Related guidance:

For Steroid Emergency Card see NHS Somerset Formulary Corticosteriod responsive conditions.

See NHS Somerset infection management guidance.

Allergic rhinitis (CKS December 2022)

Therapeutic AreaFormulary ChoicesCost for 28
(unless otherwise stated)		Rationale for decision / comments
Corticosteroids (intranasal)Green cross Mometasone - suitable for self-care50mcg/dose nasal spray: £3.03 (140)





First line for adults and children 12 years of age and older: The usual recommended dose is two actuations in each nostril once daily. Once symptoms are controlled, dose reduction to one actuation in each nostril may be effective for maintenance. If symptoms are inadequately controlled, the dose may be increased to a maximum daily dose of four actuations in each nostril once daily. Dose reduction is recommended following control of symptoms.

For children between the ages of 3 and 11 years the usual recommended dose is one actuation in each nostril once daily.

Do not prescribe Clarinaze® as not cost effective.

OTC licence for adults only.
Green cross Beclometasone - suitable for self-care50mcg/dose nasal spray: £3.55 (200)Second line for adults and children over six years of age. The recommended dosage is two sprays into each nostril twice daily. Once control has been established it may be possible to maintain control with fewer sprays. A dosage regimen of one spray into each nostril morning and evening has been shown to be efficacious in some patients. However, should symptoms recur, patients should revert to the recommended dosage of two sprays into each nostril morning and evening. The minimum dose should be used at which effective control of symptoms is maintained. Total daily administration should not normally exceed eight sprays.

Do not prescribe Beconase® as not cost effective.

OTC licence for adults only.
Budesonide as

Green cross Benacort® - suitable for self-care		64mcg/dose nasal spray: £6.42 (120)For adults, one application into each nostril morning and evening. If good effect is achieved, one application into each nostril each morning.

OTC licence for adults only.
Fluticasone propionate nasal spray is non-formulary however can be purchased over the counter (OTC licence for adults only).
Fluticasone propionate and azelastine (Dymista®) is classified as black (not recommended) as per traffic light guidance.
Fluticasone furoate

as Avamys®		27.5mcg/dose nasal spray: £6.44 (120)
For adults and adolescents (12 years and over) the recommended starting dose is two spray actuations in each nostril once daily.
Once adequate control of symptoms is achieved, dose reduction to one spray actuation in each nostril may be effective for maintenance.
The dose should be titrated to the lowest dose at which effective control of symptoms is maintained.

For children (6 to 11 years of age) the recommended starting dose is one spray actuation in each nostril once daily.
Patients not adequately responding to one spray actuation in each nostril once daily may use two spray actuations in each nostril once daily.
Once adequate control of symptoms is achieved, dose reduction to one spray actuation in each nostril once daily is recommended.

All patients currently prescribed Fluticasone propionate should be switched to Fluticasone furoate as significantly more cost effective. If necessary to use fluticasone propionate prescribe as brand Nasofan®.
Triamcinolone

Green cross Nasacort® - suitable for self-care		55mcg/dose nasal spray: £7.39 (120)For adults the recommended starting dose is 2 sprays in each nostril once daily. Once symptoms are controlled patients can be maintained on 1 spray in each nostril once daily.

For children aged 12 years and over the recommended starting dose is 2 sprays in each nostril once daily. Once symptoms are controlled patients can be maintained on 1 spray in each nostril once daily.

For children aged 6 to 12 years the recommended dose is 1 spray in each nostril once daily. In patients with more severe symptoms, a dose of 2 sprays in each nostril may be used. But once symptoms are controlled, patients should be maintained on the lowest effective dose.

For children aged 2 to 5 years the recommended and maximum dose is 1 spray in each nostril once daily.

Continuous use beyond 3 months in children under 12 years is not recommended.

OTC licence for adults only.
AntimuscarinicsIpratropium

as Rinaspray®		21mcg/dose nasal spray: £6.54 (180)
For adults only if rhinorhoea is the main problem, the recommended dose is two sprays in each nostril administered 2 - 3 times a day.
AntibacterialsMupirocin

as Bactroban Nasal®		2% nasal ointment: £4.24 (3g)First line for use in decolonisation of nasal MRSA, applied to the inside of each nostril, twice daily for 5 days.

For MRSA suspected or confirmed impetigo around the eyes (off label).
Neomycin and
chlorhexidine

as Naseptin®		0.5 and 0.1% nasal cream: £1.99 (15g)Second line if mupirocin is unavailable for use in decolonisation of nasal MRSA, applied to the inside of each nostril, four times daily for 10 days.