| Formulary Chapter 12: Ear, nose and oropharynx - Full Chapter
|
| Notes: |
This chapter of the formulary is under continual development, please let the team know if you have any comments about the contents: mlcsu.lscformulary@nhs.net.
|
|
| Details... |
| 12.01 |
Drugs acting on the ear |
|
|
|
|
| 12.01.01 |
Otitis externa |
|
|
| 12.01.01 |
Astringent preparations |
|
|
| 12.01.01 |
Anti-inflammatory preparations |
|
|
Betamethasone 0.1% with Neomycin 0.5% ear drops (Betnesol N®)
|
Formulary
|
|
|
|
Betamethasone ear drops (Betnesol ®)
|
Formulary
|
betamethasone sodium phosphate 0.1%
|
|
|
Dexamethasone with Antibacterial (Otomize®)
|
Formulary
|
|
|
|
Dexamethasone with Antibacterial (Sofradex®)
|
Formulary
|
dexamethasone (as sodium metasulphobenzoate) 0.05%, framycetin sulfate 0.5%, gramicidin 0.005%
|
|
|
Flumetasone 0.02% with Clioquinol 1% (Locorten-Vioform®)
|
Formulary
|
|
|
|
Hydrocortisone Acetate 1% with Gentamicin 0.3% (Gentisone® HC)
|
Formulary
|
|
|
|
| 12.01.01 |
Anti-infective preparations |
|
|
Chloramphenicol
|
Formulary
|
Ear drops 5%
Morecambe bay only
|
|
|
Ciprofloxacin 3mg and Dexamethasone 1mg ear drops (Cilodex®)
|
Formulary
|
Ear drops
|
|
|
Clotrimazole (Canesten®)
|
Formulary
|
Clotrimazole 1% 20mL
labelled 'solution', not 'ear drops'
in East Lancashire
|
|
|
Gentamicin (Genticin®)
|
Formulary
|
Gentamicin 0.3% 10 mL
|
|
|
Triamcinolone acetonide, nystatin, gramicidin, neomycin (Kenacomb Otic®)
|
 Unlicensed
|
Ointment 5g
|
|
|
| 12.01.01 |
Other aural preparations |
|
|
| 12.01.02 |
Otitis media |
|
|
 |
No topical treatments are recommended - see BNF |
|
Otigo 40 mg/10 mg/g ear drops, solution (Otigo ®)
|
Formulary
|
Ear drops containing - Lidocaine hydrochloride 10 mg per 1 gram with Phenazone 40 mg per 1 gram, 15mL bottle.
|
|
|
|
|
| 12.01.03 |
Removal of ear wax |
|
|
Olive Oil Ear Drops
|
Formulary
|
|
|
|
Sodium Bicarbonate
|
Formulary
|
sodium bicarbonate 5% 10mL
|
|
|
| 12.02 |
Drugs acting on the nose |
|
|
Isotonic Aqueous Spray (NASA-MIST®)
|
Formulary
|
Isotonic aqueous nasal spray
For use post-op follow local protocols
*under review*
|
|
|
Sterimar®
(For nasal washout)
|
Formulary
|
Microspray 100% natural sea water 50mL pack
Follow local protocols
*under review*
|
|
|
| 12.02.01 |
Drugs used in nasal allergy |
|
|
| 12.02.01 |
Antihistamines |
|
|
Azelastine 0.15% Nasal Spray (Azelair®)
|
Formulary
|
Symptomatic treatment of allergic rhinitis in adults, adolescents and children 6 years and older.
|
|
|
Azelastine Hydrochloride (Rhinolast®)
|
Formulary
|
nasal spray 140 microgram per 1 actuation
After tertiary referral only
in East Lancashire
|
|
|
| 12.02.01 |
Corticosteroids |
|
|
Beclometasone Dipropionate
|
First Choice
|
Aqueous nasal spray 50micrograms/metered spray
|
|
|
Betamethasone nasal drops
|
First Choice
|
Ear/eye/nose drops 0.1%
|
|
|
Fluticasone furoate (Avamys®)
|
Second Choice
|
Nasal spray 27.5micrograms/metered spray
|
|
|
Fluticasone Propionate (Flixonase Nasule®)
(for nasal polyps)
|
Second Choice
|
Nasal drops 400micrograms/unit dose
Consider alternative treatment if no improvement after 4–6 weeks
|
|
|
Mometasone Furoate (Nasonex®)
|
Second Choice
|
Nasal spray 50micrograms/metered spray
|
|
|
Fluticasone Propionate (Flixonase ®)
|
Formulary
|
Nasal spray 50microgram per dose
|
|
|
| 12.02.01 |
Cromoglicate |
|
|
Sodium Cromoglicate (Rynacrom®)
|
Formulary
|
Nasal spray 4% (5.2mg/metered spray)
Morecambe bay only
|
|
|
| 12.02.02 |
Topical nasal decongestants |
|
|
| 12.02.02 |
Sympathomimetics |
|
|
Ephedrine
|
Formulary
|
Nasal drops 0.5%, 1%
If no strength is specified 0.5% drops will be supplied
|
|
|
Xylometazoline (Otrivine®)
|
Formulary
|
Nasal drops 0.1%
Nasal spray 0.1%
Paediatric nasal drops 0.05%
|
|
|
| 12.02.02 |
Antimuscarinic |
|
|
Ipratropium Bromide (Rinatec®)
|
Formulary
|
Nasal spray 0.03% (21micrograms/metered spray)
|
|
|
| 12.02.03 |
Nasal preparations for infection |
|
|
Betamethasone Sodium Phosphate 0.1% with Neomycin Sulphate 0.5%
|
Formulary
|
Nasal drops Betamethasone Sodium Phosphate 0.1% with Neomycin Sulphate 0.5%
|
|
|
| 12.02.03 |
Nasal Staphylococci |
|
|
Chlorhexidine Hydrochloride 0.1%, Neomycin Suphate 0.5% (Naseptin®)
|
Formulary
|
Nasal cream Chlorhexidine Hydrochloride 0.1%, Neomycin Suphate 0.5%
|
 MHRA: Medical Device Alert
|
Mupirocin 2% (Bactroban Nasal®)
|
Formulary
|
Nasal ointment Mupirocin 2%
|
|
|
| 12.03 |
Drugs acting on the oropharynx |
|
|
| 12.03.01 |
Drugs for oral ulceration and inflammation |
|
|
Benzydamine (Difflam®)
|
Formulary
|
Oral rinse 0.15%
Spray 0.15%
|
|
|
Betamethasone (Betnesol®)
|
Formulary
|
Soluble tablets 500micrograms
Unlicensed use
In East Lancashire
|
|
|
Carmellose Sodium (Orabase®)
|
Formulary
|
Protective paste carmellose 16.7%, pectin 16.7%, gelatin 16.7% in Plastibase®
|
|
|
Choline Salicylate (Bonjela® Adult)
|
Formulary
|
Oral gel 8.7%
For adults and children over 16
|
|
|
Gelclair®
|
Formulary
|
Sachets
in East Lancashire
|
|
|
GelX®
|
Formulary
|
Oral spray
|
|
|
Hydrocortisone (Corlan®)
|
Formulary
|
Pellets 2.5mg
|
 MHRA: Hydrocortisone muco-adhesive buccal tablets: should not be used off-label for adrenal insufficiency in children due to serious risks
|
Lidocaine 10% spray
|
Formulary
|
spray 10mg/metered dose
Morecambe bay only
|
|
|
Lidocaine 5% ointment
|
Formulary
|
Ointment 5%
|
|
|
|
|
| 12.03.02 |
Oropharyngeal anti-infective drugs |
|
|
| 12.03.02 |
Oropharyngeal Fungal infections |
|
|
Nystatin (Nystan®)
|
First Choice
|
Oral suspension 100,000 units/mL
Will be labelled in doses of 1mL unless alternative specifically requested
|
|
|
| 12.03.02 |
Oropharyngeal Viral infections |
|
|
Aciclovir
|
Formulary
|
Cream 5%
|
|
|
| 12.03.03 |
Lozenges and sprays |
|
|
| |
No products are stocked |
|
| 12.03.04 |
Mouthwashes, gargles, and dentifrices |
|
|
Chlorhexidine gluconate (Corsodyl®)
|
Formulary
|
Mouthwash 0.2%
Dental gel 1%
|
MHRA: Medical Device Alert
|
Hexetidine (Oraldene®)
|
Formulary
|
Mouthwash 0.1%
|
|
|
Hydrogen Peroxide
|
Formulary
|
Mouthwash 6%
|
MHRA: Hydrogen peroxide: reminder of risk of gas embolism when used in surgery
|
| 12.03.05 |
Treatment of dry mouth |
|
|
| 12.03.05 |
Local Treatment |
|
|
AS saliva Orthana®
|
Formulary
|
Oral spray
|
|
|
Biotene Oralbalance® gel
|
Formulary
|
Oral gel
Reserved for use in patients with severe dry mouth as a result of an underlying condition or treatment, such as, progressive neurological conditions affecting swallowing (including but not exclusively Parkinson’s disease, Parkinson’s plus conditions, multiple sclerosis etc), Sjogren’s syndrome or after radiotherapy for head and neck cancer. It may also be suitable for end-of-life patients, anyone who is ‘nil by mouth’ or patients who are suffering from a dry mouth as a result of being on a fluid restriction due to cardiac issues. Non-pharmacological interventions should always be first-line
|
|
|
Salivix®
|
Formulary
|
Pastilles
|
|
|
| 12.03.05 |
Systemic treatment |
|
|
Pilocarpine (Salagen®)
|
Formulary
|
Tablets 5mg
Radiation-induced xerostomia, Sjogren’s syndrome
When 1st line topical agents have not been effective
|
|
|
Pilocarpine Hydrochloride
|
Formulary
|
Approved for Sjogrens Syndrome for severe cases that are unresponsive to pastilles and/or artificial saliva spray - Specialist initiation
|
|
|
| 12.04 |
Oral and Maxillofacial |
|
|
Carnoy’s Solution
|
Formulary
|
Topical adjuvant for procedures for odontogenic keratocysts
unlicensed
Specialist use only
|
|
|
Iqoro Device
|
Formulary
|
Treatment of Stroke related dysphagia
|
|
|
Iqoro Device
|
Formulary
|
Treatment of hiatus hernia
|
|
|
| .... |
| Non Formulary Items |
| |
Key |
|
|
|
|
Cytotoxic Drug
|
|
|
Controlled Drug
|
|
High Cost Medicine
|
|
Cancer Drugs Fund
|
|
NHS England |
|
Homecare |
|
CCG |
|
Low carbon footprint |
|
Medium carbon footprint |
|
High carbon footprint |
|
Traffic Light Status Information
| Status |
Description |
|
Green:
Appropriate for initiation and ongoing prescribing in both primary and secondary care.
Generally, little or no routine drug monitoring is required. |
|
Green (Restricted):
Appropriate for initiation and ongoing prescribing in both primary and secondary care provided:
Additional criteria specific to the medicine or device are met, or
The medicine or device is used following the failure of other therapies as defined by the relevant LSCMMG pathway.
Generally, little or no routine drug monitoring is required.
|
|
Red medicines:
Medicine is supplied by the hospital for the duration of the treatment course.
Primary care initiation or continuation of treatment is not recommended unless exceptional circumstances such as specialist GP.
Red medicines are those where primary care prescribing is not recommended. These treatments should be initiated by specialists only and prescribing retained within secondary care. They require specialist knowledge, intensive monitoring, specific dose adjustments or further evaluation in use. If however, a primary care prescriber has particular specialist knowledge or experience of prescribing a particular drug for a particular patient it would not always be appropriate for them to expect to transfer that prescribing responsibility back to secondary care. There should be a specific reason and a specific risk agreement, protocol and service set up to support this.
Primary care prescribers may prescribe RED medicines in exceptional circumstances to patients to ensure continuity of supply while arrangements are made to obtain ongoing supplies from secondary care. |
|
Amber level 0:
Suitable for prescribing in primary care following recommendation or initiation by a specialist.
Little or no specific monitoring required.
Patient may need a regular review, but this would not exceed that required for other medicines routinely prescribed in primary care.
Brief prescribing document or information sheet may be required.
Primary care prescribers must be familiar with the drug to take on prescribing responsibility or must get the required information.
When recommending or handing over care, specialists should ask primary care prescribers to take over prescribing responsibility, and should give enough information about the indication, dose, monitoring requirements, use outside product licence and any necessary dose adjustments to allow them to confidently prescribe. |
|
Amber level 1 (with shared care):
Suitable for prescribing in primary care following recommendation or initiation by a specialist.
Minimal monitoring required.
Patient may need a regular review, but this would not exceed that required for other medicines routinely prescribed in primary care.
Full prior agreement about patient’s on-going care must be reached under the shared care agreement.
Primary care prescribers are advised not to take on prescribing of these medicines unless they have been adequately informed by letter of their responsibilities with regards monitoring, side effects and interactions and are happy to take on the prescribing responsibility. A copy of locally approved shared care guidelines should accompany this letter which outlines these responsibilities. Primary care prescribers should then tell secondary care of their intentions as soon as possible by letter so that arrangements can be made for the transfer of care. |
|
Amber level 2 (with shared care and enhanced service):
Initiated by specialist and transferred to primary care following a successful initiation period.
Significant monitoring required on an on-going basis.
Full prior agreement about patient’s on-going care must be reached under the shared care agreement.
Suitable for enhanced service.
These medicines are considered suitable for GP prescribing following specialist initiation of therapy, as per shared care document which will be sent out with the request to prescribe, with on-going communication between the primary care prescriber and specialist. Amber Level 2 medicines require significant monitoring for which an enhanced service may be suitable. (Subject to local commissioning agreements). |
|
Do not prescribe: NOT recommended for use by the NHS in Lancashire and South Cumbria.
Includes medicines that NICE has not recommended for use and terminated technology appraisals, unless there is a local need. |
|
Grey medicines:
Medicines which have not yet been reviewed or are under the review process.
GPs and specialists are recommended not to prescribe these drugs.
This category includes drugs where funding has not yet been agreed.
|
|
Refer to local guidance. |
|
|
|
