netFormulary South East London Joint Medicines Formulary NHS
Guy's and St Thomas' NHS Foundation Trust
Kings College Hospital NHS Foundation Trust
Lewisham and Greenwich NHS Trust
 
 Search
 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...
12.02.01  Expand sub section  Drugs used in nasal allergy
12.02.01  Expand sub section  Antihistamines
Azelastine aqueous nasal spray (Rhinolast)
View adult BNF View SPC online
Formulary  
   
12.02.01  Expand sub section  Corticosteroids
Betamethasone 0.1% drops
View adult BNF View SPC online
Formulary  
   
Fluticasone furoate 27.5 micrograms nasal spray
View adult BNF View SPC online
Formulary  
   
Fluticasone propionate 400 micrograms nasal drops (nasules) (nasal polyps)
View adult BNF View SPC online
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)
View adult BNF View SPC online
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
View adult BNF View SPC online
Formulary  
   
Mometasone 50 micrograms nasal spray
View adult BNF View SPC online
Formulary  
   
Beclometasone dipropionate 50 micrograms nasal spray
View adult BNF View SPC online
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
Sodium cromoglicate 4% nasal spray
View adult BNF View SPC online
Formulary  
   
 ....
 Non Formulary Items
Budesonide 64 micrograms nasal spray

View adult BNF View SPC online
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
click to search medicines.org.uk
Link to adult 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

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  

netFormulary