| Therapeutic Area | Formulary Choices | Cost for 28 (unless otherwise stated) | Rationale for decision / comments |
|---|---|---|---|
| 12.3 Drugs acting on the oro-pharynx | |||
| Oral ulceration and inflammation |  Benzydamine | 0.15% mouthwash: £7.79 (300ml) | May be diluted with water if stinging occurs. Available OTC as Difflam mouthwash |
| Hydrocortisone | 2.5mg pellets: £6.29 (20) | Available OTC as Corlan pellets | |
Bonjela gel Bonjela Junior Gel | £2.59 (15G) £2.59 (15G) | Not under 16 years 3 months plus |
|
| Oropharyngeal anti-fungal | Preparations 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 line | Miconazole - suitable for self-care | 0.2% gel: £3.23 (15g), £4.38 (80g) | Miconazole gel is available OTC. Use with caution if patient taking warfarin. |
| Second line if miconazole intolerant | Nystatin 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 |
| Mouthwashes | Chlorhexidine - suitable for self-care | 0.2% mouthwash: £3.60 (300ml) | Available OTC as Corsodyl See NPSA alert on inadvertant injection of solutions for external use. |
| Dry mouth | PLEASE PRESCRIBE BY BRAND 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® | Pastilles: £3.55 (50) | Saliva stimulation. Available OTC. No longer subject to ACBS criteria. |
|
| Toothpastes | - suitable for self-care | Toothpastes should be considered as self care and are therefore non-formulary Where clinically appropriate, Somerset dental advisors suggest that dentists prescribe |
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