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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
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 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...
12.03  Expand sub section  Drugs acting on the oropharynx
12.03.01  Expand sub section  Drugs for oral ulceration and inflammation
Benzydamine
(oral)
View adult BNF View SPC online
Formulary
traffic lightSelf
  • oral rinse 0.15% 300ml
  • oromucosal spray 0.15% 30ml
 
 
Caphosol ®
(Medical Device)
(mouthwash)
View adult BNF View SPC online
Formulary
traffic lightRed
  • GWH only: Restricted for use in patients undergoing autologous stem cell transplant only. Consultant haematologist prescription only.
 
 
Carmellose Sodium
(Orabase®)
View adult BNF View SPC online
Formulary
traffic lightSelf
  • Please note: Patients should self-care in the first instance
 
 
Choline Salicylate
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Formulary
traffic lightSelf
  • Please note: Patients should self-care in the first instance
  • 8.7% dental gel 15g
 
 
Gelclair ®Oral gel sachet
(Medical device)
View adult BNF View SPC online
Formulary
traffic lightRed
  • GWH and RUH 
  • Contains sodium hyaluronate and polyvinylpyrrolidone
  • Used as a mouthwash for oropharyngeal lesions in Oncology patients
 
 
Hydrocortisone muco-adhesive buccal tablets
View adult BNF View SPC online
Formulary
traffic lightGreen
  •  2.5mg   (as sodium succinate)  
  • P medicine can be purchased OTC
 
Link  MHRA DSU Hydrocortisone muco-adhesive buccal tablets: should not be used off-label for adrenal insufficiency in children due to serious risks Dec 2018
 
Lidocaine 5% ointment (mouth)
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Formulary
traffic lightRed
  • GWH only
 
 
Antacid with Oxetacaine
((Magnesium Hydroxide & Aluminium Hydroxide))
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Unlicensed Drug Unlicensed
traffic lightRed
  • Oral suspension: Each 5ml contains 10mg Oxetacaine, Aluminium hydroxide equivalent to 200mg aluminium oxide + 100mg magnesium hydroxide 150ml bottle.
  • Not on formulary in GWH and SFT
  • RUH only - Antacid and anaesthetic relief of oesophageal pain in palliative care patients (unlicensed)

 

 
 
12.03.02  Expand sub section  Oropharyngeal anti-infective drugs
12.03.02  Expand sub section  Oropharyngeal Fungal infections
Nystatin
(oral suspension)
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First Choice
traffic lightGreen
  • Always prescribe by BRANDNAME in primary care to get most cost-effective version.
  • 100,000 units/ml 30ml bottle
  • Dose:  ADULT and CHILD over 2 years, 100 000 units 4 times daily
  • Due to the high sucrose content of nystatin suspension, 500mg/1ml, ensure that diabetic patients are aware of this.
  • Nystatin is the first line choice, however miconazole may be considered due to the differing formulations.
 
Miconazole
(oral gel)
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Formulary
traffic lightGreen
  • Oral gel 20mg/g 15g/80g
 
Link  MHRA DSU Sept 2017 Miconazole (Daktarin): over-the-counter oral gel contraindicated in patients taking warfarin
 
12.03.02  Expand sub section  Oropharyngeal Viral infections to top
12.03.03  Expand sub section  Lozenges and sprays
 note 
  • Note: Lozenges and sprays have not been considered for formulary inclusion. The BNF states: ‘There is no convincing evidence that antiseptic lozenges and sprays have a beneficial action and they sometimes irritate and cause sore tongue and sore lips. Some of these preparations also contain local anaesthetics, which relieve pain but may cause sensitisation.’

12.03.04  Expand sub section  Mouthwashes, gargles, and dentifrices
Chlorhexidine gluconate 1%
(dental gel)
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Formulary
traffic lightRed
  • GWH ICU only
 
 
Chlorhexidine mouthwash 0.2%
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Formulary
traffic lightSelf
  •  300ml or 600ml bottles
 
 
Hydrogen Peroxide
(solution)
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Formulary
traffic lightSelf
  • Use as mouthwash
  • 20vols (6%) 
  • 10vols (3%)
 
 
12.03.05  Expand sub section  Treatment of dry mouth
 note 
  • All of the available artificial saliva preparations may be purchased from a pharmacy and most of the products cost the same or less than a prescription charge. The majority of artificial saliva products can be prescribed on a dental NHS prescription.

12.03.05  Expand sub section  Local Treatment
Biotene Oralbalance ®
(oral gel)
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Formulary
traffic lightGreen
  • Saliva replacement oral gel
  • 50g
  • ACBS
 
 
Glandosane ® (spray)
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Formulary
traffic lightGreen
  • ACBS
  • 50ml spray
  • Lemon, Peppermint or natural
 
 
Oralieve® (spray)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • Xylitol/peroxidase and oxidase enzymes
  • 50ml
 
 
Saliveze ® (spray)
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Formulary
traffic lightGreen
  • 50ml
  • ACBS
 
 
Salivix ® (pastilles)
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Formulary
traffic lightGreen
  • sugar-free
  • reddish-amber, acacia, malic acid and other ingredients
  • ACBS
 
 
12.03.05  Expand sub section  Systemic treatment to top
Pilocarpine Hydrochloride (Oral)
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Formulary
traffic lightGreen
  • Swindon and Salisbury areas only, not previously on BCAP formulary
  • 5mg tablets
  • Useful in refractory sjogrens
 
 
 ....
 Non Formulary Items
Amphotericin Lozenges
(Fungilin®)

View adult BNF View SPC online
Non Formulary
 
Anaesthetic throat lozenges
(Tyrozets®)

View SPC online
Non Formulary
 
AS saliva Orthana ®

View adult BNF View SPC online
Non Formulary
 
Benzocaine

View adult BNF View SPC online
Non Formulary
 
BioXtra ®

View adult BNF View SPC online
Non Formulary
 
Carmellose Sodium
(Orahesive®)

View adult BNF View SPC online
Non Formulary
 
Cetylpyridinium, Chlrocresol, Lidocaine
(Anbesol®)

View adult BNF View SPC online
Non Formulary
 
Doxycycline
(Periostat®)

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Non Formulary
 
Flurbiprofen lozenge

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Non Formulary
 
Glycerol dioleate (Episil®)

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Non Formulary
 
Lidocaine 10% mouth spray

View adult BNF View SPC online
Non Formulary
 
Lidocaine and Cetylpyridinium
(Dentinox® Teething Gel)

View adult BNF View SPC online
Non Formulary
 
Lidocaine and Chlorhexidine
(Instillagel®)
(mouth)

View adult BNF View SPC online
Non Formulary
 
Lidocaine and Phenylephrine
(Cophenalcaine®)

View adult BNF View SPC online
Non Formulary
 
Miconazole (Loramyc®)

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Non Formulary
 
Mouth Swabs

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Non Formulary
 
Povidone Iodine
(Betadine®)

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Non Formulary
 
Salicylates - Salicylic acid
(Pyralvex®)

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Non Formulary
 
Salinum ®

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Non Formulary
 
SST

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Non Formulary
 
Thymol

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Non Formulary
 
Triamcinolone Acetonide 0.1% in Adhesive Basis
(Adcortyl in Orabase®)

View adult BNF View SPC online
Non Formulary

 

This product was discontinued in the UK in March 2009

 
Xerotin(r)
(Xerotin®)

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.  

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