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 Formulary Chapter 12: Ear, nose and oropharynx - Full Chapter
12.02.01  Expand sub section  Drugs used in nasal allergy
Azelastine and fluticasone (Dymista)
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Formulary
Amber 2

 Fluticasone proprionate with azelastine hydrochloride as Dymista®  Nasal spray 

Notes: 

  • 2nd line to oral antihistamine and Avamys® nasal spray following at least a month's trial of topical corticosteroid
 
   
12.02.01  Expand sub section  Antihistamines
12.02.01  Expand sub section  Corticosteroids
Betamethasone sodium phosphate
(Drops 0.1%)
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Formulary
Green

Drops 0.1%

 

Notes:

  • There are no published studies showing that any one nasal steroid is more effective than any other. Aqueous sprays tend to cause less irritation.    
  • GPs should prescribe Beconase as the first-line choice therapy for allergic rhinitis and ensure the patient knows how to use their nasal spray effectively.
  • Beclomethasone nasal spray is considered as first line therapy. It is relatively cheap, effective and well tolerated, requiring twice daily administration.
  • Systemic absorption may follow on from any nasal steroid particularly if the doses are high and prolonged.
  • CSM recommends that when children are receiving prolonged treatment with nasal corticosteroids the height of the child should be monitored. If growth is slowed then paediatric referral should be considered.
 
   
Fluticasone furoate (Avamys)
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Formulary
Amber 2

 Nasal spray, 27.5 micrograms per spray  

Notes:

  • Avamys to be used for allergic rhinitis.
 
   
Fluticasone Propionate (Flixonase Nasule)
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Formulary
Amber 1
  •  Nasule Drops ,400 micrograms (1 mg/ml), nasal drops suspension.

Notes:

      for the treatment of nasal polyps only.

 
   
Fluticasone Propionate (Flixonase)
(nasal)
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Formulary
Amber 2

 Nasal spray, 50 micrograms per spray  

Notes: 

  • Flixonase to be used for perennial rhinitis.
 
   
Triamcinolone Acetonide (Nasacort)
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Formulary
Amber 2

Nasal spray, 55 micrograms per spray

 
   
Beclometasone Dipropionate
(Nasal spray)
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Restricted Drug Restricted
Green

 Beconase® Aqueous nasal spray, 50 micrograms per spray

Notes:

  • Patients aged over 18 should not be prescribed in Primary Care or at Discharge
  • Advise patient to purchase, unless prescription is for long-term use
  • There are no published studies showing that any one nasal steroid is more effective than any other. Aqueous sprays tend to cause less irritation.    
  • GPs should prescribe Beconase as the first-line choice therapy for allergic rhinitis and ensure the patient knows how to use their nasal spray effectively.
  • Beclomethasone nasal spray is considered as first line therapy. It is relatively cheap, effective and well tolerated, requiring twice daily administration.
  • Systemic absorption may follow on from any nasal steroid particularly if the doses are high and prolonged.
  • CSM recommends that when children are receiving prolonged treatment with nasal corticosteroids the height of the child should be monitored. If growth is slowed then paediatric referral should be considered.
 
   
12.02.01  Expand sub section  Cromoglicate
 ....
 Non Formulary Items
Azelastine Hydrochloride  (Rhinolast)

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Non Formulary
Link  Notts APC allergic rhinitis treatment pathway
 
Betamethasone nasal drops

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Non Formulary
 
Budesonide
(nasal spray)

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Non Formulary
 
Flunisolide  (Syntaris)

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Non Formulary
 
Mometasone Furoate

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Non Formulary
Link  Notts APC allergic rhinitis pathway
 
Sodium Cromoglicate  (Rynacrom)

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

Green

Routine prescribing within licensed indication  

Amber 1

Specialist recommendation followed by GP initiation and continuation  

Amber 2

Specialist or GP initiation in line with local guideline after 1st line failure followed by GP continuation   

Amber 3

Specialist initiation and stabilisation followed by GP continuation  

Amber SCG

Specialist initiation and stabilisation followed by GP continuation in line with an agreed shared care guideline  

Red

Hospital or specialist prescribing only  

Red Red

These medicines have been evaluated and rejected by MKPAG and are NOT approved for use within MK. They are not recommended for use because of lack of clinical effectiveness, cost effectiveness or safety.  

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