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12.3 Oropharynx

First line drugs Second line drugs Specialist drugs Secondary care drugs

Traffic light status (TLS) explained:

  • Green: Routine prescribing within licensed indication
  • Amber 1: specialist recommendation followed by GP initiation and continuation
  • Amber 2: specialist or GP initiation in line with local guideline after 1st line failure followed by GP continuation
  • Amber 3: specialist initiation and stabilisation followed by GP continuation
  • Amber SCG: specialist initiation and stabilisation followed by GP continuation in line with an agreed shared care guideline
  • Red: Hospital or specialist prescribing only
  • Double Red: These medicines have been evaluated and rejected by MKPAG and are NOT approved for use within MK. They are not recommended for use because of lack of clinical effectiveness, cost effectiveness or safety

 

 

Dry mouth

Artificial Saliva Spray

  • Aerosol spray      

 

 

Biotene Oralbalance (Amber 1)

  • Dry mouth saliva replacement gel 50g

 

 

Oralieve Mouth Gel (Amber 1)

  • Gel 50ml

 

 

Pilocarpine  (Amber 2)

  • Tablets 5mg      

Notes:

  • When treating dry mouth it may be worthwhile to first consider non-pharmaceutical measures e.g. sugar free boiled sweets, pineapple chunks, ice cubes or frozen tonic water.
  • Glandosane® should be prescribed within ACBS guidelines to treat dry mouth as a result of receiving, or having undergone, radiotherapy, chemotherapy or sicca syndrome.
  • Pilocarpine tablets are indicated for the treatment of xerostomia following irradiation for head and neck cancer

 

 

Oral hygiene

Sodium chloride mouthwash may be used to relieve pain from traumatic ulceration. A simple sodium chloride mouthwash may be made by adding one to two teaspoonfuls of salt to a pint of freshly boiled and cooled water.

 

Chlorhexidine gluconate

  • Mouthwash 0.2%       

Notes: 

  • Should not be prescribed in Primary Care or at Discharge
  • Advise patient to purchase, unless prescription is for long-term regular use
  • Chlorhexidine may be used as an antiseptic to prevent secondary infection in mouth ulcers or following oral surgery. It can also prevent the formation of plaque.

 

Hexetidine

  • Mouthwash 0.1%

Notes: 

  • Should not be prescribed in Primary Care or at Discharge
  • Advise patient to purchase, unless prescription is for long-term regular use

 

 

Oral ulceration and inflammation

Benzydamine

  • Difflam oral rinse 0.15%
  • Difflam® spray 0.15%     

Notes:

  • Benzydamine is useful to treat discomfort in a variety of ulcerative conditions. It may cause stinging, often reduced by dilution with an equal volume of water.

 

Hydrocortisone

  • Buccal tablets 2.5mg      

Notes:

 

Carmellose sodium

  • Orabase® protective paste

Notes:

  • Orabase® is cheap and effective in providing mechanical protection of oral and perioral lesions.

 

Choline salicylate 

  • Bonjela Dental gel 8.714%   
  • For use in adults and children over 16 years only   

Notes: 

  • Should not be prescribed in Primary Care or at Discharge
  • Advise patient to purchase, unless prescription is for long-term regular use

 

Anti-Infectives

Nystatin

  • Oral suspension 100,000 units/mL      

Notes:

  • Due to the high sucrose content of nystatin suspension, 500mg/1mL, ensure that diabetic patients are aware of this.
  • Nystatin is the first line choice, however miconazole may be considered due to the differing formulations.       

 

Miconazole 

  • Oral gel - Sugar free 2%        

 

Notes:

Drug Safety Update 

MHRA Drug Safety Update: Miconazole (Daktarin) - over-the-counter oral gel contraindicated in patients taking warfarin (September 2017)

MHRA Drug Safety Update: Topical miconazole, including oral gel - reminder of potential for serious interactions with warfarin (June 2016)

 

 

 

 

 

 

Traffic light status (TLS) explained:

  • Green: Routine prescribing within licensed indication
  • Amber 1: specialist recommendation followed by GP initiation and continuation
  • Amber 2: specialist or GP initiation in line with local guideline after 1st line failure followed by GP continuation
  • Amber 3: specialist initiation and stabilisation followed by GP continuation
  • Amber SCG: specialist initiation and stabilisation followed by GP continuation in line with an agreed shared care guideline
  • Red: Hospital or specialist prescribing only
  • Double Red: These medicines have been evaluated and rejected by MKPAG and are NOT approved for use within MK. They are not recommended for use because of lack of clinical effectiveness, cost effectiveness or safety

 

 

 

Return to Chapter: 12. Ear, Nose and Oropharynx

Last updated by: Dupe Fagbenro on 13-03-2019 09:20