Therapeutic AreaFormulary ChoicesCost for 28
(unless otherwise stated)
Rationale for decision / comments
12.3 Drugs acting on the oro-pharynx
Oral ulceration and inflammationGreen cross
0.15% mouthwash: £7.79 (300ml)May be diluted with water if stinging occurs.
Available OTC as Difflam mouthwash
Green crossHydrocortisone2.5mg pellets: £6.29 (20)Available OTC as Corlan pellets
Green cross
Bonjela gel
Bonjela Junior Gel
£2.59 (15G)
£2.59 (15G)
Not under 16 years
3 months plus
Oropharyngeal anti-fungalPreparations for oral candidiasis should be used after food and retained in the mouth for as along as is practical.
Oral candidiasis is often associated with the use of inhaled corticosteroids, use of spacer devices and rinsing the mouth with water after using such inhalers may be helpful.
First lineGreen crossMiconazole - suitable for self-care0.2% gel: £3.23 (15g),
£4.38 (80g)
Miconazole gel is available OTC.
Use with caution if patient taking warfarin.
Second line
if miconazole intolerant
as Nystan®
100,000u/ml suspension: £1.80 (30ml)Please note that Somerset guidance does not match with manufacturers (and BNF) guidance. All ages- 100 000 units 4 times daily (half dose in each side of the mouth). For most patients one 30ml would provide full course. Higher dose may be given in special circumstances e.g in immunocompromised patients.
Note: Usually for taken for 7 days, and continued for 48 hours after lesions have resolved
MouthwashesGreen crossChlorhexidine - suitable for self-care0.2% mouthwash: £3.60 (300ml)Available OTC as Corsodyl
See NPSA alert on inadvertant injection of solutions for external use.

Gel Mouthspray: £3.94 (50ml)
Saliva replacement. Neutral pH. Gluten and sugar-free. Contains fluoride (4.2mg/l). Contains porcine-derived gastric mucin.
Approved for NHS prescribing where they fulfil the borderline substances criteria, for dry mouth caused by:
• radiotherapy
• sicca syndrome
Prescriptions should accordingly be endorsed as ACBS.
Available OTC
Salivix®Pastilles: £3.55 (50)Saliva stimulation. Available OTC.
No longer subject to ACBS criteria.
ToothpastesGreen cross - suitable for self-careToothpastes should be considered as self care and are therefore non-formulary
Where clinically appropriate, Somerset dental advisors suggest that dentists prescribe