Common ENT Medications

 

Otitis Externa Ear Drops

Cerumolytics

Topical Decongestants

Intranasal Saline

Topical Corticosteroids

Non-Sedating Antihistamines

Cough preparations

Vertigo

Oral Aphthous Ulcers

Analgesia / Antipyretics

Opiates

 

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Otitis Externa Ear Drops

 

Garosone / Gentisone HC (antibacterial + mild steroid)

Gentamycin, Hydrocortisone

          2-4 drops, 3-4 times daily

 

Cipro HC Otic (antibacterial + mild steroid)

          Ciprofloxacin, Hydrocortisone

          2-3 drops, 3 times daily

         

Sofradex (recently removed from BNF)

          Dexamethasone, Framycetin, Gramicidin

          2-3 drops, 3-4 times daily

 

Quadriderm cream (two antifungals, antibacterial + mild steroid)

          Betamethasone, Gentamicin, Tolnaftate, Clioquinol

Tip of finger, once daily x 5 days

 

Canesten Ear drops / Skin Lotion (antifungal)

          Clotrimazole

          2 drops, 3 times daily

 

Tinaderm

          Tolnaftate

          3 drops TDS x 5 days

 

Locacorten Vioform (antibacterial, antifungal + strong steroid)

          Flumetasone, Clioquinol

          2-3 drops BD up to 7 days

 

Otosporin

          Hydrocortisone, Neomycin

          3 drops, 3 times daily

 

AVOID use of proprietary drops in PREGNANCY, especially if patient is concerned – in otitis externa, best to use Acetic Acid (Vinegar) which is safe in pregnancy.

 

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Cerumolytics

 

Audiclean / Otomer (Sterile Saline solution spray)

·        Spray for 1 second to instil the solution in the ear

·        Gently massage the base of the ear for 10 seconds and leave the solution in the ear for about 10 minutes to take effect

·        Spray a second time to evacuate the dissolved cerumen

·        Wipe with a clean towel or tissue

 

Cerumol / Tropex

2 drops, 3 times daily for 5-7 days, review at ENT O/P for suction clearance / syringing.

 

Molcer (Docusate Sodium)

          Adults: lie on side with affected ear uppermost. Fill ear with solution and remain in position for a few minutes. Place a small plug of cotton wool in the ear before rising and leave the plug in until the next treatment. Do this for 2 – 3 nights and the wax will soften and be easily removed.

 

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Topical Decongestants

 

Balkis Nasal Drops

          < 6 yrs                  Balkis Paediatric Nose Drops

                             1 – 2 drops / nostil B.D x 5 – 7 days

          > 6 yrs                  Balkis Nose Drops

                             2 – 3 drops / nostil B.D – TDS x 5 – 7 days

 

Nasen K / Nasen E

          1 puff / nostril B.D – TDS x 5 – 7 days

 

Otrivine Nose Drops (Xylometazoline hydrochloride)

          < 6 yrs                  Otrivine Paediatric Nose Drops

                             1 – 2 drops / nostil B.D x 5 – 7 days

          > 6 yrs                  Otrivine Nose Drops

                             2 – 3 drops / nostil B.D – TDS x 5 – 7 days

 

Vibrocil Nasal Gel (Dimetindene maleate + phenylephrine)

> 6 yrs                  tip of finger deep into nose BD - TDS

 

 

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Intranasal Saline

 

Ocean Spray / Sterimar (isotonic saline solution)

< 2 yrs 1 spray / nostril several times a day

> 2 yrs 1 – 2 sprays / nostril several times a day

 

In very young babies, may use a small syringe (w/out needle) to directly instil regular saline for injection into the nose to help clear thick secretions

 

Tonimer Nose Gel (seaweed extract)

Nasal cracking and intense dryness, rhinitis and adverse environmental conditions such as presence of smoke, artificial air, chill and atrophy due to drugs.

Active ingredients of marine origin (Seaweed extract), Hyaluronic acid, Panthenol and Vitamin E Acetate provide high moisturizing power and are effective in restoring and keeping the correct moisturizing level of the nasal mucosa for a long period.

 

 

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Topical Corticosteroids (up to 3 months at a time)

 

Rhinocort / Aircort (Budesonide)

Prophylaxis and treatment of allergic and vasomotor rhinitis and nasal polyps

 

Over 12 yrs                    1 – 2 puffs / nostil once daily (100 – 200 micrograms)

 

Flixonase (Fluticasone)

Over 12 yrs          2 puffs / nostil 1 to 2 daily (100 – 200 micrograms)

4 – 11 yrs             1 puff / nostril once daily (50 micrograms)

 

 

Dexa-Rhinaspray Duo (Dexamethasone + Sympathomimetic)

Often used together with Cirrus for treatment of Eustacian tube dysfunction

Do not use for longer than 14 days

 

Over 12 yrs          1puff / nostril 2 to 3 daily

6 – 11yrs              1 puff / nostril 1 to 2 daily

 

 

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Non-Sedating Antihistamines

 

Cetirizine (Zyrtec) / Levocetirizine (Xyzal)

 

Syrup: 5mg/5ml (Zyrtec)

Tabs: 5mg (Xyzal)

          6mths – 2yrs         0.25mg/kg B.D.

          2 – 6yrs                2.5ml B.D   or      5ml dly (Zyrtec)

          > 6yrs                   5ml B.D.     or      5mg tab daily (Xyzal)

 

Cetirizine + Pseudoephedrine (Cirrus)

 

5mg tabs

Antihistamine + Decongestant

Max 2 – 3 weeks, Age 12 & older

 

Dose: 1 tab B.D. x 1 – 2 weeks

 

Fexofenadine (Telfast)

Adults > 12yrs – 120mg daily up to 180mg once daily

 

Loratadine (Claritine) – long-acting antihistamine

 

Syrup: 5mg/5ml

Tabs: 10mg

 

Weight < 30kg      5mg dly

Weight > 30kg      10mg dly

 

Promethazine (Phenergan) – sedating antihistamine available in hospital

 

Syrup: 5mg/5ml

Tabs: 10mg, 25mg

 

4 weeks – 1 yr

2.5mg B.D.

Or

2.5 – 5mg dly

1 – 5yrs

5mg B.D.

Or

5 – 10mg dly

6 – 10yrs

5 – 10mg B.D.

Or

10 – 20mg dly

> 10yrs

10 – 20mg B.D. – TDS

Or

25mg dly

 

 

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Cough preparations

 

Actifed (antihistamine + pseudoephedrine)

Green: mucolytic + expectorant + decongestant

Red: cough suppressant(codeine) + decongestant

Yellow: decongestant

 

6 months – 2 yrs   1.25mls TDS

2 yrs – 5 yrs                   2.5mls TDS

6 yrs – 12 yrs                 5mls TDS

 

 

Rhinathiol (Carbocysteine)

          or

Rhinathiol Promethazine (Carbocysteine + Antihistamine)

1 – 3yrs                5mls BD – TDS

3 – 12yrs    5mls TDS – QDS

>12 yrs                 10mls TDS

 

 

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Vertigo

 

Prochlorperazine (Stemetil)

 

Tabs:          Acute attack 20mg initially, then 10mg after 2hrs

          Prevention 5 – 10mg, BD – TDS

(Children 2.5 - 5mg BD – TDS)

 

IM: 12.5mg 8hrly PRN

 

Duxil (Almitrine bismesylate, raubasine)

 

Auditory, vestibular, and visual disorders of ischemic aetiology.

To be used by specialists only

1 – 2 tabs daily

 

Betaserc (Betahistine)

Reduces endolymphatic pressure by improving the microcirculation.

Licences for Vertigo, Tinnitus and hearing loss associated with Meniere’s disease

Dose: 16mg TDS

 

 

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Oral Aphthous Ulcers

 

Bonjela mouth ulcer gel

Dose: topical over ulcers, 4hrly PRN

 

AD-MUC gel

Dose: topical over ulcers, 4hrly PRN

 

 

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Analgesia / Antipyretics

 

Paracetamol

 

Suppositories       : 100mg, 200mg, 350mg, 500mg (Tylenol)

                   : 125mg, 250mg, 500mg (Arfen)

Syrup: 125mg/5ml (Calpol), 250mg/5ml (Calpol 6+)

 

Oral Route

·        10 – 15mg/kg every 4 – 6 hrs

·        maximum dose per day: < 3 months            60mg/kg

3 mths – 12yrs               80mg/kg     

> 12 years            4g / day

Rectal Route

·        20mg/kg every 4 – 6 hrs

·        maximum dose per day: <1 month              60mg/kg

                                      >1 month              90mg/kg up to 4g

 

 

Diclofenac Sodium (Voltaren) / Diclofenac Potassium (Cataflam)

 

Add diclofenac over and above regular paracetamol if fever is not adequately controlled (i.e. T > 102F OR 39C before next paracetamol dose is due.)

Contraindicated in Asthmatics, Peptic ulcer and Warfarin. (Avoid in elderly)

 

·        0.5 – 1mg/kg 2 – 3 times a day

·        maximum of 3mg/kg/day

·        adults 150mg/day (50mg PO TDS)

 

Do NOT use below 1 year of age

Suppositories: 12.5mg, 25mg, 50mg, 100mg (Voltaren)

Coated Tablets: 25mg, 50mg (Voltaren / Cataflam)

Drops: 0.5mg/drop (Cataflam) (approx 1 drop/kg TDS)

IM: 75mg IM STAT (Adults)

 

 

Co-Proxamol (Distalgesic)

 

May be given INSTEAD of Paracetamol, together with Votaren in severe pain, or when Voltaren contraindicated.

Two tabs 6hrly PRN (Adults only)

 

 

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Opiates

 

With all opiates, avoid in hypotension, head injury, confusion, respiratory disease and chronic liver failure.

Always administer together with Metoclopramide (Maxalon) IV or IM.

 

Pethidine

 

Always check Blood Pressure, lie patient down.

 

IM: 1mg/kg 8hrly PRN (Adults)

May give initial dose half IV + half IM if severe acute pain

 

Morphine

 

 (mix vial with 10cc of Saline, 1cc = 1mg morphia, label syringe with dose and patient’s name, and keep with you until used or disposed down drain)

 

IV: 1 – 10mg STAT, titrated according to response, 1mg every minute by doctor

 

 

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