netFormulary NHS
NHS Bath and North East Somerset, Swindon and Wiltshire CCG
Royal United Hospitals Bath NHS Foundation Trust
Great Western Hospitals NHS Foundation Trust
Salisbury NHS Foundation Trust
 Search
 Formulary Chapter 12: Ear, nose and oropharynx - Full Chapter
Notes:

ENT related prescribing guidance

Please see our Prescribing Guidelines page for a full list of guidance available.

ENT Shared Care Agreements

There are no shared care agreements available for ENT.

Self-care

Many of the products in this chapter are available for purchase over-the-counter, and patients are encouraged to self-care, with the support of their community pharmacist, in the first instance.

For further information on self-care & the NHS, please refer to https://www.england.nhs.uk/medicines/conditions-for-which-over-the-counter-items-should-not-routinely-be-prescribed/

 Details...
12.02  Expand sub section  Drugs acting on the nose
 note 

See Local Allergic Rhinitis guidance for adults: BCAP Allergic Rhinitis Guidance 2018 and MMT statement on the treatment of hayfever.

Please see MHRA Drug Safety Update August 2017 for information and advice on the rare risk of central serous chorioretinopathy with local and systemic administration of corticosteroids.

Allergic rhinitis: short term treatment, start treatment 2-3 weeks before season starts. Many of the products are available for self-purchase and self-care.

Perennial rhinitis: long term therapy required.

12.02.01  Expand sub section  Drugs used in nasal allergy
12.02.01  Expand sub section  Antihistamines
Azelastine
(Nasal spray)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • 140micrograms/dose nasal spray 22ml
  • Useful option for patients who do not want to try a corticosteroid or have contra-indications to them

 

 
 
12.02.01  Expand sub section  Corticosteroids
Mometasone Furoate
(spray)
View adult BNF View SPC online
First Choice
traffic lightGreen
  • Nasal spray 50 micrograms per spray
  • First line for treatment of allergic rhinits (prescribe generically)
  • For ENT initiation only for the treatment of nasal polyps.

 

 

 

 
Beclometasone Dipropionate (spray)
View adult BNF View SPC online
First Choice
traffic lightSelf
  • 200 dose nasal spray, 50 micrograms per spray     
  • Beclomethasone is licensed for the prophylaxis and treatment of allergic and vasomotor rhinitis.    
  • First line for treatment of allergic rhinits  . OTC for over 18 years.

 

 

 

 
Budesonide (Nasal spray)
View adult BNF View SPC online
Second Choice
traffic lightGreen
  • Budesonide nasal spray 64micrograms / spray 120 dose
  • Second line for the treatment of allergic rhinitis
  • Licensed for nasal polyps.

 

 
 
Fluticasone furoate (Nasal spray)
View adult BNF View SPC online
Second Choice
traffic lightGreen
  • Fluticasone furoate nasal spray, 27.5 micrograms per spray
  • Second line for the treatment of allergic rhinitis

 

 

 

 
 
Fluticasone Propionate
(nasal drops)
View adult BNF View SPC online
Third Choice
traffic lightGreen
  • Nasal drops 400 micrograms/unit dose  
  • Only for the treatment of nasal polyps and associated symptoms of nasal obstruction.
  • Only to be used 3rd line as per the Local allergic rhinitis guidance (see top of this section for guidance links) March 2018

 

 

 

 
 
Fluticasone + Azelastine
(Nasal spray)
View adult BNF View SPC online
Third Choice
traffic lightGreen
  • Azelastine 137 micrograms and Fluticasone propionate 50 micrograms per actuation
  • Only to be used 3rd line as per the local allergic rhinitis guidance  
 
 
Betamethasone Sodium Phosphate 0.1%
(nasal drops)
View adult BNF View SPC online
Formulary
traffic lightGreen
  •  5ml nasal drops

 

 
 
12.02.02  Expand sub section  Topical nasal decongestants to top
12.02.02  Expand sub section  Sympathomimetics
Xylometazoline
(Nasal drops and spray)
View adult BNF View SPC online
First Choice
traffic lightSelf
  • Nasal drops 0.1% and 0.05% (paedatric) 10ml
  • Spray 0.1% 10ml
 
Ephedrine
(nasal drops)
View adult BNF View SPC online
Formulary
traffic lightSelf
  • Nasal drops 0.5%
  • 1% 10ml     

 

 
 
12.02.02  Expand sub section  Antimuscarinic
Ipratropium Bromide 0.03%
(Nasal spray)
View adult BNF View SPC online
First Choice
traffic lightGreen
  • nasal spray 0.03%      
  • Useful for watery rhinorrhoea
 
12.02.03  Expand sub section  Nasal preparations for infection
Bismuth + iodoform impregnated gauze (BIPP)
View adult BNF View SPC online
Formulary
traffic lightRed
  • A paste of composition Iodoform 40% w/w, Bismuth Subnitrate 20% w/w and Paraffin Liquid 40% w/w. presented in a labelled aluminium laminated pouch.
 
 
12.02.03  Expand sub section  Nasal Staphylococci
Chlorhexidine Hydrochloride 0.1%, Neomycin Suphate 0.5%
(Naseptin)
(Nasal cream 15g)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • Contains arachis oil: Should be avoided in peanut or soya allergy
  • To avoid the development of resistance, the treatment course should not exceed 7 days and the course not repeated on more than one occasion  
 
 
Mupirocin 2%
(Bactroban )
(Nasal ointment 3g)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • Mupirocin (Bactroban® nasal) is of value when the carriage of Staphlococcus aureus in the nose or ears has to be cleared.
  • To avoid the development of resistance, the treatment course should not exceed 7 days and the course not repeated on more than one occasion

 

 

 
 
Prontoderm
(Nasal gel)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • 30ml
  • As an alternative for decolonisation of MRSA
  • To avoid the development of resistance, the treatment course should not exceed 7 days and the course not repeated on more than one occasion
 
 
 ....
 Non Formulary Items
Flunisolide (Syntaris)

View adult BNF View SPC online
Non Formulary
 
Fluticasone Propionate
(Nasofan®)

View adult BNF View SPC online
Non Formulary
 
Triamcinolone Acetonide
(Nasacort)

View adult BNF View SPC online
Non Formulary
 
  
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
Blueteq
High Cost Drug Approval System

Traffic Light Status Information

Status Description

Traffic LightRed

RED - Hospital only to be prescribed by a specialist and supplied from secondary care ONLY throughout treatment.  

Traffic LightAmber

Amber medicines are considered suitable for GP prescribing following specialist initiation or recommendation.  

Traffic LightAmber with Shared Care

Shared Care - these medicines require 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.  

Traffic LightGreen

These medicines are appropriate for initiation in both primary and secondary care. Prescribing is appropriate within licensed or local recommendations.  

Traffic LightSelf

Suitable for patient to be directed to buy themselves  

Traffic LightGrey

Not currently used. We intend to include this TLS in future to highlight where a decision to use this medicine is under review.   

Traffic LightBlack

(In use from Oct 2020) Used where a decision has been made by the BSW APC not to routinely commission this preparation for its licensed indications. Do not prescribe.   

Traffic LightRed Specialist Centre

Not currently used. We intend to include this TLS in future to highlight where this medicine and indication is ONLY available through a Specialist Centre according to a NICE Highly Specialised Technology or NHSE Specialised Commission Circular / Policy.  

netFormulary