Drugs Acting on the Oropharynx

NHSL Medicines Guidance
NHS Lanarkshire

Drugs for Oral Ulceration and Inflammation

Preferred list (P)

BENZYDAMINE HYDROCHLORIDE

  • Benzydamine mouthwash can be used 10 minutes before meals to relieve pain in patients suffering from aphthous ulcers.

 

Total list (T)

HYDROCORTISONE muco-adhesive buccal tablets

Prescribing Notes:

  • It is important to consider possible underlying diagnosis.
  • Advise the patient to avoid trigger factors (e.g. oral trauma and certain foods/drinks).
  • A simple saline mouthwash may provide relief from pain and inflammation. It could be considered where pain is mild and there is low risk of secondary infection. Saline solutions can be made by dissolving half a teaspoon of salt in a glass of warm water and using as a mouthwash.
  • Please see Scottish Palliative Care Guidelines for information on mouth care in adult patients with life limiting illness.

Oropharyngeal Anti-Infective Drugs

Preferred list (P)

MICONAZOLE 20mg/mL oral gel

  • Miconazole gel is absorbed systemically and contraindicated in patients taking anticoagulants e.g. warfarin.

  • Ensure full medication history taken to avoid use with other contraindicated medicines.

 

Total list (T)

NYSTATIN 100,000IU/mL suspension

  • For use if miconazole is contraindicated or not tolerated.

  • Nystatin is not absorbed from the gastro-intestinal tract.

FLUCONAZOLE

  • Indication: extensive/severe oral candidiasis.

  • 100mg daily should be considered for patients who have HIV infection or immunosuppression.

Prescribing Notes:

  • Oral candidiasis is uncommon in healthy adults.
  • Consideration should be given to potential underlying causes e.g. steroid inhalers, poor oral hygiene/denture care, broad spectrum antibacterials, diabetes, HIV infection, cytotoxic drugs, leukaemia and other malignancies.
  • These recommendations are in line with the NHS Lanarkshire Antimicrobial Guidelines in Adult Primary Care - ORAL CANDIDIASIS

Mouthwashes, Gargles and Dentifrices

Preferred list (P)

SALINE MOUTHWASH

  • Saline solutions can be made by dissolving half a teaspoon of salt in a glass of warm water and using as a mouthwash.

CHLORHEXIDINE GLUCONATE

  • Do not use within 30 minutes of brushing teeth.

  • May be a useful adjunct to other oral hygiene measures for oral infection or when tooth brushing is not possible.

Treatment of Dry Mouth

Preferred list (P)

ORALIEVE® moisturising mouth gel

  • Saliva replacement product

  • Indication: For symptomatic treatment of dry mouth (contains traces of milk protein and egg white protein).

 

Total list (T)

SALIVEZE® oral spray

  • Saliva replacement and stimulating product.

  • Indication: For symptomatic treatment of dry mouth as a result of having undergone radiotherapy or sicca syndrome.

Prescribing Notes:

  • Dry mouth can be relieved in many patients by simple measures such as frequent sips of cool drinks and sucking pieces of ice or sugar-free pastilles.
  • Please see Scottish Palliative Care Guidelines for information on mouth care in adult patients with life limiting illness.

NHSL Joint Adult Formulary Key

To indicate the category of a formulary medicine, updated sections adopt the following key:

Preferred list (P): First-line formulary choices.

Total list (T): Alternative choices when preferred list options not effective/not tolerated, or not indicated.

Specialist initiation (S1): Specialist initiation, or on the advice of a Consultant or Specialist Practitioner in this therapeutic area. Continuation in primary care is acceptable.

Specialist use only (S2): Supply via hospital, Homecare Service or a hospital based prescription (HBP) for dispensing by community pharmacy. Not prescribed in primary care setting.

Editorial Information

Last reviewed: 31/01/2022

Next review date: 31/01/2025

Author(s): NHSL.

Version: Please refer to the introduction section for an explanation of the review dates above.

Approved By: ADTC

Reviewer name(s): ADTC.