Doncaster & Bassetlaw Medicines Formulary Section 12.2.1: Drugs Used in Nasal Allergy Mometasone 50micrograms/spray nasal spray Beclometasone 50micrograms/spray nasal spray Fluticasone 400micrograms/dose nasal drops Fluticasone 27.5micrograms/spray nasal spray Fluticasone 50micrograms and Azelastine 137micrograms/spray (Dymista) nasal spray Section 12.2.3: Nasal Preparations for Infection Chlorhexidine 0.1% plus Neomycin 0.5% nasal cream (Naseptin) Nasal Carriage of Staphylococci Mupirocin 2% nasal ointment Approved by Drug and Therapeutics Committee: June 2019 Review Date: June 2022 Prescribing Guidance: Beclometasone nasal spray is available over the counter for a maximum period of use of three months. The combination product containing both azelastine and fluticasone should be reserved for those with persistent symptoms, in whom the combination of an oral antihistamine and an intra-nasal corticosteroid has been tried and found to be sufficiently ineffective. The oral antihistamine can then be stopped. It should not be used as a first-line therapy. Sodium chloride 0.9% solution used either as a nasal spray (or inhaled warm moist air) is also effective decongestants. Sterimar is one such commercial preparation which may be prescribed post-operatively. Patients should be made aware (prior to discharge from secondary care) that products for short term aliments that are available over the counter e.g. steroid or saline nasal sprays, or antihistamine tables are unlikely to be continued by their GP practice once discharged. They will need to purchase these from a shop or pharmacy in line with national self-care guidance. Mupirocin nasal ointment is used for eradication of nasal carriage of MRSA, and should be reserved for this indication. It should be applied to both nostrils three times daily for 5 days. KEY: [UL] Unlicensed Preparation; Drug – first line choice; Drug – hospital only; Drug – Amber (TLS), Drug – Red (TLS), see http://medicinesmanagement.doncasterccg.nhs.uk/traffic- light-system/ .