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12. Ear, Nose and Oropharynx

Anti-inflammatory Preparations
First Choice
• Betamethasone
Alternative
• Prednisolone


Anti-infective Preparations
• Gentamicin
• Chloramphenicol
• Clotrimazole


Compound Antibacterial / Corticosteroid Preparations
First Choice
• Gentamicin and Hydrocortisone
Alternatives
• Sofradex®
• Otomize®
• Betamethasone and Neomycin
• Otosporin®

Betamethasone
BNF | BNFC | SPC

Ear Drops - 0.1%

Prednisolone
BNF | BNFC | SPC

Ear Drops - 0.5%

Gentamicin
BNF | BNFC | SPC

Ear Drops - 0.3%

Chloramphenicol
BNF | BNFC | SPC

5% (or 10%) ear drops (in propylene glycol)

Clotrimazole
BNF | BNFC | SPC

1% solution

Gentisone HC
BNF | BNFC | SPC

Ear Drops

Sofradex
BNF | BNFC | SPC

Eye/ear drops containing dexamethasone 0.05%, framycetin sulphate 0.5% & gramicidin 0.005%

Otomize
BNF | BNFC | SPC

Ear Spray

Betnesol-N
BNF | BNFC | SPC

Ear Drops

Otosporin
BNF | BNFC | SPC

Ear drops containing hydrocortisone 1%, neomycin sulph. 0.439% & polymyxin B sulph. 10,000 units/ml

Acetic acid
BNF | BNFC | SPC

2% Spray (EarCalm)OTC

Ear wax softening drops should be purchased for self-care. Drops containing simple remedies such as olive oil, almond oil and sodium bicarbonate are available

Olive Oil
BNF | BNFC | SPC

Ear DropsOTC

Should be purchased for self-care. Drops containing simple remedies such as olive oil, almond oil and sodium bicarbonate are available.

The County Durham & Darlington or Tees DO NOT PRESCRIBE List can be accessed online at: http://medicines.necsu.nhs.uk/guidelines/durhamdarlington or 
https://medicines.necsu.nhs.uk/guidelines/tees-guidelines/

The County Durham & Darlington or Tees GREY List – items to be prescribed in certain specific circumstances only can be accessed online at: http://medicines.necsu.nhs.uk/guidelines/durham-darlington or https://medicines.necsu.nhs.uk/guidelines/tees-guidelines/

Sodium Bicarbonate
BNF | BNFC | SPC

Ear Drops - 5%OTC

Ear wax softening drops should be purchased for self-care. Drops containing simple remedies such as olive oil, almond oil and sodium bicarbonate are available

The County Durham & Darlington or Tees DO NOT PRESCRIBE List can be accessed online at: http://medicines.necsu.nhs.uk/guidelines/durhamdarlington or 
https://medicines.necsu.nhs.uk/guidelines/tees-guidelines/

The County Durham & Darlington or Tees GREY List – items to be prescribed in certain specific circumstances only can be accessed online at: http://medicines.necsu.nhs.uk/guidelines/durham-darlington or https://medicines.necsu.nhs.uk/guidelines/tees-guidelines/

Nasal sprays for the symptomatic relief of hayfever and congestion can be purchased by the patient under self-care with community pharmacist support.

Hayfever Prescribing Guidelines

CD&D APC Grey List: Nasal sprays for the symptomatic relief of hayfever and congestion can be
purchased by the patient under self-care with community pharmacist support.

Beclometasone
BNF | BNFC | SPC

Nasal Spray - 50 microgramOTC

Nasal sprays for the symptomatic relief of hayfever and congestion can be purchased by the patient under self-care with community pharmacist support.

The County Durham & Darlington or Tees DO NOT PRESCRIBE List can be accessed online at: http://medicines.necsu.nhs.uk/guidelines/durhamdarlington or 
https://medicines.necsu.nhs.uk/guidelines/tees-guidelines/

The County Durham & Darlington or Tees GREY List – items to be prescribed in certain specific circumstances only can be accessed online at: http://medicines.necsu.nhs.uk/guidelines/durham-darlington or https://medicines.necsu.nhs.uk/guidelines/tees-guidelines/

Betamethasone
BNF | BNFC | SPC

0.1% eye/ear/nose drops (betamethasone sod. phos.)

Fluticasone Furoate (Avamys)
BNF | BNFC | SPC

27.5 microgram / dose nasal spray.

N.B. Take care to
avoid confusion with fluticasone propionate

Fluticasone Propionate
BNF | BNFC | SPC

50 microgram / dose nasal sprayOTC

400 microgram unit dose nasal drops

N.B. Take care to avoid confusion with fluticasone furoate

Nasal sprays for the symptomatic relief of hayfever and congestion can be purchased by the patient under self-care with community pharmacist support.

The County Durham & Darlington or Tees DO NOT PRESCRIBE List can be accessed online at: http://medicines.necsu.nhs.uk/guidelines/durhamdarlington or 
https://medicines.necsu.nhs.uk/guidelines/tees-guidelines/

The County Durham & Darlington or Tees GREY List – items to be prescribed in certain specific circumstances only can be accessed online at: http://medicines.necsu.nhs.uk/guidelines/durham-darlington or https://medicines.necsu.nhs.uk/guidelines/tees-guidelines/



Mometasone
BNF | BNFC | SPC

Nasal Spray - 50 microgramOTC

Nasal sprays for the symptomatic relief of hayfever and congestion can be purchased by the patient under self-care with community pharmacist support.

The County Durham & Darlington or Tees DO NOT PRESCRIBE List can be accessed online at: http://medicines.necsu.nhs.uk/guidelines/durhamdarlington or 
https://medicines.necsu.nhs.uk/guidelines/tees-guidelines/

The County Durham & Darlington or Tees GREY List – items to be prescribed in certain specific circumstances only can be accessed online at: http://medicines.necsu.nhs.uk/guidelines/durham-darlington or https://medicines.necsu.nhs.uk/guidelines/tees-guidelines/

Triamcinolone acetonide
BNF | BNFC | SPC

55 microgram metered dose nasal sprayOTC

Nasal sprays for the symptomatic relief of hayfever and congestion can be purchased by the patient under self-care with community pharmacist support.

The County Durham & Darlington or Tees DO NOT PRESCRIBE List can be accessed online at: http://medicines.necsu.nhs.uk/guidelines/durhamdarlington or 
https://medicines.necsu.nhs.uk/guidelines/tees-guidelines/

The County Durham & Darlington or Tees GREY List – items to be prescribed in certain specific circumstances only can be accessed online at: http://medicines.necsu.nhs.uk/guidelines/durham-darlington or https://medicines.necsu.nhs.uk/guidelines/tees-guidelines/

Azelastine
BNF | BNFC | SPC

0.1% nasal spray (140 micrograms/metered spray)

Sodium Cromoglycate
BNF | BNFC | SPC

Nasal Spray - 4%

Fluticasone / Azelastine
BNF | BNFC | SPC

Dymista Nasal Spray

One actuation (0.14 g) delivers 137 micrograms azelastine hydrochloride (= 125 micrograms azelastine) and 50 micrograms fluticasone propionate.

Xylometazoline
BNF | BNFC | SPC

Nasal Spray - 0.1%OTC

Nasal sprays for the symptomatic relief of hayfever and congestion can be purchased by the patient under self-care with community pharmacist support.

The County Durham & Darlington or Tees DO NOT PRESCRIBE List can be accessed online at: http://medicines.necsu.nhs.uk/guidelines/durhamdarlington or 
https://medicines.necsu.nhs.uk/guidelines/tees-guidelines/

The County Durham & Darlington or Tees GREY List – items to be prescribed in certain specific circumstances only can be accessed online at: http://medicines.necsu.nhs.uk/guidelines/durham-darlington or https://medicines.necsu.nhs.uk/guidelines/tees-guidelines/

Ipratropium
BNF | BNFC | SPC

Nasal Spray - 0.03%OTC

Nasal sprays for the symptomatic relief of hayfever and congestion can be purchased by the patient under self-care with community pharmacist support.

The County Durham & Darlington or Tees DO NOT PRESCRIBE List can be accessed online at: http://medicines.necsu.nhs.uk/guidelines/durhamdarlington or 
https://medicines.necsu.nhs.uk/guidelines/tees-guidelines/

The County Durham & Darlington or Tees GREY List – items to be prescribed in certain specific circumstances only can be accessed online at: http://medicines.necsu.nhs.uk/guidelines/durham-darlington or https://medicines.necsu.nhs.uk/guidelines/tees-guidelines/

Sodium Chloride
BNF | BNFC | SPC

0.9% nasal dropsOTC

Nasal sprays for the symptomatic relief of hayfever and congestion can be purchased by the patient under self-care with community pharmacist support.

The County Durham & Darlington or Tees DO NOT PRESCRIBE List can be accessed online at: http://medicines.necsu.nhs.uk/guidelines/durhamdarlington or 
https://medicines.necsu.nhs.uk/guidelines/tees-guidelines/

The County Durham & Darlington or Tees GREY List – items to be prescribed in certain specific circumstances only can be accessed online at: http://medicines.necsu.nhs.uk/guidelines/durham-darlington or https://medicines.necsu.nhs.uk/guidelines/tees-guidelines/

Ephedrine
BNF | BNFC | SPC

0.5% & 1% nasal drops

Mupirocin
BNF | BNFC | SPC

Nasal Ointment - 2% 

First choice for use in MRSA eradication.

Chlorhexidine 0.1% Neomycin 0.5%
BNF | BNFC | SPC

Cream

MRSA Only

Bismuth Subnitrate and Iodoform (BIPP) Paste
BNF | BNFC | SPC

Paste 1.25cm x 100cm & 2.5cm x 100cm impregnated gauze

Dental products should only be prescribed by dentists and GPs should not accept requests to prescribe medicines that the dentist could reasonably prescribe themselves, nor accept requests from patients to issue FP10 prescriptions for items prescribed on a private prescription by their dentist.  Patients should be advised of self-care measures and signposted to purchase over the counter remedies for dental conditions where appropriate.

PrescQIPP bulletin 95: Medicines for dental conditions on FP10

Benzydamine
BNF | BNFC | SPC

Oral Rinse - 0.15%OTC

SprayOTC

Can be purchased by the patient under self-care with community pharmacist support.

Dental products should only be prescribed by dentists and GPs should not accept requests to prescribe medicines that the dentist could reasonably prescribe themselves, nor accept requests from patients to issue FP10 prescriptions for items prescribed on a private prescription by their dentist. 

The County Durham & Darlington or Tees DO NOT PRESCRIBE List can be accessed online at: http://medicines.necsu.nhs.uk/guidelines/durhamdarlington or 
https://medicines.necsu.nhs.uk/guidelines/tees-guidelines/

The County Durham & Darlington or Tees GREY List – items to be prescribed in certain specific circumstances only can be accessed online at: http://medicines.necsu.nhs.uk/guidelines/durham-darlington or https://medicines.necsu.nhs.uk/guidelines/tees-guidelines/

 

Orabase
BNF | BNFC | SPC

PasteOTC containing carmellose sodium 16.7%, pectin 16.7%
& gelatin 16.7% in plastibase

Can be purchased by the patient under self-care with community pharmacist support.

Dental products should only be prescribed by dentists and GPs should not accept requests to prescribe medicines that the dentist could reasonably prescribe themselves, nor accept requests from patients to issue FP10 prescriptions for items prescribed on a private prescription by their dentist. 

The County Durham & Darlington or Tees DO NOT PRESCRIBE List can be accessed online at: http://medicines.necsu.nhs.uk/guidelines/durhamdarlington or 
https://medicines.necsu.nhs.uk/guidelines/tees-guidelines/

The County Durham & Darlington or Tees GREY List – items to be prescribed in certain specific circumstances only can be accessed online at: http://medicines.necsu.nhs.uk/guidelines/durham-darlington or https://medicines.necsu.nhs.uk/guidelines/tees-guidelines/

 

Hydrocortisone
BNF | BNFC | SPC

Mucoadhesive Buccal Tablets - 2.5mgOTC

MHRA Drug Safety Update (Dec 2018): Hydrocortisone muco-adhesive buccal tablets: should not be used off-label for adrenal insufficiency in children due to serious risks.

Can be purchased by the patient under self-care with community pharmacist support.

Dental products should only be prescribed by dentists and GPs should not accept requests to prescribe medicines that the dentist could reasonably prescribe themselves, nor accept requests from patients to issue FP10 prescriptions for items prescribed on a private prescription by their dentist. 

The County Durham & Darlington or Tees DO NOT PRESCRIBE List can be accessed online at: http://medicines.necsu.nhs.uk/guidelines/durhamdarlington or 
https://medicines.necsu.nhs.uk/guidelines/tees-guidelines/

The County Durham & Darlington or Tees GREY List – items to be prescribed in certain specific circumstances only can be accessed online at: http://medicines.necsu.nhs.uk/guidelines/durham-darlington or https://medicines.necsu.nhs.uk/guidelines/tees-guidelines/

 

Choline salicylate
BNF | BNFC | SPC

Oral Gel - 8.7% (Bonjela)OTC

Can be purchased by the patient under self-care with community pharmacist support.

Dental products should only be prescribed by dentists and GPs should not accept requests to prescribe medicines that the dentist could reasonably prescribe themselves, nor accept requests from patients to issue FP10 prescriptions for items prescribed on a private prescription by their dentist. 

The County Durham & Darlington or Tees DO NOT PRESCRIBE List can be accessed online at: http://medicines.necsu.nhs.uk/guidelines/durhamdarlington or 
https://medicines.necsu.nhs.uk/guidelines/tees-guidelines/

The County Durham & Darlington or Tees GREY List – items to be prescribed in certain specific circumstances only can be accessed online at: http://medicines.necsu.nhs.uk/guidelines/durham-darlington or https://medicines.necsu.nhs.uk/guidelines/tees-guidelines/

Hyaluronan
BNF | BNFC | SPC

0.2% gel & 0.025% mouthwash (Gengigel)

For limited second-line use on specialist advice in the treatment of orofacial granulomatosis, severe oral ulceration and mucositis secondary to mmunosuppression where conventional treatments are unsuitable or
have failed.

MuGard®
Restricted to use in patients who are currently on sunitinib (Sutent®) treatment, and is cheaper than treatment that is currently used.

Caphosol
BNF | BNFC | SPC

1 dose=1 x 15ml Caphosol A + 1 x 15ml Caphosol B mixed
together

CD&D APC Grey List: For limited use in patients having chemo-radiotherapy or radiotherapy to malignancies of the oral cavity, hypopharnyx and oro-pharynx on specialist recommendation.

Doxycycline
BNF | BNFC | SPC

20mg tablets

For Periodontitis

Antacid with Oxetacaine
BNF | BNFC | SPC

 Unlicensed preparation

Used in patients receiving radiotherapy only

Usual dose is 5-10ml tds (prior to meals)  

 

Gelclair®
BNF | BNFC | SPC

To treat Oral mucositis associated with chemo and radiotherapy

Miconazole
BNF | BNFC | SPC

Oral Gel - 24mg/ml

Gel not recommended under 4m of age due to choking risk

MHRA Drug Safety Update (June 2016): Topical miconazole, including oral gel: reminder of potential for serious interactions with warfarin

MHRA Drug Safety Update (Sept 2017): Miconazole (Daktarin): over-the-counter oral gel contraindicated in patients taking warfarin

Nystatin
BNF | BNFC | SPC

Suspension - 100,000units/ml

 

Miconazole Muco-adhesive Buccal Tablets
BNF | BNFC | SPC

50mg muco-adhesive buccal tablets

Restricted to use in immunocompromised patients with severe oropharyngeal candidiasis, where the use of other antifungal agents e.g. nystatin, fluconazole is not appropriate and for use on the advice of microbiologists.

Dental products should only be prescribed by dentists and GPs should not accept requests to prescribe medicines that the dentist could reasonably prescribe themselves, nor accept requests from patients to issue FP10 prescriptions for items prescribed on a private prescription by their dentist. 

Patients should be advised of self-care measures and signposted to purchase over the counter remedies where appropriate.

Chlorhexidine
BNF | BNFC | SPC

Mouthwash - 0.2%OTC

Dental Gel - 1%OTC

Can be purchased by the patient under self-care with community pharmacist support.

Dental products should only be prescribed by dentists and GPs should not accept requests to prescribe medicines that the dentist could reasonably prescribe themselves, nor accept requests from patients to issue FP10 prescriptions for items prescribed on a private prescription by their dentist. 

The County Durham & Darlington or Tees DO NOT PRESCRIBE List can be accessed online at: http://medicines.necsu.nhs.uk/guidelines/durhamdarlington or 
https://medicines.necsu.nhs.uk/guidelines/tees-guidelines/

The County Durham & Darlington or Tees GREY List – items to be prescribed in certain specific circumstances only can be accessed online at: http://medicines.necsu.nhs.uk/guidelines/durham-darlington or https://medicines.necsu.nhs.uk/guidelines/tees-guidelines/

Chlorhexidene Dental Gel
BNF | BNFC | SPC

2% oral gelu

For hospital use in the prevention of ventilator-associated pneumonia in adult patients who are ventilated (for >48 hours).

Hexitidine
BNF | BNFC | SPC

0.1% mouthwashOTC

Can be purchased by the patient under self-care with community pharmacist support.

Dental products should only be prescribed by dentists and GPs should not accept requests to prescribe medicines that the dentist could reasonably prescribe themselves, nor accept requests from patients to issue FP10 prescriptions for items prescribed on a private prescription by their dentist. 

The County Durham & Darlington or Tees DO NOT PRESCRIBE List can be accessed online at: http://medicines.necsu.nhs.uk/guidelines/durhamdarlington or 
https://medicines.necsu.nhs.uk/guidelines/tees-guidelines/

The County Durham & Darlington or Tees GREY List – items to be prescribed in certain specific circumstances only can be accessed online at: http://medicines.necsu.nhs.uk/guidelines/durham-darlington or https://medicines.necsu.nhs.uk/guidelines/tees-guidelines/

Tranexamic Acid Mouthwash
BNF | BNFC | SPC

 

ENT, maxillofacial or haematology only

Made to order by pharmacy aseptic unit so order in good time

Injection (500mg/5ml) can be diluted with equal parts water

One Tablet can also be crushed in 10mls water 

 

AS Saliva Orthana
BNF | BNFC | SPC

Oral Spray

Preferred to Glandosane as it is less likely to damage tooth enamel

Patients should be advised of self-care measures and signposted to purchase over the counter remedies where appropriate.

Biotene
BNF | BNFC | SPC

Oralbalance Gel

Prescribable on the NHS in primary care as a Borderline Substance.

Patients should be advised of self-care measures and signposted to purchase over the counter remedies where appropriate.

Glandosane
BNF | BNFC | SPC

Spray

Patients should be advised of self-care measures and signposted to purchase over the counter remedies where appropriate.

Malic Acid (Salivix)
BNF | BNFC | SPC

Sugar-free pastilles containing malic acid

Patients should be advised of self-care measures and signposted to purchase over the counter remedies where appropriate.

Pilocarpine
BNF | BNFC | SPC

5mg tablets

Treatment to be initiated with specialist advice.

BioXtra
BNF | BNFC | SPC

Salivary gel and toothpaste.

The gel, but not the toothpaste, is prescribable on the NHS in primary care as a Borderline Substance.

Patients should be advised of self-care measures and signposted to purchase over the counter remedies where appropriate.