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Birmingham, Sandwell, Solihull and environs APC Formulary
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 Formulary Chapter 12: Ear, nose and oropharynx - Full Chapter
Notes:
 
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12.02.01  Expand sub section  Drugs used in nasal allergy
Azelastine and fluticasone (Dymista)
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Formulary
Green
  • Third line option for adults and children over 12 years with moderate to severe allergic rhinitis who have failed to respond to a steroid nasal spray with the addition of an oral antihistamine.

    Follow treatment algorithm
     
  • Link  BSSE APC: Allergic Rhinitis Treatment Pathway
       
    12.02.01  Expand sub section  Antihistamines
    12.02.01  Expand sub section  Corticosteroids
    Beclometasone Dipropionate nasal preparations
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    First Choice
    Green
     
    Mometasone Furoate nasal spray
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    Second Choice
    Green
     
    Link  Primary care antimicrobial guidelines
       
    Betamethasone Sodium Phosphate nasal preparations
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    Formulary
    Green
     
       
    Fluticasone furoate (Avamys®)
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    Formulary
    Green
  • previous APC decision reviewed in December 2015.
  • Approved for use in children and adults. 
  •    
    Fluticasone Propionate (Flixonase Nasule®)
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    Formulary
    Amber Initiation
    • Specialist Recommendations for Nasal Polyps.
     
       
    12.02.01  Expand sub section  Cromoglicate
     ....
     Non Formulary Items
    Azelastine Hydrochloride  (Rhinolast®)

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    Non Formulary
     
    Budesonide

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    Non Formulary
    Black
     
    Budesonide  (Rhinocort Aqua®)

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    Non Formulary
    Black
     
    Flunisolide  (Syntaris®)

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    Non Formulary
     
    Fluticasone Propionate Aqueous Nasal spray  (Flixonase®)

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    Non Formulary
    Black
     
    Fluticasone Propionate Aqueous Nasal spray  (Nasofan®)

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    Non Formulary
    Black
     
    Sodium Cromoglicate  (Rynacrom®)

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    Non Formulary
     
    Sodium Cromoglicate  (Vividrin®)

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    Non Formulary
     
    Triamcinolone Acetonide  (Nasacort®)

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    Non Formulary
     
      
    Key
    note Notes
    Section Title Section Title (top level)
    Section Title Section Title (sub level)
    First Choice Item First Choice item
    Non Formulary Item Non Formulary section
    Restricted Drug
    Restricted Drug
    Unlicensed Drug
    Unlicensed
    Track Changes
    Display tracking information
    click to search medicines.org.uk
    Link to adult BNF
    click to search medicines.org.uk
    Link to children's BNF
    click to search medicines.org.uk
    Link to SPCs
    Cytotoxic Drug
    Cytotoxic Drug
    CD
    Controlled Drug
    High Cost Medicine
    High Cost Medicine
    Cancer Drugs Fund
    Cancer Drugs Fund
    NHSE
    NHS England
    Homecare
    Homecare
    CCG
    CCG

    Traffic Light Status Information

    Status Description

    Prescribing in children

    The APC notes that the informed use of unlicensed medicines or of licensed medicines for unlicensed applications (‘off-label’ use) is often necessary in paediatric practice.

    The APC advises GPs to consider specialist prescribing recommendations for Green and Amber medicines that are not subject to ESCAs or RICaDs in combination with the information provided in the BNFC which goes beyond that of marketing authorisations. The BNFC has been designed for rapid reference and the information presented has been carefully selected to aid decisions on prescribing.
      

    Green

    Medicines suitable for routine use within primary care. Initiation and maintenance of prescribing by Specialists, GPs and other qualified clinicians.   

    Amber Initiation

    Amber Specialist Initiation: Initiation and maintenance of prescribing by Specialists and transfer to Primary Care prescribing when appropriate. This may be supported by a RICaD, annotated within the formulary entry.  

    Amber Recommended

    Amber Specialist Recommendation: Initiation and maintenance of prescribing in Primary Care following recommendation from a Specialist.  

    Amber SC

    Amber Shared Care: Initiation and maintenance of prescribing by Specialists and transfer to Primary Care prescribing, in accordance with an ESCA, annotated within the formulary entry.  

    Red

    Medicines for initiation and maintenance prescribing by Specialists only.  

    Black

    Non-formulary Medicines which APC/Trust DTC has actively reviewed and do not recommend for use.  

    Grey

    Positive NICE TA and/or awaiting local clarification on place in therapy; Please contact your Medicines Optimisation team for more information.  

    The term 'Specialist' refers to Consultants, General Practitioners and Independant Prescribers with a Specialist Interest.  

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