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Nottinghamshire Area Prescribing Committee
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 Formulary Chapter 12: Ear, nose and oropharynx - Full Chapter
12.03.01  Expand sub section  Drugs for oral ulceration and inflammation
Anaesthetic throat lozenges (Tyrozets®)
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Formulary
Green

Contains benzocaine.

  • OTC 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
 
Link  NHS choices information on Tyrozets
   
Antacid with Oxetacaine
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Formulary
Red
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®)
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    Formulary
    Green

    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
    • OTC Patients should be advised to purchase over the counter 
     
       
    Betamethasone
    (mouth ulcers)
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    Formulary
    Green
    Soluble tablets 
       
    Carmellose Sodium (Orabase®)
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    Formulary
    Green
    Protective paste
  • SFH guide to all mouthcare products
     
  •    
    Choline Salicylate (Bonjela® Adult)
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    Formulary
    Green

    Oral gel

    • OTC 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
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    Formulary
    Green
    Dispersible tablet (unlicensed indication)
  • Disperse in water and use as a mouthwash 
  •    
    Hydrocortisone (Corlan®)
    (mouth ulcers)
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    Formulary
    Green
    Pellets 2.5mg
  • SFH guide to all mouthcare products
     
  • Link  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
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    Formulary
    Green

    unlicensed indication

    • OTC 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)
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    Formulary
    Green

    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)
    • OTC Patients should be advised to purchase a suitable product over the counter

    • SFH guide to all mouthcare products

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

    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.
    • OTC 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
     
    Link  MHRA alert: Anaphylaxis risk with chlorhexidine
       
    Lidocaine mouth gel (Teething Gel)
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    Formulary
    Green
    1. Lidocaine 1%, Chlorocresol 0.1% and Cetylpyridinium Chloride 0.02% (Anbesol teething gel)
    2. Lidocaine 0.33% and Cetylpyridinium Chloride 0.1% (Dentinox teething gel) - Currently unavailable Oct 2019
    • OTC 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 Drug Restricted
    Red
    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®
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    Restricted Drug Restricted
    Red
    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®)
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    Restricted Drug Restricted
    Red
    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®)
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    Restricted Drug Restricted
    Red
    Spray- specialist use only 
       
     ....
     Non Formulary Items
    Benzocaine

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    Non Formulary
    Grey
     
    Cetylpyridinium, Chlrocresol, Lidocaine  (Anbesol®)

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    Non Formulary
    Grey
    Liquid
     
    Doxycycline  (Periostat®)

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    Non Formulary
    Grey
     
    Flurbiprofen lozenge

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    Non Formulary
    Grey
    For relief of sore throat
    Link  Link to reviews
     
    Salicylates - Salicylic acid  (Pyralvex®)

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

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    Non Formulary
    Grey
    Oral paste
  • Discontinued December 2009)
  •  
      
    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

    Grey

    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.
      

    Red

    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.
      

    Amber 1

    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.
      

    Amber 2

    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
      

    Amber 3

    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.
      

    Green

    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.   

    OTC

      

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