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] | |
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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. |
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RED Dequadin® lozenges |
12.3.4 Mouth-washes, gargles, and dentifrices
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. (see ELHT Mouth Care Policy May 2003) |
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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 |
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