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Ipswich and East Suffolk CCG
North East Essex CCG
East Suffolk and North East Essex NHS Foundation Trust
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 Formulary Chapter 12: Ear, nose and oropharynx - Full Chapter
12.01  Expand sub section  Drugs acting on the ear
12.01.01  Expand sub section  Otitis externa
 note 

Joint guidance

Avoid chloramphenicol ear drops - contain propylene glycol and cause contact dermatitis in about 10% of people.

 

Primary care guidance

Otitis externa

When prescribing ear drops in primary care the Suffolk Antibiotic Formulary should be used

12.01.01  Expand sub section  Astringent preparations
Acetic Acid 2% (Earcalm ®)
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Formulary
Blue

Avaiable OTC


For mild cases of otitis externa

 
   
12.01.01  Expand sub section  Anti-inflammatory preparations
Betamethasone 0.1% with Neomycin 0.5% ear drops
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First Choice
Blue

 First line For moderate/severe cases

 
Sofradex  ( Dexamethasone, Framycetin and Gramicidin)
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Formulary
Blue
 
   
Otomize (Dexamethasone ,Acetic acid and Neomycin)
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Formulary
Blue
 
   
Flumetasone 0.02% with Clioquinol 1%
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Formulary
Blue

Expensive

 
   
Gentisone HC (Hydrocortisone Acetate 1% with Gentamicin 0.3%)
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Formulary
Blue

Expensive

 
   
Betamethasone drops (eye, ear and nose)
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Formulary
Blue
 
   
12.01.01  Expand sub section  Anti-infective preparations to top
Ciprofloxacin
(ear drops)
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Formulary

Approved for ENT use at Ipswich and Colchester Hospitals

 
   
Clotrimazole 1% solution
(ear drops)
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Formulary
Blue

Available OTC

 
   
Fluoroquinolone
(ear drops)
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Formulary
Green

Unlicensed product

 
   
12.01.02  Expand sub section  Otitis media
12.01.03  Expand sub section  Removal of ear wax
Sodium Bicarbonate
(ear drops)
Formulary
Blue

Available OTC

 
   
Olive Oil Ear Drops
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Formulary
Blue

Available OTC

 
   
12.02  Expand sub section  Drugs acting on the nose
12.02.01  Expand sub section  Drugs used in nasal allergy
Azelastine and fluticasone (Dymista)
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Formulary
Blue

Licensed for 12 and over

Ipswich Hospital

Azelastine / fluticasone (Dymista) is a formulary medicines choice

Colchester Hospital

Azelastine / fluticasone (Dymista) is a non-formulary medicine

 


Primary care guidance

Relief of symptoms of moderate-severe perennial allergic rhinitis in patients who have failed to respond to a steroid nasal spray with the addition of an oral antihistamine.

Treatment must be reviewed after 3 months and only continued for patients who are benefitting from it.

 
   
12.02.01  Expand sub section  Antihistamines to top
12.02.01  Expand sub section  Corticosteroids
 note 

MHRA:Risk of psychological and behavioural side effects

Beclometasone Dipropionate
(Nasal spray)
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First Choice
Blue

Available OTC for 18+ yrs


First choice for nasal spray

POM use -Licensed for 6 and over

 
Betamethasone Sodium Phosphate (eye, ear, nose drops)
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First Choice
Blue

First choice for nasal drops

 
Mometasone Furoate
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Formulary
Blue

Available OTC

 
   
Fluticasone Propionate (Nasofan®)
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Formulary
Blue

Available OTC for >18 years


 POM use- Licensed for 4 and over

 
   
Fluticasone Propionate (Flixonase Nasule®)
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Formulary
Blue

Licensed for 16 and over

 
   
Triamcinolone Acetonide (Nasacort®)
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Restricted Drug Restricted

Ipswich Hospital

Triamcinolone acetonide nasal spray (Nasocort) is non-formulary

Colchester Hospital

Triamcinolone acetonide nasal spray (Nasocort) is considered a formulary medicine

 
   
Budesonide (Rhinocort Aqua®)
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Restricted Drug Restricted

Ipswich Hospital

Budesonide nasal spray (Rhinocort Aqua) is non-formulary

Colchester Hospital

Budesonide nasal spray (Rhinocort Aqua) is considered a formulary medicine

 
   
Fluticasone furoate (Avamys®)
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Restricted Drug Restricted

Ipswich Hospital

Fluticasone furoate nasal spray (Avamys) is non-formulary

Colchester Hospital

Fluticasone furoate nasal spray (Avamys) is considered a formulary medicine choice

 
   
12.02.01  Expand sub section  Cromoglicate
12.02.02  Expand sub section  Topical nasal decongestants
12.02.02  Expand sub section  Sympathomimetics
Ephedrine nasal drops
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Formulary
Blue

Available OTC

 
   
Xylometazoline (Otrivine®)
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Formulary
Blue

Avaiable OTC


Avaiable as

  • 0.1% nasal spray and drops,
  • 0.05% paediatric nasal drops
 
   
12.02.02  Expand sub section  Antimuscarinic to top
Ipratropium Bromide
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Formulary
Blue
 
   
12.02.02  Expand sub section  Other decongestants
Sodium chloride 0.9%
Formulary
Blue

Can also be bought OTC

 
   
12.02.03  Expand sub section  Nasal preparations for infection
12.02.03  Expand sub section  Nasal Staphylococci
Naseptin  (Chlorhexidine Hydrochloride 0.1%, Neomycin Suphate 0.5%)
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Formulary
Blue

For eradication and prevention of nasal carriage of staphylococci

Avoid in the following groups due to arachis oil content

  • Nut allergy
  • Soya allergy
 
   
Bactroban Nasal (Mupirocin 2%)
(nasal)
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Formulary
Blue

Eradication of nasal carriage of MRSA or in patients who cannot have Naseptin®

 
   
Octenidine  (Nasal gel)
(nasal)
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Formulary
Blue

Use in the following cases:

  • If patient cannot use naseptin due to nut/soya allergy 

                      AND

  • If bactroban not available
 
   
12.03  Expand sub section  Drugs acting on the oropharynx
12.03.01  Expand sub section  Drugs for oral ulceration and inflammation to top
Benzydamine (Difflam®)
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Formulary
Blue

Available OTC


Available as 

  • 0.15% mouthwash
  • 0.15% oromucosal spray
 
   
Hydrocortisone (Corlan®)
(mouth ulcers)
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Formulary
Blue

MHRA:Should not be used off-label for adrenal insufficiency in children due to serious risks


Available OTC

 
   
Betamethasone (soluble tablets)
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Formulary
Blue

Unlicensed indication

Expensive

 
   
Caphosol ®
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Restricted Drug Restricted

Ipswich Hospital

Caphosol mouth rinse is non-formulary

Colchester Hospital

Caphosol mouth rinse is a formulary medicine choice and is utilised within oncology practice

 
   
Choline Salicylate (dental gel)
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Formulary
Blue

For hospital inpatient use only. 

Available OTC for all other situations

 
   
Lidocaine and Hydrocortisone mouthwash
(mouth ulcers)
Formulary
Red Hospital

Hospital use only

Unlicensed special (made in the pharmacy manufacturing unit at IHT)

 
   
12.03.02  Expand sub section  Oropharyngeal anti-infective drugs
12.03.02  Expand sub section  Oropharyngeal Fungal infections
Miconazole (Daktarin®)
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Formulary
Blue

MHRA:Significant interaction with warfarin


Available OTC

 
   
Nystatin
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Formulary
Blue
 
   
Fluconazole
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Formulary
Blue
Only if topical ineffective/ inappropriate 
   
12.03.02  Expand sub section  Oropharyngeal Viral infections
Chlorhexidine mouthwash
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Formulary
Blue

Available OTC

 
   
12.03.03  Expand sub section  Lozenges and sprays
12.03.04  Expand sub section  Mouthwashes, gargles, and dentifrices to top
Chlorhexidine mouthwash
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Formulary
Blue
 
   
Hydrogen Peroxide 3%
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Formulary
Red Hospital

For post-tonsillectomy haemorrhage

 
   
Hydrogen Peroxide 6%
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Formulary
Red Hospital

Acute ulcerative gingivitis

 
   
Tranexamic Acid Mouthwash 5%
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Formulary
Red Hospital

unlicensed Unlicensed medicine

For use in Radiotherapy or oncology

 
   
Tranexamic Acid Topical Solution
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Formulary
Green

unlicensed Unlicensed medicine

For use in Palliative Care

 
   
12.03.05  Expand sub section  Treatment of dry mouth
12.03.05  Expand sub section  Local Treatment
Biotene Oralbalance ®
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Formulary
Blue

Can be bought OTC

 
   
AS saliva Orthana ®
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Formulary
Blue

Can be bought OTC



Primary care guidance

ACBS

For patients suffering from dry mouth as a result of having (or having undergone) radiotherapy, or sicca syndrome.

 
   
12.03.05  Expand sub section  Systemic treatment
 ....
 Non Formulary Items
ACETIC ACID 5% solution in IMS

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Non Formulary
 
Aciclovir

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Non Formulary
 
Almond Oil

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Non Formulary
 
Amphotericin Lozenges  (Fungilin®)

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Non Formulary
 
Anaesthetic throat lozenges  (Tyrozets®)

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Non Formulary
 
Antacid with Oxetacaine

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Non Formulary
 
Azelastine Hydrochloride  (Rhinolast®)

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Non Formulary
 
Benzocaine

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Non Formulary
 
BioXtra ®

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Non Formulary
 
Budesonide

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Non Formulary
 
Carmellose Sodium  (Orabase®)

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Non Formulary
 
Carmellose Sodium  (Orahesive®)

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Non Formulary
 
Cerumol ®

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Non Formulary
 
Cetylpyridinium, Chlrocresol, Lidocaine  (Anbesol®)

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Non Formulary
 
Chloramphenicol
(ear drops)

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Non Formulary

See notes above

 
Chlorhexidine & Chlorobutanol  (Eludril®)
(mouthwash)

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Non Formulary
 
Docusate 0.5% eardrops  (Waxsol®)

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Non Formulary
 
Doxycycline

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Non Formulary
 
Exterol ®

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Non Formulary
 
Flunisolide  (Syntaris®)

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Non Formulary
 
Flurbiprofen lozenge

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Non Formulary
 
Gelclair ®

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Non Formulary
 
Gentamicin
(ear drops)

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Non Formulary
 
Glandosane ®

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Non Formulary
 
Glycerol dioleate  (Episil®)

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Non Formulary
 
Lidocaine 10% mouth spray

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Non Formulary
 
Lidocaine 5% ointment
(mouth)

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Non Formulary
 
Lidocaine and Cetylpyridinium  (Dentinox® Teething Gel)

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Non Formulary
 
Lidocaine and Chlorhexidine  (Instillagel®)
(mouth)

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Non Formulary
 
Lidocaine and Phenylephrine  (Cophenalcaine®)

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Non Formulary
 
Luborant ®

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Non Formulary
 
Miconazole  (Loramyc®)

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Non Formulary
 
Molcer ®

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Non Formulary
 
Otex ®

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Non Formulary
 
Otosporin  ( Hydrocortisone, neomycin)

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Non Formulary
 
pilocarpine Hydrochloride  (Salagen®)

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Non Formulary
 
Povidone Iodine  (Betadine®)

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Non Formulary
 
Prednisolone ear drops  (Predsol®)

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Non Formulary
 
Predsol-N  (Prednisolone 0.5% with Neomycin 0.5%)

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Non Formulary
 
Salinum ®

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Non Formulary
 
Saliveze ®

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Non Formulary
 
Salivix ®

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Non Formulary
 
Sodium Cromoglicate  (Rynacrom®)

Non Formulary
 
SST

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Non Formulary
 
Thymol

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Non Formulary
 
Xerotin(r)  (Xerotin®)

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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 children's 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

Blue

For routine prescribing in primary and secondary care.   

Green

Initiated (if clinically urgent) or advised (if non-urgent) by specialist in secondary care, prescribing can be continued in primary care.   

Amber

Shared care  

Red Hospital

Hospital only  

Double Red

There should be no prescribing of these drugs  

Mixed

The traffic light of the drug is dependant on the indication. Please see individual drug entry for details  

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