SYMPATHOMIMETICS › VASOCONSTRICTOR
Nasal congestion | Sinusitis affecting the maxillary antrum
▶ BY INTRANASAL ADMINISTRATION
▶ Child 12–17 years: Apply 1–2 drops up to 4 times a day as
required for a maximum of 7 days, to be instilled into
each nostril, administer ephedrine 0.5% nasal drops
▶ Adult: Apply 1–2 drops up to 4 times a day as required
for a maximum of 7 days, to be instilled into each
The CHM/MHRA has stated that non-prescription cough
and cold medicines containing ephedrine can be
considered for up to 5 days’ treatment in children aged
6–12 years after basic principles of best care have been
tried; these medicines should not be used in children
disease (in adults). prostatic hypertrophy (risk of acute
urinary retention) (in adults)
l INTERACTIONS → Appendix 1: sympathomimetics,
▶ Common or very common Anxiety . headache . insomnia . nausea
l PREGNANCY Manufacturer advises avoid.
l BREAST FEEDING Present in milk; manufacturer advises
avoid—irritability and disturbed sleep reported.
l PRESCRIBING AND DISPENSING INFORMATION For nasal
drops, the BP directs that if no strength is specified 0.5%
l PROFESSION SPECIFIC INFORMATION
Dental practitioners’ formulary
Ephedrine nasal drops may be prescribed.
l EXCEPTIONS TO LEGAL CATEGORY Ephedrine nasal drops
can be sold to the public provided no more than 180 mg of
ephedrine base (or salts) are supplied at one time, and
pseudoephedrine salts are not supplied at the same time;
for conditions that apply to supplies made at the request of
a patient, see Medicines, Ethics and Practice, London,
Pharmaceutical Press (always consult latest edition).
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug. Forms available
from special-order manufacturers include: nasal drops
▶ Ephedrine hydrochloride (Non-proprietary)
Ephedrine hydrochloride 5 mg per 1 ml Ephedrine 0.5% nasal
drops | 10 ml p £1.90–£1.94 DT = £1.90
Ephedrine hydrochloride 10 mg per 1 ml Ephedrine 1% nasal drops
| 10 ml p £1.94–£2.01 DT = £1.94
Congestion of mucous membranes of upper respiratory
▶ Child 6–11 years: 30 mg 3–4 times a day
▶ Child 12–17 years: 60 mg 3–4 times a day
▶ Adult: 60 mg 3–4 times a day
Children under 6 years should not be given over-thecounter cough and cold medicines containing
pressure (in children). susceptibility to angle-closure
l INTERACTIONS → Appendix 1: sympathomimetics,
l PREGNANCY Defective closure of the abdominal wall
(gastroschisis) reported very rarely in newborns after first
l BREAST FEEDING May suppress lactation; avoid if lactation
not well established or if milk production insufficient.
l HEPATIC IMPAIRMENT Manufacturer advises caution in
l RENAL IMPAIRMENT Use with caution in mild to moderate
renal impairment. Manufacturer advises avoid in severe
l LESS SUITABLE FOR PRESCRIBING Pseudoephedrine
hydrochloride is less suitable for prescribing.
l EXCEPTIONS TO LEGAL CATEGORY Galpseud ® and Sudafed ®
can be sold to the public provided no more than 720 mg of
pseudoephedrine salts are supplied, and ephedrine base
(or salts) are not supplied at the same time; for details see
Medicines, Ethics and Practice, London, Pharmaceutical
Press (always consult latest edition).
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
EXCIPIENTS: May contain Alcohol
▶ Galpseud (Thornton & Ross Ltd)
Pseudoephedrine hydrochloride 6 mg per 1 ml Galpseud
30mg/5ml linctus sugar-free | 2000 ml P £14.00
▶ Galpseud (Thornton & Ross Ltd)
l DRUG ACTION Xylometazoline is a sympathomimetic.
▶ BY INTRANASAL ADMINISTRATION USING NASAL DROPS
▶ Child 6–11 years: 1–2 drops 1–2 times a day as required
for maximum duration of 5 days, 0.05% solution to be
administered into each nostril
▶ Child 12–17 years: 2–3 drops 2–3 times a day as required
for maximum duration of 7 days, 0.1% solution to be
administered into each nostril
▶ Adult: 2–3 drops 2–3 times a day as required for
maximum duration of 7 days, 0.1% solution to be
administered into each nostril
▶ BY INTRANASAL ADMINISTRATION USING NASAL SPRAY
▶ Child 12–17 years: 1 spray 1–3 times a day as required for
maximum duration of 7 days, to be administered into
▶ Adult: 1 spray 1–3 times a day as required for
maximum duration of 7 days, to be administered into
The CHM/MHRA has stated that non-prescription cough
and cold medicines containing oxymetazoline or
xylometazoline can be considered for up to 5 days’
treatment in children aged 6–12 years after basic
principles of best care have been tried; these medicines
should not be used in children under 6 years of age.
l CAUTIONS Angle-closure glaucoma . avoid excessive or
▶ Rebound congestion Sympathomimetic drugs are of limited
value in the treatment of nasal congestion because they
can, following prolonged use (more than 7 days), give rise
to a rebound congestion (rhinitis medicamentosa) on
withdrawal, due to a secondary vasodilatation with a
subsequent temporary increase in nasal congestion. This
in turn tempts the further use of the decongestant, leading
l INTERACTIONS → Appendix 1: sympathomimetics,
SIDE-EFFECTS, FURTHER INFORMATION Use of
decongestants in infants and children under 6 years has
been associated with agitated psychosis, ataxia,
hallucinations, and even death—avoid.
l PREGNANCY Manufacturer advises avoid.
l BREAST FEEDING Manufacturer advises caution—no
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
▶ Otrivine (GlaxoSmithKline Consumer Healthcare)
Xylometazoline hydrochloride 1 mg per 1 ml Otrivine Congestion
Relief 0.1% nasal spray | 10 ml G £3.05 DT = £2.18
Otrivine Adult Measured Dose Sinusitis spray | 10 ml G £2.62 DT =
Otrivine Allergy Relief 0.1% nasal spray | 10 ml G £2.62 DT =
Otrivine Adult nasal spray | 10 ml G £2.18 DT = £2.18
Otrivine Adult Metered Dose 0.1% nasal spray | 10 ml G £2.62 DT
▶ Sudafed Congestion Relief (McNeil Products Ltd)
Xylometazoline hydrochloride 1 mg per 1 ml Sudafed Congestion
Relief 0.1% nasal spray | 10 ml G £3.46 DT = £2.18
▶ Sudafed Non-Drowsy Decongestant (xylometazoline) (McNeil
Xylometazoline hydrochloride 1 mg per 1 ml Sudafed Blocked Nose
▶ Sudafed Sinus-Ease (McNeil Products Ltd)
Xylometazoline hydrochloride 1 mg per 1 ml Sudafed Sinus-Ease
0.1% nasal spray | 15 ml G £2.80
▶ Otrivine (GlaxoSmithKline Consumer Healthcare)
Xylometazoline hydrochloride 500 microgram per 1 ml Otrivine
Child nasal drops | 10 ml p £1.91 DT = £1.91
Xylometazoline hydrochloride 1 mg per 1 ml Otrivine Adult 0.1%
nasal drops | 10 ml G £2.18 DT = £2.18
Sinusitis is an inflammation of the mucosal lining of the
Occasionally, acute sinusitis may become complicated by a
bacterial infection (see Antibacterial therapy for acute sinusitis
in Nose infections, antibacterial therapy p. 513).
Patients with acute sinusitis usually present with
symptoms of nasal blockage or congestion, nasal discharge,
dental or facial pain or pressure, and reduction or loss of the
Symptoms usually improve within 2 to 3 weeks without
Rarely, acute sinusitis may lead to orbital, intracranial or
skeletal complications (e.g. periorbital cellulitis, symptoms
Treatment is aimed at managing symptoms including pain,
fever, and nasal congestion as well as treatment of bacterial
g Patients presenting with symptoms for around 10 days
or less, should be given advice about the usual duration of
acute sinusitis, self-care of pain or fever with paracetamol
p. 444 or ibuprofen p. 1141, and when to seek medical help.
Patients should be reassured that antibiotics are usually not
required. Some patients may try nasal saline or nasal
decongestants, however there is limited evidence to show
they help to relieve nasal congestion.
Patients presenting with symptoms for around 10 days or
more with no improvement could be considered for
treatment with a high-dose nasal corticosteroid, such as
mometasone furoate p. 1207 [unlicensed use] or fluticasone
p. 1206 [unlicensed use] for 14 days. Supply of a back-up
antibiotic prescription could be considered and used if
symptoms do not improve within 7 days, or if they worsen
If the patient is systemically very unwell, has signs and
symptoms of a more serious illness or condition, or is at
high-risk of complications, an immediate antibiotic should
be given. h(see Antibacterial therapy for acute sinusitis in
Nose infections, antibacterial therapy p. 513).
g Patients presenting with symptoms of acute sinusitis
associated with a severe systemic infection or with orbital or
intracranial complications should be referred to hospital. h
Sinusitis (acute): antimicrobial prescribing. National
Institute for Health and Care Excellence. NICE guideline 79.
ANTIBACTERIALS › AMINOGLYCOSIDES
Eradication of nasal carriage of staphylococci
▶ BY INTRANASAL ADMINISTRATION
▶ Child: Apply 4 times a day for 10 days
▶ Adult: Apply 4 times a day for 10 days
Preventing nasal carriage of staphylococci
▶ BY INTRANASAL ADMINISTRATION
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
EXCIPIENTS: May contain Arachis (peanut) oil, cetostearyl alcohol
(including cetyl and stearyl alcohol)
▶ Naseptin (Alliance Pharmaceuticals Ltd)
Chlorhexidine hydrochloride 1 mg per 1 gram, Neomycin sulfate
5 mg per 1 gram Naseptin nasal cream | 15 gram P £1.99 DT =
For eradication of nasal carriage of staphylococci,
including meticillin-resistant Staphylococcus aureus
▶ BY INTRANASAL ADMINISTRATION
▶ Child: Apply 2–3 times a day for 5 days; a sample
should be taken 2 days after treatment to confirm
eradication. Course may be repeated once if sample
positive (and throat not colonised), dose to be applied
to the inner surface of each nostril
▶ Adult: Apply 2–3 times a day for 5 days; a sample
should be taken 2 days after treatment to confirm
eradication. Course may be repeated once if sample
positive (and throat not colonised), dose to be applied
to the inner surface of each nostril
▶ Common or very common Skin reactions
▶ Uncommon Nasal mucosal disorder
l PREGNANCY Manufacturer advises avoid unless potential
benefit outweighs risk—no information available.
l BREAST FEEDING No information available.
l RENAL IMPAIRMENT Manufacturer advises caution when
mupirocin ointment used in moderate or severe
impairment because it contains macrogols (polyethylene
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
▶ Bactroban (GlaxoSmithKline UK Ltd)
Mupirocin (as Mupirocin calcium) 20 mg per 1 gram Bactroban
2% nasal ointment | 3 gram P £4.24 DT = £4.24
CORTICOSTEROIDS › CORTICOSTEROID
COMBINATIONS WITH ANTI-INFECTIVES
The properties listed below are those particular to the
combination only. For the properties of the components
please consider, betamethasone p. 674, neomycin sulfate
▶ BY INTRANASAL ADMINISTRATION USING NASAL DROPS
▶ Child: Apply 2–3 drops 2–3 times a day, to be applied
▶ Adult: Apply 2–3 drops 2–3 times a day, to be applied
l INTERACTIONS → Appendix 1: corticosteroids . neomycin
l LESS SUITABLE FOR PRESCRIBING Betamethasone with
neomycin nasal-drops are less suitable for prescribing;
there is no evidence that topical anti-infective nasal
preparations have any therapeutic value in rhinitis or
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
EXCIPIENTS: May contain Benzalkonium chloride, disodium edetate
▶ Betnesol-N (RPH Pharmaceuticals AB)
Betamethasone (as Betamethasone sodium phosphate) 1 mg per
1 ml, Neomycin sulfate 5 mg per 1 ml Betnesol-N ear/eye/nose
drops | 10 ml P £2.39 DT = £2.39
Other drugs used for Nasal inflammation, nasal polyps
and rhinitis Desloratadine, p. 280 . Fexofenadine
hydrochloride, p. 280 . Ketotifen, p. 286 . Rupatadine, p. 282
▶ BY INTRANASAL ADMINISTRATION
▶ Child 6–17 years: 1 spray twice daily, to be administered
▶ Adult: 1 spray twice daily, to be administered into each
DOSE EQUIVALENCE AND CONVERSION
▶ 1 spray equivalent to 140 micrograms.
l INTERACTIONS → Appendix 1: antihistamines, nonsedating
▶ Common or very common Taste bitter (if applied
▶ Uncommon Epistaxis . nasal complaints
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
▶ Rhinolast (Meda Pharmaceuticals Ltd)
Azelastine hydrochloride 140 microgram per
1 actuation Rhinolast 140micrograms/dose nasal spray | 22 ml P £10.50 DT = £10.50
Combinations available: Fluticasone with azelastine, p. 1207
1204 Nasal inflammation, nasal polyps and rhinitis BNF 78
Ipratropium bromide 25-Jul-2018
Rhinorrhoea associated with allergic and non-allergic
▶ BY INTRANASAL ADMINISTRATION
▶ Child 12–17 years: 2 sprays 2–3 times a day, dose to be
▶ Adult: 2 sprays 2–3 times a day, dose to be sprayed into
DOSE EQUIVALENCE AND CONVERSION
▶ 1 metered spray of nasal spray = 21 micrograms.
l CAUTIONS Avoid spraying near eyes . bladder outflow
obstruction . cystic fibrosis . prostatic hyperplasia (in
adults). susceptibility to angle-closure glaucoma
l INTERACTIONS → Appendix 1: ipratropium
▶ Common or very common Epistaxis . gastrointestinal
motility disorder. headache . nasal complaints .throat
▶ Rare or very rare Palpitations
l ALLERGY AND CROSS-SENSITIVITY Contra-indicated in
patients with hypersensitivity to atropine or its
l PREGNANCY Manufacturer advises only use if potential
l BREAST FEEDING No information available—manufacturer
advises only use if potential benefit outweighs risk.
l PATIENT AND CARER ADVICE Patients or carers should be
counselled on appropriate administration technique and
warned against accidental contact with the eye (due to risk
Driving and skilled tasks Manufacturer advises patients and
carers should be counselled on the effects on driving and
performance of skilled tasks—increased risk of dizziness
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
EXCIPIENTS: May contain Benzalkonium chloride, disodium edetate
Ipratropium bromide 21 microgram per 1 dose Rinatec
21micrograms/dose nasal spray | 180 dose P £6.54 DT = £6.54
Corticosteroids (intranasal) f
MHRA/CHM ADVICE: CORTICOSTEROIDS: RARE RISK OF CENTRAL
SEROUS CHORIORETINOPATHY WITH LOCAL AS WELL AS SYSTEMIC
Central serous chorioretinopathy is a retinal disorder
that has been linked to the systemic use of
corticosteroids. Recently, it has also been reported after
local administration of corticosteroids via inhaled and
intranasal, epidural, intra-articular, topical dermal, and
periocular routes. The MHRA recommends that patients
should be advised to report any blurred vision or other
visual disturbances with corticosteroid treatment given
by any route; consider referral to an ophthalmologist for
evaluation of possible causes if a patient presents with
l CAUTIONS Avoid after nasal surgery (until healing has
occurred). avoid in pulmonary tuberculosis . avoid in the
presence of untreated nasal infections . patients
transferred from systemic corticosteroids may experience
▶ Systemic absorption Systemic absorption may follow nasal
administration particularly if high doses are used or if
treatment is prolonged; therefore also consider the
cautions and side-effects of systemic corticosteroids. The
risk of systemic effects may be greater with nasal drops
than with nasal sprays; drops are administered incorrectly
▶ Rare or very rare Glaucoma . nasal septum perforation
(more common following nasal surgery). vision blurred
SIDE-EFFECTS, FURTHER INFORMATION Systemic
absorption may follow nasal administration particularly if
high doses are used or if treatment is prolonged. Therefore
also consider the side-effects of systemic corticosteroids.
▶ In children The height of children receiving prolonged
treatment with nasal corticosteroids should be monitored;
if growth is slowed, referral to a paediatrician should be
Beclometasone dipropionate 04-Jan-2016
Prophylaxis and treatment of allergic and vasomotor
▶ BY INTRANASAL ADMINISTRATION
▶ Child 6–17 years: 100 micrograms twice daily, dose to be
administered into each nostril, reduced to
50 micrograms twice daily, dose to be administered
into each nostril, dose to be reduced when symptoms
controlled; maximum 400 micrograms per day
▶ Adult: 100 micrograms twice daily, dose to be
administered into each nostril, reduced to
50 micrograms twice daily, dose to be administered
into each nostril, dose to be reduced when symptoms
controlled; maximum 400 micrograms per day
l INTERACTIONS → Appendix 1: corticosteroids
l EXCEPTIONS TO LEGAL CATEGORY
▶ In adults Preparations of beclometasone dipropionate can
be sold to the public for nasal administration as a nasal
spray if supplied for the prevention and treatment of
allergic rhinitis in adults over 18 years subject to max.
single dose of 100 micrograms per nostril, max. daily dose
of 200 micrograms per nostril for max. 3 months, and a
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
EXCIPIENTS: May contain Benzalkonium chloride, polysorbates
▶ Beclometasone dipropionate (Non-proprietary)
Beclometasone dipropionate 50 microgram per
1 dose Beclometasone 50micrograms/dose nasal spray |
▶ Beconase (GlaxoSmithKline UK Ltd, Omega Pharma Ltd)
Beclometasone dipropionate 50 microgram per 1 dose Beconase
Aqueous 50micrograms/dose nasal spray | 200 dose P £2.63 DT =
BNF 78 Nasal inflammation, nasal polyps and rhinitis 1205
Beclometasone dipropionate 50 microgram per 1 dose Nasobec
Aqueous 50micrograms/dose nasal spray | 200 dose P £3.06 DT =
l DRUG ACTION Betamethasone has very high glucocorticoid
activity and insignificant mineralocorticoid activity.
Non-infected inflammatory conditions of nose
▶ BY INTRANASAL ADMINISTRATION
▶ Adult: Apply 2–3 drops 2–3 times a day, dose to be
Non-infected inflammatory conditions of nose
▶ BY INTRANASAL ADMINISTRATION
▶ Adult: Apply 2–3 drops twice daily, dose to be applied
l INTERACTIONS → Appendix 1: corticosteroids
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
EXCIPIENTS: May contain Benzalkonium chloride, disodium edetate
▶ Betnesol (RPH Pharmaceuticals AB)
Betamethasone sodium phosphate 1 mg per 1 ml Betnesol 0.1%
eye/ear/nose drops | 10 ml P £2.32 DT = £2.32
▶ Vistamethasone (Martindale Pharmaceuticals Ltd)
Betamethasone sodium phosphate 1 mg per 1 ml Vistamethasone
0.1% ear/eye/nose drops | 5 ml P £1.02 | 10 ml P £1.16 DT =
l DRUG ACTION Budesonide is a glucocorticoid, which exerts
significant local anti-inflammatory effects.
Allergic rhinitis | Nasal polyps
▶ BY INTRANASAL ADMINISTRATION
▶ Child 6–17 years: 128 micrograms once daily, dose to be
administered into each nostril in the morning,
alternatively 64 micrograms twice daily, dose to be
administered to each nostril, reduce dose when control
▶ Adult: 128 micrograms once daily, dose to be
administered into each nostril in the morning,
alternatively 64 micrograms twice daily, dose to be
administered to each nostril, reduce dose when control
Prophylaxis and treatment of allergic and vasomotor
▶ BY INTRANASAL ADMINISTRATION
▶ Child 12–17 years: Initially 200 micrograms once daily,
dose to be administered into each nostril in the
morning, alternatively initially 100 micrograms twice
daily, dose to be administered to each nostril; reduced
to 100 micrograms once daily, dose to be administered
into each nostril, dose can be reduced when control
▶ Adult: Initially 200 micrograms once daily, dose to be
administered into each nostril in the morning,
alternatively initially 100 micrograms twice daily, dose
to be administered to each nostril; reduced to
100 micrograms once daily, dose to be administered
into each nostril, dose can be reduced when control
▶ BY INTRANASAL ADMINISTRATION
▶ Child 12–17 years: 100 micrograms twice daily for up to
3 months, dose to be administered into each nostril
▶ Adult: 100 micrograms twice daily for up to 3 months,
dose to be administered into each nostril
▶ BY INTRANASAL ADMINISTRATION
▶ Adult: 128 micrograms once daily, dose to be
administered into each nostril in the morning,
alternatively 64 micrograms twice daily, dose to be
administered into each nostril; reduced to
64 micrograms once daily when control achieved. Use
for maximum 3 months, doses to be administered into
▶ BY INTRANASAL ADMINISTRATION
▶ Adult: 64 micrograms twice daily for up to 3 months,
dose to be administered into each nostril
l INTERACTIONS → Appendix 1: corticosteroids
▶ Rare or very rare Adrenal suppression
l EXCEPTIONS TO LEGAL CATEGORY
▶ In adults Preparations of budesonide can be sold to the
public for nasal administration as a nasal spray if supplied
for the prevention and treatment of seasonal allergic
rhinitis in adults over 18 years subject to max. single dose
of 200 micrograms per nostril, max. daily dose of
200 micrograms per nostril for max. period of 3 months,
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
EXCIPIENTS: May contain Disodium edetate, polysorbates, potassium
▶ Budesonide (Non-proprietary)
Budesonide 64 microgram per 1 dose Budesonide
64micrograms/dose nasal spray | 120 dose P £4.77 DT = £4.77
▶ Budeflam (Imported (South Africa))
Budesonide 100 microgram per 1 dose Budeflam Aquanase
100micrograms/dose nasal spray | 150 dose P s
Aircort 100micrograms/dose nasal spray | 200 dose P s
▶ Benacort (McNeil Products Ltd)
Budesonide 64 microgram per 1 dose Benacort 64micrograms
nasal spray | 120 dose p £5.83 DT = £4.77
▶ Rhinocort (Johnson & Johnson Ltd)
Budesonide 64 microgram per 1 dose Rhinocort Aqua 64 nasal
spray | 120 dose P £3.77 DT = £4.77
Prophylaxis and treatment of allergic rhinitis and
▶ BY INTRANASAL ADMINISTRATION USING NASAL SPRAY
▶ Child 4–11 years: 50 micrograms once daily, to be
administered into each nostril preferably in the
morning, increased if necessary to 50 micrograms twice
▶ Child 12–17 years: 100 micrograms once daily, to be
administered into each nostril preferably in the
morning, increased if necessary to 100 micrograms
twice daily; reduced to 50 micrograms once daily, dose
to be administered into each nostril, dose to be reduced
▶ Adult: 100 micrograms once daily, to be administered
into each nostril preferably in the morning, increased if
necessary to 100 micrograms twice daily; reduced to
1206 Nasal inflammation, nasal polyps and rhinitis BNF 78
50 micrograms once daily, dose to be administered into
each nostril, dose to be reduced when control achieved
▶ BY INTRANASAL ADMINISTRATION USING NASAL DROPS
▶ Child 16–17 years: 200 micrograms 1–2 times a day, to
be administered into each nostril, alternative
treatment should be considered if no improvement
after 4–6 weeks, (200 micrograms is equivalent to
▶ Adult: 200 micrograms 1–2 times a day, to be
administered into each nostril, alternative treatment
should be considered if no improvement after
4–6 weeks, (200 micrograms is equivalent to
Prophylaxis and treatment of allergic rhinitis
▶ BY INTRANASAL ADMINISTRATION
▶ Child 6–11 years: 27.5 micrograms once daily, dose to be
sprayed into each nostril, then increased if necessary to
55 micrograms once daily, dose to be sprayed into each
nostril, reduced to 27.5 micrograms once daily, to be
sprayed into each nostril, dose to be reduced once
control achieved; use minimum effective dose
▶ Child 12–17 years: 55 micrograms once daily, dose to be
sprayed into each nostril, reduced to 27.5 micrograms
once daily, to be sprayed into each nostril, dose to be
reduced once control achieved; use minimum effective
▶ Adult: 55 micrograms once daily, dose to be sprayed
into each nostril, reduced to 27.5 micrograms once
daily, to be sprayed into each nostril, dose to be
reduced once control achieved; use minimum effective
DOSE EQUIVALENCE AND CONVERSION
▶ 1 spray equivalent to 27.5 micrograms.
l INTERACTIONS → Appendix 1: corticosteroids
l SIDE-EFFECTS Adrenal suppression
SIDE-EFFECTS, FURTHER INFORMATION Nasal ulceration
occurs commonly with nasal preparations containing
l EXCEPTIONS TO LEGAL CATEGORY
▶ With intranasal use in adults Preparations of fluticasone
propionate can be sold to the public for nasal
administration (other than by pressurised nasal spray) if
supplied for the prevention and treatment of allergic
rhinitis in adults over 18 years, subject to max. single dose
of 100 micrograms per nostril, max. daily dose of
200 micrograms per nostril for max. 3 months, and a pack
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
EXCIPIENTS: May contain Benzalkonium chloride, disodium edetate,
▶ Avamys (GlaxoSmithKline UK Ltd)
Fluticasone furoate 27.5 microgram per 1 dose Avamys
27.5micrograms/dose nasal spray | 120 dose P £6.44 DT = £6.44
▶ Flixonase (GlaxoSmithKline Consumer Healthcare, GlaxoSmithKline UK
Fluticasone propionate 50 microgram per 1 dose Flixonase
50micrograms/dose aqueous nasal spray | 150 dose P £11.01 DT
Fluticasone propionate 50 microgram per 1 dose Nasofan
50micrograms/dose aqueous nasal spray | 150 dose P £8.04 DT =
EXCIPIENTS: May contain Polysorbates
▶ Flixonase (GlaxoSmithKline UK Ltd)
Fluticasone propionate 400 microgram Flixonase Nasule
400microgram/unit dose nasal drops | 28 unit dose P £12.99 DT =
The properties listed below are those particular to the
combination only. For the properties of the components
please consider, fluticasone p. 1206, azelastine
Moderate to severe seasonal and perennial allergic
rhinitis, if monotherapy with antihistamine or
▶ BY INTRANASAL ADMINISTRATION
▶ Child 12–17 years: 1 spray twice daily, dose to be
administered into each nostril
▶ Adult: 1 spray twice daily, dose to be administered into
l INTERACTIONS → Appendix 1: antihistamines, nonsedating . corticosteroids
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
EXCIPIENTS: May contain Benzalkonium chloride, polysorbates
▶ Dymista (Meda Pharmaceuticals Ltd)
Fluticasone propionate 50 microgram per 1 actuation, Azelastine
hydrochloride 137 microgram per 1 actuation Dymista
137micrograms/dose / 50micrograms/dose nasal spray | 120 dose P £14.80 DT = £14.80
Mometasone furoate 21-Dec-2017
Prophylaxis and treatment of seasonal allergic or
▶ BY INTRANASAL ADMINISTRATION
▶ Child 3–11 years: 50 micrograms daily, dose to be
▶ Child 12–17 years: 100 micrograms daily, increased if
necessary up to 200 micrograms daily, dose to be
sprayed into each nostril; reduced to 50 micrograms
daily, dose to be reduced when control achieved, dose
to be sprayed into each nostril
▶ Adult: 100 micrograms daily, increased if necessary up
to 200 micrograms daily, dose to be sprayed into each
nostril; reduced to 50 micrograms daily, dose to be
reduced when control achieved, dose to be sprayed into
▶ BY INTRANASAL ADMINISTRATION
▶ Adult: Initially 100 micrograms daily for 5–6 weeks,
dose to be sprayed into each nostril, then increased if
necessary to 100 micrograms twice daily, dose to be
sprayed into each nostril, consider alternative
treatment if no improvement after further 5–6 weeks,
reduce to the lowest effective dose when control
l INTERACTIONS → Appendix 1: corticosteroids
SIDE-EFFECTS, FURTHER INFORMATION Nasal ulceration
occurs commonly with preparations containing
BNF 78 Nasal inflammation, nasal polyps and rhinitis 1207
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
EXCIPIENTS: May contain Benzalkonium chloride, polysorbates
▶ Mometasone furoate (Non-proprietary)
Mometasone furoate 50 microgram per 1 dose Mometasone
50micrograms/dose nasal spray | 140 dose P £7.30 DT = £1.71
▶ Nasonex (Merck Sharp & Dohme Ltd)
Mometasone furoate 50 microgram per 1 dose Nasonex
50micrograms/dose nasal spray | 140 dose P £7.68 DT = £1.71
Triamcinolone acetonide 21-Dec-2017
l DRUG ACTION Triamcinolone exerts predominantly
glucocorticoid effects with minimal mineralcorticoid
Prophylaxis and treatment of allergic rhinitis
▶ BY INTRANASAL ADMINISTRATION
▶ Child 6–11 years: 55 micrograms once daily, dose to be
sprayed into each nostril, increased if necessary to
110 micrograms once daily, dose to be sprayed into
each nostril; reduced to 55 micrograms once daily, dose
to be sprayed into each nostril, reduce dose when
control achieved; maximum duration of treatment
▶ Child 12–17 years: 110 micrograms once daily, dose to be
sprayed into each nostril, reduced to 55 micrograms
once daily, dose to be sprayed into each nostril, reduce
▶ Adult: 110 micrograms once daily, dose to be sprayed
into each nostril, reduced to 55 micrograms once daily,
dose to be sprayed into each nostril, reduce dose when
l INTERACTIONS → Appendix 1: corticosteroids
l EXCEPTIONS TO LEGAL CATEGORY
▶ In adults Preparations of triamcinolone acetonide can be
treatment of seasonal allergic rhinitis in adults over
18 years, subject to maximum daily dose of
110 micrograms per nostril for maximum 3 months, and a
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
EXCIPIENTS: May contain Benzalkonium chloride, disodium edetate,
Triamcinolone acetonide 55 microgram per 1 dose Nasacort
55micrograms/dose nasal spray | 120 dose P £7.39 DT = £7.39
Sodium cromoglicate 25-Jul-2018
Prophylaxis of allergic rhinitis
▶ BY INTRANASAL ADMINISTRATION
▶ Child: 1 spray 2–4 times a day, to be administered into
▶ Adult: 1 spray 2–4 times a day, to be administered into
▶ In children Licensed for use in children (age range not
▶ Rare or very rare Bronchospasm (transient)
▶ Frequency not known Local reaction
l MEDICINAL FORMS No licensed medicines listed.
Dry mouth (xerostomia) may be caused by drugs with
antimuscarinic (anticholinergic) side-effects (e.g.
antispasmodics, tricyclic antidepressants, and some
antipsychotics), by diuretics, by irradiation of the head and
neck region or by damage to or disease of the salivary glands.
Patients with a persistently dry mouth may develop a
burning or scalded sensation and have poor oral hygiene;
they may develop increased dental caries, periodontal
disease, intolerance of dentures, and oral infections
(particularly candidiasis). Dry mouth may be relieved in
many patients by simple measures such as frequent sips of
cool drinks or sucking pieces of ice or sugar-free fruit
pastilles. Sugar-free chewing gum stimulates salivation in
patients with residual salivary function.
Artificial saliva can provide useful relief of dry mouth. A
properly balanced artificial saliva should be of a neutral pH
and contain electrolytes (including fluoride) to correspond
approximately to the composition of saliva. The acidic pH of
some artificial saliva products may be inappropriate. Of the
proprietary preparations, Aquoral ®, Biotène Oralbalance ® gel
or Xerotin ® can be used for any condition giving rise to a dry
mouth. BioXtra ®, Glandosane ®, Saliva Orthana ®, and
Saliveze ®, have ACBS approval for dry mouth associated only
with radiotherapy or sicca syndrome. Salivix ® pastilles,
which act locally as salivary stimulants, are also available for
any condition leading to a dry mouth and SST tablets may be
prescribed for dry mouth in patients with salivary gland
impairment (and patent salivary ducts).
Pilocarpine tablets p. 1210 are licensed for the treatment
of xerostomia following irradiation for head and neck cancer
and for dry mouth and dry eyes (xerophthalmia) in Sjögren’s
syndrome. They are effective only in patients who have some
residual salivary gland function, and therefore should be
withdrawn if there is no response.
Mucin 65 mg, xylitol 59 mg, in a sorbitol basis, pH neutral
Dry mouth as a result of having (or having undergone)
radiotherapy (ACBS) | Dry mouth as a result of sicca
▶ Adult: 1 lozenge as required, allow to dissolve slowly in
l PRESCRIBING AND DISPENSING INFORMATION AS Saliva
Orthana ® lozenges do not contain fluoride.
AS Saliva Orthana lozenges (A S Pharma Ltd)
30 lozenge(ACBS) . NHS indicative price = £3.50 . Drug Tariff (Part VIIIA
Gastric mucin (porcine) 3.5%, xylitol 2%, sodium fluoride
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