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 Formulary Chapter 12: Ear, nose and oropharynx - Full Chapter
12.02.01  Expand sub section  Drugs used in nasal allergy
 note 
  • Corticosteroid nasal sprays are appropriate as first-line treatment. They are more effective than oral antihistamines in reducing nasal blockage, postnasal drip and providing overall relief of symptoms. Additional benefit may be obtained by combining with an antihistamine.
  • All corticosteroid nasal sprays are equally effective.
  • Regular use is essential to ensure maximum benefit and non-compliance is a common cause of treatment failure.
  • Antihistamine nasal sprays tend to be less effective than topical steroids. They offer an alternative for a small number of patients (or parents) that express concern about the long-term safety of corticosteroids. Local infection should be treated.
  • Local advice on technique for using steroid nasal sprays / Dymista is as follows:
    It is best to use the nasal spray when the nose is clearest, not when blocked.  Point the spray slightly away from the midline to reduce the risk of nosebleeds.  Don't sniff when taking the spray (keeping the mouth open will facilitate this) This prevents the majority of the spray ending up in the throat and improves compliance as patients complain of the bitter taste of some sprays.
    For patients who do experience nosebleeds use Vaseline to both sides of the nose twice a day ideally before using the spray.   
  • For patients not responding to treatment check technique before considering alternative therapy.
  • Mometasone nasal spray may be used in children aged 3-6 years of age as it is the only licensed product for this age group.
12.02.01  Expand sub section  Corticosteroids
Beclometasone Nasal Spray
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First Choice
Green
 
Fluticasone Furoate Nasal Spray (Avamys®)
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Second Choice
Green
More costly choice than beclometasone. 
   
Fluticasone + Azelastine  (Dymista®)
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Second Choice
Green
For use in line with allergic rhinitis guideline.
For patients who have not responded to other therapies and who would otherwise be considered for Sub Lingual Immunotherapy (SLIT) or a referral to secondary care

 
Link  Leicestershire Evaluation: Dymista® in Allergic Rhinitis
   
 ....
 Non Formulary Items
Budesonide nasal spray  (Benacort®)

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Non Formulary
Black
 
Fluticasone Propionate (nasules)

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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
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Link to adult BNF
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Link to children's BNF
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Link to SPCs
SMC
Scottish Medicines Consortium
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

Black

Drugs not recommended for use in the Leicestershire Health Community because of lack of evidence of clinical effectiveness, cost prioritization or concerns over safety. All new drugs will be black until they have been through the appropriate approval process - then they will appear as a specific entry   

Red

Drugs which should be prescribed only by hospital specialists (clinical review by specialist as appropriate and annually as a minimum).  

Amber SCA

Drugs which would initially be prescribed by a hospital specialist and then by a GP where full agreement to share the care of each specific patient has been reached under a LMSG Shared Care Agreement (SCA). Specific patient monitoring or intervention required.   

Amber Simple

Drugs suitable to be initiated and prescribed in primary care only after specialist assessment and recommendation. A shared care agreement is not required.  

Green Conditional

Drugs for which GPs are able to take full responsibility for prescribing and monitoring subject to specified conditions e.g. prescribing in line with agreed LMSG guidance or able to demonstrate suitable competence see comments under individual entries.   

Green

Drugs for which GPs would normally take full responsibility for prescribing and monitoring. Drugs included in this list have been specifically considered by LMSG.   

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