12.3 DRUGS ACTING ON THE OROPHARNYNX

12.3 Drugs acting on the oropharnynx

12.3.1 Drugs for oral ulceration and inflammation

Oral ulceration may be treated with corticosteroids.

New advice on oral salicylate gels in under 16s from the MHRA

The main products affected are Bonjela® and Bonjela® Cool Mint Gel.

The new advice recommends that these products should not be used in those under 16 years of age. This is due to salicylate salts

having the same effect on the body as aspirin which is already contraindicated in children and young people under 16 years of

age.

GREEN Bonjela® oral gel

GREEN Hydrocortisone pellets 2.5mg

AMBER Gelclair® - only for acute chemotherapy/radiation induced mucositis

AMBER Betamethasone 500 microgram soluble tablets

This product is used in oral surgery practice only: dissolved in water and used as a mouthwash

Treatment of inflammatory conditions

GREEN Benzydamine oral rinse 0.15%, spray 0.15% [Consider OTC/Self care]

12.3.2 Oropharyngeal anti-infective drugs

The most common cause of a sore throat is a viral infection which will not benefit from anti-infective treatment.

Chlorhexidine mouthwash renders nystatin ineffective, therefore wait 15-30 minutes before applying nystatin.

Fungal infections

First line:

GREEN Fluconazole* 50mg (capsules) orally once daily

Course duration 7 days

*Fluconazole has clinically significant interactions with other medicines - check these before prescribing*

Second line or for infants under 4 months or patients taking warfarin:

GREEN Nystatin

suspension 100,000 units/mlL

pastilles 100,000 units

[adult dose: 4mL every 6 hours for 7 days]

12.3.3 Lozenges and sprays

There is no convincing evidence that antiseptic lozenges have a beneficial action and they sometimes irritate and cause

sore tongue and sore lips. Some of these preparations also contain local anaesthetics which relieve pain but may cause

sensitisation. The following products are stocked within the hospitals for symptom relief only but are not generally

recommended for prescribing.

RED Dequadin® lozenges

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12.3.4 Mouth-washes, gargles and dentrifrices

For use if a patient has, or is at risk of, an oral infection. Chlorhexidine inhibits the formation of plaque and may be

useful when tooth-brushing is not possible.

GREEN Chlorhexidine mouth wash 0.2%

GREEN Chlorhexidine oral gel 1%

12.3.5 Treatment of dry mouth

Endorse prescription with ‘ACBS’ – patients suffering from dry mouth as a result of having (or having undergone) radiotherapy, or sicca syndrome, apply to gums and tongue as required.

GREEN Glandosane® synthetic saliva spray

(acidic pH – try to avoid for patients with their own teeth in situ)

GREEN Biotene Oralbalance® - saliva replacement gel

(pH neutral when used in vivo)

GREEN Saliveze® synthetic saliva spray

(pH neutral)

AMBER Pilocarpine 4% eye drops - Unlicensed use *

AMBER BioXtra® saliva replacement gel

{for use as additional saliva replacement gel in patients who have had radiotherapy to oral cavity)

AMBER Oralieve® Moisturising Mouth Spray [palliative care use only]

* refer to Lancashire ad South Cumbria Specialist Palliative Care Prescribing

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All material in this section is aimed at health care professionals, but is information currently held in the public domain,

members of the public seeking advice on medicine-related matters are advised to speak with their GP,

pharmacist, nurse or contact NHS111 Service

Email: info.elmmb@nhs.net