| Therapeutic Area | Formulary Choices | Cost for 28 (unless otherwise stated) | Rationale for decision / comments |
|---|---|---|---|
| Analgesics, Non-steroidal anti-inflammatory drugs |  Benzydamine - suitable for self-care | 0.15% mouthwash sugar free: £4.88 (300ml) | For the relief of painful inflammatory conditions of the mouth and throat including for adults rinse or gargle with 15 ml every 1½ to 3 hours as required for pain relief. The solution should be expelled from the mouth after use. Should generally be used undiluted, but if 'stinging' occurs the rinse may be diluted with water. Uninterrupted treatment should not exceed seven days, except under medical supervision. |
| Corticosteroids | Hydrocortisone - suitable for self-care | 2.5 mg muco-adhesive buccal tablets sugar free: £9.24 (20) | For adults in previously diagnosed aphthous ulceration of the mouth. Should not be sucked, but kept in the mouth and allowed to dissolve slowly in close proximity to the ulcers. One tablet should be used in this way four times a day for 5 days. |
| Salicylic acid and derivatives | Choline salicylate as Bonjela® - suitable for self-care | 8.7% oromucosal gel sugar free: £3.55 (15g) | For the relief of pain, discomfort and inflammation caused by common mouth ulcers and sore spots for adults and children over the age of 16. Using a clean finger massage approximately half an inch of the gel onto the sore area, not more than once every 3 hours. |
| Lidocaine | Lidocaine and cetylpyridinium as Bonjela junior® - suitable for self-care | 0.5 and 0.025% oromucosal gel sugar free: £2.58 (15g) | For the relief of pain from common mouth ulcers and denture irritation for adults and children over 5 months. Apply a little gel to the sore area with either a clean fingertip or swab. This may be repeated after twenty minutes and then every three hours. |
| Antifungals, Imidazole | Miconazole as Daktarin® - suitable for self-care | 20mg/g oromucosal gel sugar free: £4.46 (15g) | For oral treatment of superficial fungal (e.g. Candida) infections of the oropharynx in adults and paediatric patients 4 months and older. Infants (4 – 24 months): 1.25 ml (¼ measuring spoon of gel) applied four times a day after meals. Each dose should be divided into smaller portions and the gel should be applied to the affected area(s) with a clean finger. The gel should not be applied to the back of the throat due to possible choking. The gel should not be swallowed immediately, but kept in the mouth as long as possible. Adults and children 2 years of age and older: 2.5 ml (½ measuring spoon of gel) applied four times a day after meals. The gel should not be swallowed immediately, but kept in the mouth as long as possible/. The treatment should be continued for at least a week after the symptoms have disappeared. For oral candidosis, dental prostheses should be removed at night and brushed with the gel. |
| 20mg/g oromucosal gel sugar free: £4.38 (80g) | |||
| Antifungals, Polyene | Nystatin as Nystan® | 100,000units/ml suspension: £1.80 (30ml) | NHS Somerset classify as second line if miconazole intolerant for 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. Usually for taken for 7 days, and continued for 48 hours after lesions have resolved |
| Antiseptics and disinfectants | Chlorhexidine - suitable for self-care | 0.2% mouthwash: £2.19 (300ml) | For adults and children of 12 years and over as an aid in the treatment and prevention of gingivitis and in the maintenance of oral hygiene, particularly in situations where toothbrushing cannot be adequately employed (e.g. following oral surgery, in mentally or physically handicapped patients). Thoroughly rinse the mouth for about one minute with 10 ml twice daily. Spit out after use. |
| Dry mouth | BioXtra® | 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® | Pastille: £3.55 (50) | Saliva stimulation. Available OTC. No longer subject to ACBS criteria. |
|
| Toothpaste | Sodium fluoride | 1.1% dental paste sugar free: £5.73 (51g) | NHS Somerset classify high strength fluoride toothpaste as green for head and neck cancer patients on the recommendation of hospital specialist. Other indications remain self-care/dental prescribing only. |
| Oral film forming agents | Polyvinylpyrrolidone (PVP), zinc gluconate and taurine GelX® | Oral spray: £49.21 (100ml) | For treatment and prevention of oral mucositis. Apply 3 sprays, 3 times a day. |
