formulary
Green
 
 
12.02.03  Expand sub section  Nasal preparations for infection
Boric Acid & Povidone Iodine
(Insufflation)
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Formulary
Red
 
 
Lidocaine and Phenylephrine Nasal spray
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Formulary
Red
 
 
12.02.03  Expand sub section  Nasal Staphylococci
Chlorhexidine Hydrochloride 0.1%, Neomycin Suphate 0.5% (Naseptin®)
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Formulary
Green
 
 
Mupirocin 2% (Bactroban Nasal®)
(nasal)
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Formulary
Green
  • First choice the treatment of MRSA
 
 
Bismuth Subnitrate and Iodoform (B.I.P.P.)
(Paste)
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Formulary
Red
1.25cm x 100cm & 2.5cm x 100cm impregnated gauze 
 
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 Mouthwash & Spray (Difflam®)
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Formulary
Green
 
 
Betamethasone
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Formulary
Green plus
  • Soluble tablets 500 micrograms
  • Used as mouth gargle
 
 
Caphosol®
(liquid)
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Formulary
Green plus
  • For limited use in patients having chemo-radiotherapy or radiotherapy to malignancies of the oral cavity, hypopharynx and oro-pharynx.
  • Trusts encouraged to prescribe enough between chemotherapy and radiotherapy appointments in secondary care in anticipation of mucositis developing.
 
 
Choline Salicylate (Bonjela® Adult)
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Formulary
Green
 
 
Doxycycline 20mg tablets
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Formulary
Green
  • Treatment of periodontitis.
 
 
Gelclair®
(Gel)
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Formulary
Green plus
  • Trusts encouraged to prescribe enough between chemotherapy and radiotherapy appointments in secondary care in anticipation of mucositis developing.
 
 
Hyaluronan
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Formulary
Green
  • 0.2% gel and 0.025% mouthwash.
  • For limited second-line use on specialist advice in the treatment of
    orofacial granulomatosis, severe oral ulceration and mucositis secondary
    to immunosuppression where conventional treatments are unsuitable or
    have failed.
 
 
Hydrocortisone 2.5mg Lozenges
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Formulary
Green
 
Link  MHRA Drug Safety Update (Dec 2018): Hydrocortisone muco- adhesive buccal tablets: should not be used off-label for adrenal insufficiency in children due to serious risks.
 
12.03.02  Expand sub section  Oropharyngeal anti-infective drugs
12.03.02  Expand sub section  Oropharyngeal Fungal infections
Miconazole 24mg/ml sugar-free oral gel (Daktarin®)
(20mg/g)
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Formulary
Green
 
Link  MHRA Drug Safety Update (June 2016): Topical miconazole, including oral gel: reminder of potential for serious interactions with warfarin
Link  MHRA Drug Safety Update (Sept 2017): Miconazole (Daktarin): over-the-counter oral gel contraindicated in patients taking warfarin
 
Miconazole 50mg muco-adhesive buccal tablets (Loramyc®)
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Formulary
Red
  • Restricted to use in immunocompromised patients with severe oropharyngeal candidiasis, where the use of other antifungal agents e. g. nystatin, fluconazole is not appropriate and for use on the advice of microbiologists.
 
 
Nystatin 1000,000units/ml suspension (Nystan®)
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Formulary
Green
 
 
12.03.02  Expand sub section  Oropharyngeal Viral infections
Aciclovir tablets and suspension
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Formulary
Green

see section 05.03.02

 
 
12.03.03  Expand sub section  Lozenges and sprays
12.03.04  Expand sub section  Mouthwashes, gargles, and dentifrices to top
Chlorhexidine
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Formulary
Green
  • 0.2% mouthwash.
  • 0.2% mint flavoured spray.
  • 1% dental gel.
  • Dental products should only be prescribed by dentists and GPs should not accept requests to prescribe medicines that the dentist could reasonably prescribe themselves, nor accept requests from patients to issue FP10 prescriptions for items prescribed on a private prescription by their dentist.
  • 2% oral gel unlicensedunlicensed Red
    • For hospital use in the prevention of ventilator-associated pneumonia in adult patients who are ventilated (for >48 hours).
 
Link  MHRA Drug Safety Update (November 2012): Chlorhexidine: reminder of potential for hypersensitivity
 
Hexetidine 0.1% mouthwash
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Formulary
Green
 
 
Tranexamic Acid Mouthwash
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Formulary
Red
 
 
12.03.05  Expand sub section  Treatment of dry mouth
Artificial Saliva
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Formulary
Green
  • Use cheapest
  • Available products include
    • AS Saliva Orthana®
    • Biotene Oralbalance® gel
    • BioXtra® Glandosane® spray
    • Malic acid Salivix®
    • Oralieve® Moisturising Spray & Gel 
  • Patients should be advised of self-care measures and signposted to purchase over the counter remedies where appropriate.
 
 
12.03.05  Expand sub section  Local Treatment
Pilocarpine 5mg tablets
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Alternatives
Green plus
  • Treatment to be initiated with specialist advice.
 
 
12.03.05  Expand sub section  Systemic treatment
12.04  Expand sub section  Miscellaneous
Carnoy’s solution
(Treatment of Keratocystic odontogenic tumours)
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Restricted Drug Restricted
Red
  • Unlicensed Drug Unlicensed
  • 10ml bottle
 
 
Cocaine 5% Nasal Spray
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Unlicensed Drug Unlicensed
Red
 
 
 ....
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
NHSE
NHS England
Homecare
Homecare
CCG
CCG

Traffic Light Status Information

Status Description

Red

Drugs for hospital use only. The responsibility for initiation and monitoring treatment should rest with an appropriate hospital clinician and the drug should be supplied through the hospital throughout the duration of treatment. In some very exceptional circumstances (e.g. due to distance from the hospital, storage, supply or mobility/transport problems) it may be appropriate for the GP to be asked to prescribe a Red drug. This should be negotiated on an individual patient basis and should only be done with the GP’s prior informed agreement where the roles of the GP and hospital services are clearly defined and agreed. The GP should not feel under pressure to prescribe in these circumstances. For all RED drugs automatically added to the formulary in response to a positive NICE TA: Prescribers need to ensure that local Trust new drug governance procedures and pharmacy processes are followed before any prescribing.  

Amber

Drugs initiated by hospital specialist, but where continuing treatment by GPs may be appropriate under a shared care arrangement. The specialist should send the GP a copy of the shared care agreement to sign. The GP should sign the shared care agreement, or indicate they do not want to be part of such an agreement, and return a copy back to the specialist. Shared care guidelines are available or are being developed for most of the drugs listed as Amber. If no shared care guideline is available, the hospital specialist should provide the patient’s GP with sufficient information and support to allow treatment to be continued and managed safely in primary care.  

Green plus

Drugs normally recommended or initiated by a specialist (hospital or GP with an extended role https://www.rcgp.org.uk/gpwer), but can be safely maintained in primary care with very little or no monitoring required. In some cases there may be a further restriction for use outlined - these will be defined in each case. Provision of additional information, or an information leaflet, may be appropriate in some cases to facilitate continuing treatment by GPs.  

Green

Drugs where prescribing by GPs is appropriate. Can be initiated and prescribed in all care settings, and if appropriate, discontinued without recourse to secondary care.  

Black

NOT APPROVED: Drugs that have been considered by NTAG or the NENC ICB Medicines Subcommittee (or other approved body) and are not approved for prescribing within the North East and North Cumbria.   

Brown

UNDER REVIEW: drugs whose current formulary status or RAG status is currently under review.  

Not Recomended

NOT REVIEWED: Drugs that haven not been reviewed yet. This usually means that an application is in progress. These drugs are not normally considered appropriate for prescribing in the North East and North Cumbria until such time that a decision is taken on their formulary status.  

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