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Guy's and St Thomas' NHS Foundation Trust
Kings College Hospital NHS Foundation Trust
Lewisham and Greenwich NHS Trust
 
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 Formulary Chapter 12: Ear, nose and oropharynx - Full Chapter
Notes:

Where a formulary entry does not detail a medicine’s indications for use, the medicine can be assumed to be approved for all licensed indications.

Formulary approved "off-label" use is detailed separately.

 Details...
12.02  Expand sub section  Drugs acting on the nose
12.02.01  Expand sub section  Drugs used in nasal allergy
12.02.01  Expand sub section  Antihistamines
Azelastine aqueous nasal spray (Rhinolast)
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Formulary  
   
12.02.01  Expand sub section  Corticosteroids
Betamethasone 0.1% drops
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Formulary  
   
Fluticasone furoate 27.5 micrograms nasal spray
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Formulary  
   
Fluticasone propionate 400 micrograms nasal drops (nasules) (nasal polyps)
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Formulary
Green

Approved for the management of nasal polyps and associated symptoms of nasal obstruction

Approved off-label use:

  • For treatment of chronic sinusitis after functional endoscopic sinus surgery (FESS) surgery for polyps.  One nasule (400 micrograms) added to saline nasal irrigation, used twice a day.
 
   
Fluticasone propionate 50 micrograms and azelastine 137 micrograms nasal spray (Dymista)
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Formulary
Green

Approved in adults and children from 12 years for moderate to severe seasonal and perennial allergic rhinitis

Restricted to use where a combination of oral antihistamines and nasal corticosteroids have failed (step 4 of SE London Allergic Rhinitis Pathway - see above for link)

 
Link  SE London APC Recommendation: Fluticasone propionate and azelastine combination nasal spray (Dymista) for
   
Fluticasone propionate 50 micrograms nasal spray
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Formulary  
   
Mometasone 50 micrograms nasal spray
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Formulary  
   
Beclometasone dipropionate 50 micrograms nasal spray
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Restricted Drug Restricted

Beclomethasone nasal spray is reserved for use when a nasal corticosteroid less dependent on CYP3A metabolism is required, e.g. patients taking cobicistat or ritonavir (see MHRA alert below)

Mometasone, fluticasone propionate and fluticasone furoate are preferred intranasal cotricosteroid sprays for prescribing in SE London.

See APC allergic rhinitis integrated guideline (link above)

 
Link  MHRA Dec 2016:Cobicistat, ritonavir and coadministration with a steroid: risk of systemic corticosteroid adverse effects
   
12.02.01  Expand sub section  Cromoglicate to top
Sodium cromoglicate 4% nasal spray
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Formulary  
   
12.02.02  Expand sub section  Topical nasal decongestants
NeilMed Sinus Rinse Isotonic
Formulary
Red
Hospital prescribing only 
   
Sodium chloride nose drops 0.9%
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Formulary  
   
12.02.02  Expand sub section  Sympathomimetics
Ephedrine nasal drops 0.5%, 1%
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Formulary  
   
Xylometazoline nasal spray 0.1% & nasal drops 0.1%
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Formulary  
   
12.02.02  Expand sub section  Antimuscarinic
Ipratropium 21 micrograms nasal spray
(Rinatec)
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Formulary  
   
12.02.03  Expand sub section  Nasal preparations for infection
12.02.03  Expand sub section  Nasal Staphylococci to top
Bismuth subnitrate & iodoform gauze
Formulary  
   
Chloramphenicol 1% eye ointment  (ENT and plastics post surgical use - off-label)
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Formulary

Approved off-label indication:

Topical use post ENT surgery or plastic surgery (to wound)

Applied twice or three times daily for a short course (usually 5 days) post-procedure for prevention of infection

 
   
Mupirocin 2% nasal ointment
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Formulary USE ON MICROBIOLOGY/VIROLOGY ADVICE 
   
Naseptin cream
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Formulary

USE ON MICROBIOLOGY/VIROLOGY ADVICE Contains:

  • Chlorhexidine hydrochloride 0.1%
  • Neomycin sulphate 0.5%

Caution: also contains arachis oil (peanut oil)

 
   
Octenidine nasal gel
Formulary
Red
USE ON MICROBIOLOGY/VIROLOGY ADVICE 
   
Polyfax eye ointment
View adult BNF
Restricted Drug Restricted

USE ON MICROBIOLOGY/VIROLOGY ADVICE only - for eradication of nasal carriage of MRSA

Contains:

  • Polymixin B sulphate 10 000units/g
  • Bacitaricin zinc 500 units/g

Instructions:

  • Eye ointment is used in the nose
  • A matchhead size portion to be applied into each nostril
  • Close nostrils to spread the ointment throughout the nares
  • Dose = 2-3 times daily
  • Continue treatment for 5-7 days
 
   
Alkaline nasal douche
Unlicensed Drug Unlicensed

Powder containing:

  • Sodium bicarbonate 20g
  • Sodium chloride 20g
  • Borax 20g

Indications:

  • Post-operatively after nasal surgery and functional endoscopic sinus surgery.
  • For any condition causing crusting of nasal cavities

Instructions for use:

  • 5 mL spoonful of powder added to a tumblerful of warm water and mixed well.
  • Small aliquots of the solution are sniffed.
  • Any solution that goes into the throat should not be swallowed
  • Dose = three times daily
 
   
 ....
 Non Formulary Items
Budesonide 64 micrograms nasal spray

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Non Formulary
Grey
Mometasone, fluticasone propionate and fluticasone furoate are preferred intranasal cotricosteroid sprays for prescribing in SE London. See APC allergic rhinitis integrated guideline (link above)
 
  
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
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Link to adult BNF
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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

Specialist or hospital prescribing only. The responsibility for prescribing, monitoring, dose adjustment and review should remain with the specialist or hospital. In very exceptional circumstances a specialist may discuss individual patient need for a RED drug to be prescribed by a GP and the GP should consider informing the Medicines Management team before a decision is made to prescribe for individual patients.   

Amber 1

Treatment can be initiated in primary care after a recommendation from an appropriate specialist  

Amber 2

Specialist initiation followed by maintenance prescribing in primary care  

Amber 3

Specialist initiation with ongoing monitoring required. After dose stabilisation GPs can be requested to take over prescribing responsibilities using the approved APC shared care documentation  

Green

Specialist and non-specialist initiation  

Grey

Not recommended for prescribing  

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