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Airedale NHS Foundation Trust
Airedale, Wharfedale and Craven CCG
 
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 Formulary Chapter 12: Ear, nose and oropharynx - Full Chapter
Notes:
Unless explicitly stated, any brand names included in brackets next to a drug's generic name are there solely to aid searching and identification, and should not be considered to limit use to that specific brand.
 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%  (Betnesol, Vistamethasone)
(Ear/Eye/Nose Drops)
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Formulary
Green
  • Betnesol Drops
  • Vistamethasone Drops
 
 
12.01.01  Anti-infective preparations to top
 note 

Otitis media (acute): antimicrobial prescribing

Acetic Acid 2% w/w (EarCalm )
(Ear Spray)
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Formulary
Green
  • Acetic Acid 2% Ear Spray
 
 
Chloramphenicol
(Ear Drops)
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Formulary
Green
  • Chloramphenicol 5% Ear Drops
 
 
Gentamicin 0.3% (Genticin)
(Ear/Eye Drops)
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Formulary
Green
  • Gentamicin 0.3% Ear/Eye Drops
 
 
Otocomb Otic
(Ear Ointment)
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Red ULM
  • Otocomb Otic Ear Ointment
 
Link  Unlicensed Medicines Consultant Request Form (ANHSFT access only)
Link  Unlicensed Medicines Patient Agreement for Use Form (ANHSFT access only)
Link  Unlicensed Medicines Patient Information Leaflet (ANHSFT access only)
Link  Unlicensed Medicines Policy (ANHSFT access only)
 
12.01.01  Combination products
Betamethasone with Neomycin (Betnesol N Vista-Methasone N)
(Ear/Eye/Nose Drops)
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Formulary
Green
  • Betamethasone 0.1% Neomycin Sulphate 0.5% Eye/Ear/Nose Drops
 
 
Clotrimazole 1%  (Canesten)
(Solution)
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Restricted Drug Restricted
Green
  • Clotrimazole 1% Solution

Under recommendation of consultant ENT surgeon only.

 
 
Dexamethasone, Framycetin Sulphate and Gramicidin (Sofradex)
(Ear/Eye Drops)
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Formulary
Green
  • Dexamethasone (Sodium Metasulphobenzoate) 0.05%, Framycetin Sulphate 0.5%, Gramicidin 0.005% Ear/Eye Drops
 
 
Dexamethasone, Neomycin and Glacial Acetic Acid (Otomize)
(Ear Spray)
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Formulary
Green
  • Dexamethasone 0.1%, Neomycin Sulphate 3250units/ml, Glacial Acetic acid 2% Ear Spray
 
 
Flumetasone Pivulate with Clioquinol (Locorten Vioform)
(Ear Drops)
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Formulary
Green
  • Flumetasone Pivulate 0.02%, Clioquinol 1% Ear Drops
     

Contraindicated in iodine sensitivity.

 
 
Hydrocortisone Acetate and Gentamicin (Gentisone HC )
(Ear Drops)
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Formulary
Green
  • Hydrocortisone Acetate 1%, Gentamicin 0.3% Ear Drops
 
 
Polymyxin B Sulphate, Neomycin Sulphate, Hydrocortisone (Otosporin)
(Ear drops)
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Formulary
Green
  • Polymyxin B Sulphate, Neomycin Sulphate, Hydrocortisone Ear Drops
 
 
Ciprofloxacin
(Drops)
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Restricted Drug Restricted
Red ULM
  • Ciprofloxacin 0.3% Ear Drops

Under recommendation of consultant ENT surgeon only.

EAR drops not available, but EYE drops are acceptable to use in the ear (See BNF section 12.1.2). Usually 2-3 drops, 3-4 times daily. (unlicensed use)

 
Link  DSU: Systemic and inhaled fluoroquinolones: small increased risk of aortic aneurysm and dissection; advice for prescribing in high-risk patients
 
12.01.02  Otitis media
12.01.03  Removal of ear wax
Arachis Oil  (Cerumol)
(Ear Drops)
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Formulary
Green
  • Arachis Oil (refined peanut oil) Ear Drops
 
 
Olive Oil
(Ear Drops)
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Formulary
Green
  • Olive Oil Ear Drops
 
 
Sodium Bicarbonate
(Ear Drops)
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Formulary
Green
  • Sodium Bicarbonate 5% Ear Drops
 
 
Urea-hydrogen Peroxide (Otex, Exterol)
(Ear Drops)
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Formulary
Green
  • Urea-hydrogen Peroxide 5% Ear Drops
 
 
12.02  Drugs acting on the nose
12.02.01  Drugs used in nasal allergy to top
Sterimar
(Nasal Rinse)
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Formulary
Green
  • Isotonic sea water Nasal Rinse
 
 
12.02.01  Antihistamines
12.02.01  Corticosteroids
Beclometasone Dipropionate (Beconase, Nasobec)
(Nasal Spray)
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First Choice
Green
  • Beclometasone Dipropionate Nasal Spray

Please prescribe as Beconase® 200 dose in Primary Care.

 
Mometasone Furoate (Nasonex)
(Aqueous Nasal Spray)
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Second Choice
Green
  • Mometasone Furoate Aqueous Nasal Spray

Prescribe generically in primary care.

 
 
Budesonide (Rhinocort Aqua )
(Nasal Spray)
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Second Choice
Green
  • Budesonide Nasal Spray
 
 
Fluticasone
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Formulary
Green
  • Formulary: Fluticasone Furoate 27.5mcg (Avamys® Nasal Spray)
  • Second Choice: Fluticasone Propionate 50mcg (Flixonase® Nasal Spray)
  • Restricted: Fluticasone Propionate 400mcg (Flixonase® Nasule Drop) Consultant recommendation only.
 
 
12.02.01  Cromoglicate
12.02.02  Topical nasal decongestants
12.02.02  Sympathomimetics to top
Ephedrine Hydrochloride
(Nasal Drops)
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Formulary
Green
  • Ephedrine Hydrochloride Nasal Drops
 
Link  MHRA Drug Safety Update: Pseudoephedrine and ephedrine: regular review of minimising risk of misuse in the UK (June 2017)
Link  MHRA Drug Safety Update: Pseudoephedrine and ephedrine: update on managing risk of misuse in the UK (September 2015)
 
Sodium Chloride
(Nasal Drops)
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Formulary
Green
  • Sodium Chloride Nasal Spray
  • Sodium Chloride Nasal Drops
 
 
Xylometazoline Hydrochloride (Otrivine)
(Nasal Spray and Drops)
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Formulary
Green
  • Xylometazoline Hydrochloride Nasal Spray
  • Xylometazoline Hydrochloride Nasal Drops
 
 
12.02.02  Antimuscarinic
12.02.03  Nasal preparations for infection
Betamethasone Sodium Phosphate 0.1% with Neomycin Sulphate 0.5% (Betnesol N)
(Eye/Ear/Nose Drops)
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Formulary
Green
  • Betamethasone 0.1%, Neomycin 0.5%  Eye/Ear/Nose Drops
 
 
BIPP
(Guaze)
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Formulary
Red
  • BIPP Gauze (1.25cm x 1m, 2.5cm x 1m)
 
 
12.02.03  Nasal Staphylococci
Prontoderm
(Nasal Gel)
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Second Choice
Green
  • Prontoderm Nasal Gel® Nasal

For MRSA decolonisation.

 
 
Chlorhexidine Hydrochloride 0.1%, Neomycin Suphate 0.5% (Naseptin)
(Nasal Cream)
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Formulary
Green
  • Chlorhexidine Hydrochloride 0.1%, Neomycin Sulphate 0.5% Nasal Cream
 
 
Octenidine Hydrochloride (Octenisan)
(Nasal Ointment)
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Restricted Drug Restricted
Green
  • Octenidine Hydrochloride Nasal Ointment

For restricted use as a second-line option for MRSA decolonisation for patients resistant to or with contraindications to mupirocin.

 
 
12.03  Drugs acting on the oropharynx
12.03.01  Drugs for oral ulceration and inflammation to top
Benzydamine (Difflam)
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Formulary
Green
  • Benzydamine Oral Spray
  • Benzydamine Mouthwash (Oral Rinse)
 
 
Carmellose Sodium (Orabase)
(Oral Paste)
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Formulary
Green
  • Carmellose Sodium Oral Paste
 
 
Choline Salicylate (Bonjela Adult)
(Oral Gel)
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Restricted Drug Restricted
Green
  • Choline Salicylate Oral Gel

For patients over 16 years only.

 
 
Gelclair
(Oral Gel)
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Restricted Drug Restricted
Amber
  • Gelclair Oral Gel

ENT, Oncology and Haematology use only.

 
 
GelX oral spray
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Restricted Drug Restricted
Amber
  • GelX oral spray

Specialist initiation only.

 
 
Lidocaine Hydrochloride , Cetalkonium Chloride  (Bonjela Teething Gel)
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Formulary
Green
  • Lidocaine Hydrochloride , Cetalkonium Chloride Teething Gel
 
Link  DSU:Oral lidocaine-containing products for infant teething: only to be available under the supervision of a pharmacist (December 2018)
 
Antacid with Oxetacaine
(Sugar Free Suspension)
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Restricted Drug Restricted
Red
  • Antacid with Oxetacaine Sugar Free Suspension

Restricted for Oncology and Haematology patients only
unlicensed unlicensed special ULM

 
 
12.03.02  Oropharyngeal anti-infective drugs
12.03.02  Oropharyngeal Fungal infections
Nystatin
(Sugar Free Suspension )
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First Choice
Green
  • Nystatin 100,000units/mL Sugar Free Suspension

 

 
Miconazole  (Daktarin)
(Oral Gel)
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Second Choice
Green
  • Miconazole 20mg/g Oral Gel (80g) Available for general use.
  • Miconazole 20mg/g Oral Gel (15g) Available for Children's Unit.
 
Link  Antibiotic Prescribing Guidelines Superficial Fungal Infections (ANHSFT access only)
Link  Drug Safety Update: Topical miconazole, including oral gel: reminder of potential for serious interactions with warfarin (June 2016)
 
12.03.02  Oropharyngeal Viral infections
12.03.03  Lozenges and sprays
Benzocaine, Tyrothricin (Tyrozets)
(Lozenges)
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Formulary
Green
  • Benzocaine, Tyrothricin Lozenges
 
 
Hydrocortisone
(Muco-adhesive Buccal Tablets)
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Formulary
Green
  • Hydrocortisone Muco-adhesive Buccal Tablets
 
Link  DSU: Hydrocortisone muco-adhesive buccal tablets: should not be used off-label for adrenal insufficiency in children due to serious risks (December 2018)
 
12.03.04  Mouthwashes, gargles, and dentifrices to top
Chlorhexidine Gluconate
(Mouthwash and Dental Gel)
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Formulary
Green
  • Chlorhexidine Gluconate Mouthwash
  • Chlorhexidine Gluconate Dental Gel
 
 
12.03.05  Treatment of dry mouth
12.03.05  Local Treatment
Oralieve
(Moisturising Gel)
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First Choice
Green
  • Oralieve® Moisturising Gel
 
Glandosane
(Artificial Saliva Spray)
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Formulary
Green
  • Glandosane® Artificial Saliva Spray
 
 
AS Saliva Orthana
(Spray)
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Restricted Drug Restricted
Green
  • AS Saliva Orthana® Spray

Reserved for Oncologists, Haematologists and ENT consultants only.

 
 
Biotene
(Oral Balance Gel)
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Formulary
Green
  • Biotene® Oral Balance Gel

Reserved for patients who can't tolerate the alternative options. Not routinely stocked at ANHSFT.

 
 
12.03.05  Systemic treatment
Pilocarpine Hydrochloride (Salagen)
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Formulary
Amber
  • Pilocarpine Hydrochloride Tablets

Supported for treatment of the symptoms of dry mouth and dry eyes in patients with Sjögren's sydrome.

For use following consultant recommendation only.

 
 
 ....
 Non Formulary Items
Oral mucosa lubricant  (Caphosol)

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Non Formulary
Black
Not routinely commissioned as no evidence of benefit.
  
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

Green - Drugs suitable for generalised use in accordance with position summary. Inform primary care of need to prescribe using a TTO chart if in patient or Treatment Advice Note (TAN) if Outpatient.   

Amber

Amber - these drugs require specialist initiation or recommendation  

Amber SCG

Amber Share Care - Drugs suitable for generalist use, in accordance with position summary, normally following specialist initiation and stabilisation. Ongoing division of responsibility for drug and disease monitoring between specialist and GP by a Shared Care Guideline (SCG). If no SCG in place status reverts to red.  

Red

Red - Drugs for specialist use only, in accordance with position summary. GPs should not be asked to prescribe these products.  

Red ULM

Red ULM - Unlicensed medicines for specialist use only, in accordance with position summary. GPs should not be asked to prescribe these products.  

Grey

Grey drugs - No formal commissioning position. Check appropriate CCG /NHSE commissioning list or contact CCG/NHSE Medicines Management team for advice. Fill in individual funding request for appropriate CCG/NHSE. This will need to be signed by the Chief Pharmacist and a copy of the relevant DTC submission attached.   

Black

Black - Drugs not routinely commissioned so should not usually be prescribed  

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