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 Formulary Chapter 12: Ear, nose and oropharynx - Full Chapter
12.01  Drugs acting on the ear
12.01.01  Otitis externa
Aluminium Acetate Ear drops
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Unlicensed Drug Unlicensed
Red

Available as 8% and 13% ear drops for treatment of inflammation in otitis externa.

 
   
Triadcortyl Ointment
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Unlicensed Drug Unlicensed
Red

For use by ENT only for otitis externa and mastoid cavity infections. Short course provided by hospital.

APCO January 2014.

 
   
12.01.01  Astringent preparations
Acetic Acid 2% (Earcalm® Spray)
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Formulary
Green

In line with Guidelines for Antibiotic Prescribing in the Community 2018.

Also available to purchase over the counter. 

 
   
12.01.01  Anti-inflammatory preparations
Betamethasone 0.1% (Betnesol®, Vistamethasone®)
(Ear)
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Formulary
Green

0.1% drops for ear, eye, or nose. 

 
   
Betamethasone 0.1% with Neomycin 0.5% ear drops (Betnesol N®)
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Formulary
Green
 
   
Dexamethasone with Antibacterials (Otomize®)
(Ear)
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Formulary
Green

Ear spray - (Dexamethasone 0.1%, Neomycin Sulphate 3250 units per mL and Glacial Acetic Acid 2%).

 
   
Dexamethasone with Antibacterials (Sofradex®)
(Ear)
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Formulary
Green

Contains dexamethasone 0.05%, Framycetin Sulphate 0.5%, Gramicidin 0.005%.

 
   
Flumetasone 0.02% with Clioquinol 1% (Locorten-Vioform®)
(Ear)
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Formulary
Green

Note: Clioquinol stains skin and clothing.

 
   
Hydrocortisone Acetate 1% with Gentamicin 0.3% (Gentisone® HC)
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Formulary
Green
 
   
Prednisolone 0.5% Ear drops (Predsol®)
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Formulary
Green
 
   
12.01.01  Anti-infective preparations to top
Chloramphenicol
(Ear drops)
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Formulary
Green

Available as 5% or 10% ear drops. 

 
   
Ciprofloxacin 2mg/ml (Cetraxal®)
(Ear Drops)
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Formulary
Green

Licensed ear drops now available. 

APCO July 2018. 

 
Link  Medicines for Children: Ciprofloxacin drops for infection
   
Clotrimazole 1% Solution (Canesten®)
(Ear)
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Formulary
Green

Note this is called '1% solution' rather than 'ear drops'.

 
   
Gentamicin 0.3% Ear drops (Genticin®)
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Formulary
Green
 
   
12.01.01  Other aural preparations
12.01.02  Otitis media
12.01.03  Removal of ear wax
Olive Oil
(Ear)
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Restricted Drug Restricted
Brown

For removing earwax and available to purchase over the counter. Allow to warm to room temperature before use.

Only prescribe if required for prevention of chronic or recurrent otitis externa, in line with Clinical Commissioning Policy 88D.

 
   
Sodium Bicarbonate
(Ear)
Restricted Drug Restricted
Brown

For removing earwax and available to purchase over the counter.

Only prescribe if required for prevention of chronic or recurrent otitis externa, in line with Clinical Commissioning Policy 88D.

 
   
12.02  Drugs acting on the nose
12.02.01  Drugs used in nasal allergy to top
12.02.01  Antihistamines
12.02.01  Corticosteroids
Beclometasone Dipropionate
(Nasal spray)
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First Choice
Green

Available to purchase over the counter for adults over 18s. 

See Clinical Commissioning Policy 88D.

 
Mometasone Furoate
(Nasal spray)
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Second Choice
Green

Second line use after beclomethasone nasal spray.

 
   
Fluticasone furoate 27.5mcg (Avamys®)
(Nasal spray)
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Restricted Drug Restricted
Brown

Beclomethasone (first line) and mometasone (second line) are more cost effective preparations.

APCO March 2012.

 
   
Betamethasone Sodium Phosphate
(Ear/Eye/Nose drops)
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Formulary
Green
 
   
Fluticasone Propionate (Flixonase Nasule®)
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Restricted Drug Restricted
Brown

Restricted prescribing:

  • After a 6 week trial of steroid nasal spray for nasal polyps; second line fluticasone nasules for 6 weeks then review.
  • Patients with hypo osmia - 6 week course to try and recover the sense of smell.
  • ASA (Aspirin Sensitive Asthma) phenotype. It is often preferable to maintain these patients on a high topical steroid dose (nasules) - sometimes indefinitely as well as using other medications.


APCO January 2010.

 
   
12.02.01  Cromoglicate
Sodium Cromoglicate (Rynacrom®)
Formulary
Green

Sodium cromoglicate 4%.

 
   
12.02.02  Topical nasal decongestants
12.02.02  Sympathomimetics to top
Ephedrine
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Formulary
Green

Nasal drops 0.5%
Nasal drops 1%

 
   
Xylometazoline (Otrivine®)
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Formulary
Green

Available to purchase over the counter as nasal spray 0.1%, nasal drops 0.05% (paediatric)  and nasal drops 0.1% (adult).

Max. duration 7 days to avoid rebound congestion.

 
   
12.02.02  Antimuscarinic
Ipratropium Bromide (Rinatec®)
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Formulary
Green

Nasal spray 0.03%.

 
Link  UKMI Q&A: Treatment options for hypersalivation
   
12.02.03  Nasal preparations for infection
12.02.03  Nasal Staphylococci
Chlorhexidine Hydrochloride 0.1%, Neomycin Suphate 0.5% (Naseptin®)
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Formulary
Green

Contains arachis (peanut) oil so should not be used in patients with a peanut allergy.

 
Link  MHRA alert: Anaphylaxis risk with chlorhexidine
   
Mupirocin 2% (Bactroban Nasal®)
(nasal)
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Formulary
Green

Reserve mupirocin for MRSA, in line with Guidelines for Antibiotic Prescribing in the Community 2018.

NB. Ointment licensed in children – age range not specified by manufacturer. Cream licensed from 1 year.

 
   
12.03  Drugs acting on the oropharynx
12.03.01  Drugs for oral ulceration and inflammation to top
Hydrocortisone (Corlan®)
(Mouth ulcers)
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Formulary
Green

Mucoadhesive buccal tablets (oromucosal tablets) for treatment of mouth ulcers. 

 
   
Betamethasone Soluble tablets
(Mouth ulcers)
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Formulary
Green

For oral ulceration (unlicensed indication) in adult and child over 12 years. Usual dose is 500 micrograms dissolved in 20 mL water and rinsed around the mouth 4 times daily.

 
   
Lidocaine 5% ointment
(Mouth)
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Restricted Drug Restricted
Brown

To be rubbed gently into dry gum.

Topical preparations of local anaesthetics are available to purchase in pharmacies and should only be prescribed in line with Clinical Commissioning Policy 88D.

 
   
Benzydamine (Difflam®)
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Restricted Drug Restricted
Brown

Available as oromucosal spray and mouthwash. Available to purchase over the counter in line with Clinical Commissioning Policy 88D.

 
   
Choline Salicylate (Bonjela® Adult)
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Restricted Drug Restricted
Brown

Available to purchase over the counter, in line with Clinical Commissioning Policy 88D.

To be used in over 16s only. 

 
   
Fluticasone Propionate (Flixonase Nasule®)
(Mouthwash)
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Formulary
Red

Secondary care use only as a mouthwash for a variety of oral mucosal diseases. Also available for use by ENT surgery. 

APCO March 2017.

 
   
Gelclair®
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Formulary
Red

Oral gel (sachets) for the treatment of oral mucositis in oncology. 

Gelclair® is classed as a medical device.

 
   
Caphosol®
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Formulary
Red

Oral rinse or dispersible tablets for the treatment of oral mucositis in oncology.

Caphosol® is classed as a medical device.

 
   
12.03.02  Oropharyngeal anti-infective drugs
12.03.02  Oropharyngeal Fungal infections
Miconazole (Daktarin®)
(Oral gel )
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First Choice
Green

First-line treatment for oral candidiasis for immunocompetent adult and children older than 2 years of age, in line with Guidelines for Antibiotic Prescribing in the Community 2018.

Available to purchase over the counter in line with Clinical Commissioning Policy 88D.

 
Nystatin (Nystan®)
(Oral suspension)
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First Choice
Green

Clarification from the BNF (March 2017) has confirmed that the dose should be 100,000 units (1ml) FOUR times daily.

For oral candidiasis if miconazole oral gel is unsuitable or not tolerated, in line with Guidelines for Antibiotic Prescribing in the Community 2018.

 
Fluconazole
(Oral)
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Second Choice
Green

Second line treatment for oral candidiasis, in line with Guidelines for Antibiotic Prescribing in the Community 2018.

 
   
12.03.02  Oropharyngeal Viral infections
Aciclovir
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Restricted Drug Restricted
Brown

Cold sores resolve after 7–10d without treatment. Topical over the counter antivirals (aciclovir) can be purchased in line with Clinical Commissioning Policy 88D.

See Guidelines for Antibiotic Prescribing in the Community 2018.

 
   
12.03.03  Lozenges and sprays
12.03.04  Mouthwashes, gargles, and dentifrices to top
Chlorhexidine gluconate (Corsodyl®)
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Restricted Drug Restricted
Brown

Available as 0.2% mouthwash, 0.2% oral spray and 1% dental gel. 

Available to purchase over the counter in line with Clinical Commissioning Policy 88D.

 

 
Link  MHRA alert: Anaphylaxis risk with chlorhexidine
   
Hexetidine (Oraldene®)
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Restricted Drug Restricted
Brown

Available to purchase over the counter in line with Clinical Commissioning Policy 88D.

 

 
   
Tranexamic Acid Mouthwash
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Unlicensed Drug Unlicensed
Red

To be used by Haemophilia and MaxFax only.

 
   
12.03.05  Treatment of dry mouth
12.03.05  Local Treatment
Glandosane®
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Formulary
Green

May be prescribed under ACBS for patients suffering from dry mouth as a result of having (or having undergone) radiotherapy, or sicca syndrome, spray onto oral and pharyngeal mucosa as required.

 
Link  UKMI Q&A: Saliva substitutes- Choosing and prescribing the right product.
   
AS saliva Orthana®
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Formulary
Green

Available as oral spray or lozenges. 

 
Link  UKMI Q&A: Saliva substitutes- Choosing and prescribing the right product.
   
Biotene Oralbalance®
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Formulary
Green

Saliva replacement gel. 

 
Link  UKMI Q&A: Saliva substitutes- Choosing and prescribing the right product.
   
12.03.05  Systemic treatment
 ....
 Non Formulary Items
Acetic Acid 5% solution in IMS

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Non Formulary
 
Almond Oil
(Ear)

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Non Formulary

For removing earwax and available to purchase from pharmacies. Allow to warm to room temperature before use.

 
Anaesthetic throat lozenges  (Tyrozets®)

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Non Formulary

Contains benzocaine. Available to purchase over the counter. 

 
Antacid with Oxetacaine

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Non Formulary

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

 
Azelastine and Fluticasone  (Dymista®)

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Non Formulary
Black

Not recommended as there are more cost effective alternatives available.

Use of intranasal corticosteriod with oral antihistamine is recommended.

APCO May 2013.

 
Azelastine Hydrochloride  (Rhinolast®)

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Non Formulary

Discontinued.

 
Benzocaine

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Non Formulary
 
Betamethasone Sodium Phosphate 0.1% with Neomycin Sulphate 0.5%  (Betnesol-N®)

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Non Formulary
 
Betamethasone Sodium Phosphate with Antibacterial  (Vista-Methasone N®)

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Non Formulary
 
BioXtra®

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Non Formulary

ACBS: patients suffering from dry mouth as a result of having (or having undergone) radiotherapy, or sicca syndrome, apply to oral mucosa as required.

 
Budesonide
(Nasal spray)

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Non Formulary

Nasal spray 64micrograms per spray.

 
Carmellose Sodium  (Orabase®)

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Non Formulary

Protective paste. 

 
Cerumol®
(Ear)

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Non Formulary

For removing earwax and available to purchase over the counter. Please note this product contains arachis (peanut) oil

 
Cetylpyridinium, Chlrocresol, Lidocaine  (Anbesol®)

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Non Formulary

Available to purchase over the counter, in line with Clinical Commissioning Policy 88D.

 
Chlorhexidine & Chlorobutanol  (Eludril®)
(Mouthwash)

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Non Formulary

Available to purchase over the counter in line with Clinical Commissioning Policy 88D.

 
Docusate 0.5%  (Waxsol® Ear drops)

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Non Formulary

For removing earwax and available to purchase from pharmacies.

 
Doxycycline

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Non Formulary

Dispersible tablets (unlicensed indication) to be dispersed in water and used as a mouthwash.

 
Doxycycline

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Non Formulary

Dispersible tablet (unlicensed indication) may be dispersed in water and use as a mouthwash. 

 
Doxycycline  (Periostat®)

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Non Formulary

For periodontitis (as an adjunct to gingival scaling and root planing). May be difficult to obtain.

 
Exterol®
(Ear)

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Non Formulary

For removing earwax and available to purchase from pharmacies.

 
Flurbiprofen lozenge  (Strefen®)

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Non Formulary

Available to purchase over the counter for sore throat, in line with Clinical Commissioning Policy 88D.

 
Glycerol dioleate  (Episil®)

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Non Formulary

Treatment of oral mucositis for oncology patients. Episil® is classified as medical device.  

 
Hydrocortisone with Antibacterial  (Neo-Cortef®)

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Non Formulary
 
Hydrocortisone with Antibactrial  (Otosporin®)

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Non Formulary

Discontinued and removed from BNF 2014.

 
Hydrogen Peroxide
(Mouthwash)

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Non Formulary

Available to purchase over the counter in line with Clinical Commissioning Policy 88D.

Link  MHRA alert: Risk of gas embolism when used in surgery
 
Lidocaine 10% mouth spray  (Xylocaine®)

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Non Formulary
 
Lidocaine and Cetylpyridinium  (Dentinox® Teething Gel)

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Non Formulary

Available to purchase over the counter, in line with Clinical Commissioning Policy 88D.

 
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

Mucoadhesive buccal tablets licensed for oropharyngeal candidiasis in patients who are immunocompromised.

 
Molcer®
(Ear)

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Non Formulary

For removing earwax and available to purchase from pharmacies.

 
Mouth Swabs

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Non Formulary
 
Neomycin Sulphate with corticosteroids  (Neo-Cortef®)

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Non Formulary
 
Neomycin Sulphate with corticosteroids  (Otosporin®)

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Non Formulary

Discontinued and removed from BNF 2014.

 
Otex®
(Ear)

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Non Formulary

For removing earwax and available to purchase over the counter.

 
Pilocarpine Hydrochloride  (Salagen®)

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Non Formulary
 
Povidone Iodine  (Betadine®)

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

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Non Formulary

Discontinued in 2011.

 
Salicylates - Salicylic acid  (Pyralvex®)

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Non Formulary

May cause temporary discolouration of teeth and oral mucosa.

 
Salinum®

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Non Formulary
 
Saliveze®

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Non Formulary

Spray (mint flavour), has more transient effect than BioXtra gel.

 
Salivix®

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Non Formulary

Pastilles: Only effective if there is a functioning salivary gland.

Acidic and so should only be used for patients who do not have their own dentition.

 
Sodium Chloride
(mouthwash compound BP)

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Non Formulary
 
SST

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Non Formulary

Saliva Stimulating Tablets.

 
Thymol

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Non Formulary
 
Triamcinolone Acetonide  (Nasacort®)
(Nasal spray)

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Non Formulary

Available to purchase over the counter. 

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

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Non Formulary

Discontinued in December 2009.

 
Triamcinolone with antibacterial  (Otocomb Otic®)

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Non Formulary
 
Triamcinolone with Antibacterial  (Tri-Adcortyl Otic®)

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Non Formulary

Discontinued in November 2008.

 
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

Red

Red: Medicines which should only be prescribed in secondary care by a specialist.  

Amber Continuation

Amber Continuation: Medicines which should be initiated or recommended by a specialist for continuation in primary care. The specialist must notify the GP that the prescribing responsibility has been transferred.   

Amber Shared Care Protocol

Amber Shared Care Protocol: Medicines which are appropriate to be initiated and stabilised by a specialist, once stabilised the medicine may be appropriate for responsibility to be transferred from secondary to primary care with the agreement of a GP and a formal ‘shared care’ agreement. The shared care protocol must be approved by the Area Prescribing Committee Oxfordshire (APCO).   

Green

Green: Medicines which are suitable for initiation and ongoing prescribing within primary care.   

Brown

Brown: Medicines which should only be prescribed in restricted circumstances.  

Black

Black: Medicines which are not recommended for use because of lack of evidence of clinical effectiveness, cost effectiveness or safety.  

OCCG Green

not used  

netFormulary