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Area Prescribing Committee Formulary  
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 Formulary Chapter 12: Ear, nose and oropharynx - Full Chapter
Notes:

NORTH OF TYNE/GATESHEAD GUIDELINES FOR MANAGEMENT OF COMMON ENT CONDITIONS IN PRIMARY CARE

 Details...
12.01  Drugs acting on the ear
12.01.01  Otitis externa
12.01.01  Astringent preparations
Acetic Acid 2% spray (Earcalm ®)
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Formulary
Green
 
   
12.01.01  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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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.
 
   
12.01.01  Anti-infective preparations to top
Chloramphenicol 5% and 10% ear drops
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Formulary
Green
 
   
Clotrimazole 1% solution
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Formulary
Green
 
   
Gentamicin 0.3% ear/eye drops
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Formulary
Green
 
   
Ciprofloxacin 0.3% eye drops
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Unlicensed Drug Unlicensed
Red
  • To be used in the ear unlicensedunlicensed indication.
 
   
12.01.01  Other aural preparations
12.01.02  Otitis media
12.01.03  Removal of ear wax
Cerumol®
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Formulary
Green
 
   
Olive Oil Ear Drops
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Formulary
Green
 
   
Sodium Bicarbonate ear drops
 Track Changes
Formulary
Green
 
   
12.02  Drugs acting on the nose
12.02.01  Drugs used in nasal allergy to top
12.02.01  Antihistamines
Azelastine Hydrochloride 140microgram nasal spray (Rhinolast®)
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Formulary
Green
 
   
12.02.01  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  Cromoglicate
12.02.02  Topical nasal decongestants
NeilMed® Sinus Rinse
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Formulary
Red
  • Sachets containing powder for preparing a buffered saline solution for nasal irrigation using the NeilMed Irrigation device. Available as kits containing the irrigation device and sachets and separate (isotonic) sachets.
  • Note: NeilMed Sinus Rinse is classified as a medical device and, as it is not currently included in the Drug Tariff, it cannot be prescribed on the NHS in primary care.
 
   
Sodium Chloride 0.9%
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Formulary
Green
  • Nasal drops and UDV's.
 
   
12.02.02  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
Green
  • 0.5% and 1% nasal drops.
 
   
12.02.02  Antimuscarinic
Ipratropium Bromide 21 microgram/puff nasal spray (Rinatec®)
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Formulary
Green
 
   
12.02.03  Nasal preparations for infection
Boric Acid & Povidone Iodine
(Insufflation)
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Formulary
Green plus
 
   
Lidocaine and Phenylephrine Nasal spray
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Formulary
Red
 
   
12.02.03  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  Drugs acting on the oropharynx
12.03.01  Drugs for oral ulceration and inflammation to top
Benzocaine
(Spray)
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Formulary
Green
 
   
Benzocaine/Dequalinium (Dequacaine® )
(Lozenges)
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Formulary
Green
 
   
Benzydamine Mouthwash & Spray (Difflam®)
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Formulary
Green
 
   
Caphosol®
(liquid & effervescent tablets)
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Formulary
Red
  • For limited use in patients having chemo-radiotherapy or radiotherapy to malignancies of the oral cavity, hypopharynx and oro-pharynx.
 
   
Carmellose Sodium paste (Orabase®)
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Formulary
Green
 
   
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
 
   
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 (Corlan®)
(Pellets)
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Formulary
Green
 
   
12.03.02  Oropharyngeal anti-infective drugs
12.03.02  Oropharyngeal Fungal infections
Amphotericin 100mg/1ml oral suspension
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Formulary
Red
  • Approved for specialist use in chronic mucocutaneous candidiasis unlicensedunlicensed.
 
   
Miconazole 24mg/ml sugar-free oral gel (Daktarin®)
(20mg/g)
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Formulary
Green
 
   
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  Oropharyngeal Viral infections
Aciclovir tablets and suspension
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Formulary
Green

see section 05.03.02

 
   
12.03.03  Lozenges and sprays
Benzocaine 1.5mg spray
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Formulary
Green
 
   
Cetylpyridinium chloride 1.4mg Lozenges (Merocet®)
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Formulary
Green
 
   
Merocaine
(Lozenges)
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Formulary
Green
 
   
12.03.04  Mouthwashes, gargles, and dentifrices to top
Chlorhexidine
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Formulary
Green
  • 0.2% mouthwash.
  • 0.2% mint flavoured spray.
  • 1% dental gel.
  • 2% oral gel unlicensedunlicensed.
    • For hospital use in the prevention of ventilator-associated pneumonia in adult patients who are ventilated (for >48 hours).

 
   
Hexetidine 0.1% mouthwash
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Formulary
Green
 
   
Mouthwash solution tablets
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Formulary
Green
 
   
Triclosan toothpaste (Mentadent P®)
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Formulary
Green
 
   
12.03.05  Treatment of dry mouth
12.03.05  Local Treatment
AS Saliva Orthana®
(Oral spray and lozenges)
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First Choice
Green
  • preferred to Glandosane® as it is less likely to damage tooth enamel.
 
Glandosane® spray
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Second Choice
Green
 
   
Biotene Oralbalance® gel
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Alternatives
Green
 
   
BioXtra®
(Oral gel, gel spray & toothpaste)
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Alternatives
Green
  • The gel, but not the toothpaste, is prescribable on the NHS in primary care as a
    Borderline Substance
 
   
Malic acid  (Salivix®)
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Alternatives
Green
 
   
Pilocarpine 5mg tablets
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Alternatives
Green plus
  • Treatment to be initiated with specialist advice.
 
   
12.03.05  Systemic treatment
 ....
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
SMC
Scottish Medicines Consortium
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

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.   

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 hospital specialist, but where the provision of an information leaflet may be appropriate to facilitate continuing treatment by GPs. Many of these information sheets are in the process of development.  

Green

Drugs where prescribing by GPs is appropriate. Drugs not classified as Red, Amber or Green Plus (formerly blue in North of Tyne) are generally classified as ‘Green’ by default. The Green drugs listed here include those products normally initiated by hospital specialists where there was a need for discussion and debate as to the category in which they should be placed.  

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