Nottinghamshire Area Prescribing Committee Formulary


	Nottinghamshire Area Prescribing Committee Joint Formulary

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Formulary Chapter 12: Ear, nose and oropharynx - Full Chapter

12.03.01

Drugs for oral ulceration and inflammation

Anaesthetic throat lozenges (Tyrozets^®)

Formulary

Contains benzocaine.

Patients should be advised to purchase over the counter

May be prescribed if appropriate to in-patients; patients should be advised on discharge that further supply should be purchased
SFH guide to all mouthcare products

NHS choices information on Tyrozets

Antacid with Oxetacaine

Formulary

Mouthwash (unlicensed) - Named patient use only

Usual dose is 5-10ml slowly sipped and swallowed four times a day.

Not routinely stocked at SFH- usually takes 3 days for delivery.

SFH guide to all mouthcare products

Benzydamine (Difflam^®)

Formulary

Oral rinse, Spray

May be prescribed if appropriate to in-patients; patients should be advised on discharge that further supply should be purchased
SFH guide to all mouthcare products
Patients should be advised to purchase over the counter

Betamethasone
(mouth ulcers)

Formulary

Soluble tablets

Carmellose Sodium (Orabase^®)

Formulary

Protective paste

SFH guide to all mouthcare products

Choline Salicylate (Bonjela^® Adult)

Formulary

Oral gel

Patients should be advised to purchase over the counter
May be prescribed if appropriate to in-patients; patients should be advised on discharge that further supply should be purchased
NB: Bonjela Adult is suitable from 16 years only

Doxycycline

Formulary

Dispersible tablet (unlicensed indication)

Disperse in water and use as a mouthwash

Hydrocortisone (Corlan^®)
(mouth ulcers)

Formulary

Pellets 2.5mg

SFH guide to all mouthcare products

MHRA (Dec18): Hydrocortisone muco-adhesive buccal tablets: should not be used off-label for adrenal insufficiency in children due to serious risks

Lidocaine 10% mouth spray

Formulary

unlicensed indication

Patients should be advised to purchase a suitable product over the counter
May be prescribed if appropriate to in-patients; patients should be advised on discharge that further supply should be purchased

Lidocaine 5% ointment
(mouth)

Formulary

15g tube (£5)

For external use on nipples, genitals, gums etc.
For intact skin use EMLA® or Ametop® instead.
Weaker versions which can also be used for mouth ulcers are dentinox teething gel (0.33% lidocaine) or Instillagel (2% lidocaine, tastes foul)
Patients should be advised to purchase a suitable product over the counter
SFH guide to all mouthcare products

Lidocaine and Chlorhexidine (Instillagel^®)
(mouth)

Formulary

Contains Lidocaine 2%, Chlorhexidine 0.25%

In the mouth is an unlicensed indication and it tastes foul.
Other versions which can be used for mouth ulcers are dentinox teething gel (0.33% lidocaine) or in extreme circumstance 5% lidocaine ointment.
Patients should be advised to purchase a suitable product over the counter

May be prescribed if appropriate to in-patients; patients should be advised on discharge that further supply should be purchased

MHRA alert: Anaphylaxis risk with chlorhexidine

Lidocaine mouth gel (Teething Gel)

Formulary

Lidocaine 1%, Chlorocresol 0.1% and Cetylpyridinium Chloride 0.02% (Anbesol teething gel)
Lidocaine 0.33% and Cetylpyridinium Chloride 0.1% (Dentinox teething gel) - Currently unavailable Oct 2019

Patients should be advised to purchase over the counter
May be prescribed if appropriate to in-patients; patients should be advised on discharge that further supply should be purchased
SFH guide to all mouthcare products

Caphosol^®

Restricted

Oral rinse, dispersible tablets

At SFH supplied from pharmacy.

Treatment of oral mucositis.

ONLY for oncology patients.

Relatively expensive - £35 per box of 30 (£1.14 per dose).

SFH guide to all mouthcare products

Patient information leaflet for caphosol tablets

Gelclair^®

Restricted

Oral gel - sachets (at SFH usually obtained through supplies rather than pharmacy, but Pharmacy may have stock)

Treatment of oral mucositis.

ONLY for oncology patients.

Relatively expensive - £40 per box of 21 (£2 per dose).

Classified as a medical device

SFH guide to all mouthcare products

Glycerol dioleate (Episil®)

Restricted

Oral Spray

Treatment of oral mucositis.

ONLY for oncology patients.

£49.21 per 10mL (£0.75 per dose)

Classified as a medical device

Click here for independent reviews

Lidocaine and Phenylephrine (Cophenalcaine^®)

Restricted

Spray- specialist use only

BMJ infographic: Corticosteroids for sore throat

Mouth ulcers - Self-care patient information (Notts APC)

SFH guide to mouthcare products

Teething - Self-care patient information (Notts APC)

....

Non Formulary Items

Benzocaine

Non Formulary

Cetylpyridinium, Chlrocresol, Lidocaine (Anbesol^®)

Non Formulary

Liquid

Doxycycline (Periostat^®)

Non Formulary

Flurbiprofen lozenge

Non Formulary

For relief of sore throat

Link to reviews

Salicylates - Salicylic acid (Pyralvex^®)

Non Formulary

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

Non Formulary

Oral paste

Discontinued December 2009)

Key

	Notes
	Section Title (top level)
	Section Title (sub level)
	First Choice item
	Non Formulary section
	Restricted Drug
	Unlicensed
	Display tracking information
	Link to adult BNF
	Link to children's BNF
	Link to SPCs
	Scottish Medicines Consortium

	Cytotoxic Drug
	Controlled Drug
	High Cost Medicine
	Cancer Drugs Fund
	NHS England
	Homecare
	CCG

Traffic Light Status Information

Status	Description
	Grey / Non-Formulary: Medicines, which the Nottinghamshire APC has actively reviewed and does not recommend for use at present due to limited clinical and/or cost effective data. Grey / Non-Formulary (undergoing assessment): Work is ongoing and will be reviewed at a future APC meeting. Grey / Non-Formulary (no formal assessment): APC has not formally reviewed this medicine or indication because it had never been requested for formulary inclusion. Often used for drugs new to market.
	Medicines which should normally be prescribed by specialists only. eg hospital only. For patients already receiving prescriptions in primary care - continue. No new patients to receive prescriptions in primary care.
	Medicines that should be initiated by a specialist and prescribed by primary care prescribers only under a shared care protocol, once the patient has been stabilised. Prior agreement must be obtained by the specialist from the primary care provider before prescribing responsibility is transferred. The shared care protocol must have been agreed by the relevant secondary care trust Drugs and Therapeutics Committee(s) (DTC) and approved by the Nottinghamshire APC.
	*Medicines suitable to be prescribed in primary care / general practice after specialist recommendation or initiation.** A supporting prescribing guideline may be requested which must have been agreed by the relevant secondary care trust DTCs and approved by the Nottinghamshire APC. *Specialist is defined by the APC as a clinician who has undertaken an appropriate formal qualification or recognised training programme within the described area of practice
	Primary care/ non specialist may initiate as per APC guideline. The supporting prescribing guideline must have been agreed by the relevant secondary care trust D&TC(s) and approved by the Nottinghamshire APC.
	Medicines suitable for routine use within primary care. Can be initiated within primary care within their licensed indication, in accordance with nationally recognised formularies, for example the BNF, BNF for Children, Medicines for Children or Palliative Care Formulary. Primary care prescribers take full responsibility for prescribing.