Indications And Dose
Softening and removal of earwax ▶TO THE EAR ▶Adult: (consult product literature)
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Drug reference
Softening and removal of earwax ▶TO THE EAR ▶Adult: (consult product literature)
PDF page 1287
There can be variation in the licensing of different medicines containing the same drug. Ear drops ▶Exterol (Dermal Laboratories Ltd) Urea hydrogen peroxide 50 mg per 1 gram Exterol 5% ear drops | 8 ml p £1.75 DT = £2.89 ▶Otex (Dendron Ltd) Urea hydrogen peroxide 50 mg per 1 gram Otex 5% ear drops | 8 ml p £2.89 DT = £2.89 Nose Nose Rhinitis Rhinitis may be acute or chronic, allergic or non-allergic. Nasal spray and drop preparations often carry indications for the management of allergic rhinitis and perennial rhinitis. Many nasal preparations contain sympathomimetic drugs which may irritate the nasal mucosa. Drugs used in nasal allergy g Sodium chloride 0.9% solution p. 1101 may be used as nasal irrigation in allergic rhinitis for modest symptom reduction, and to reduce the need for other drug treatment. Mild allergic rhinitis is controlled by antihistamines (see under Antihistamines, allergen immunotherapy and allergic emergencies p. 291) or topical nasal corticosteroids. Topical antihistamines (e.g. azelastine hydrochloride p. 1269) are faster acting than oral antihistamines and therefore useful for controlling breakthrough symptoms in allergic rhinitis; they are less effective than topical nasal corticosteroids. Topical nasal decongestants can be used for a short period to provide quick relief from congestion and allow penetration of a topical nasal corticosteroid. Systemic nasal decongestants are weakly effective in reducing nasal obstruction but have considerable potential for side-effects, and therefore are not recommended. Sodium cromoglicate is a weakly effective alternative in patients with mild symptoms, sporadic seasonal problems, or limited allergen exposure. Moderate to severe allergic rhinitis can be relieved by topical nasal corticosteroids during periods of allergen exposure. Severe allergic rhinitis causing very disabling symptoms despite conventional treatment may justify the use of oral corticosteroids for short periods. In severe cases, oral corticosteroids may also be used in combination with nasal corticosteroids during treatment initiation to relieve severe mucosal oedema and allow the spray to penetrate the nasal cavity. Nasal ipratropium bromide p. 1269 may be added to allergic rhinitis treatment when watery rhinorrhoea persists despite treatment with topical nasal corticosteroids and antihistamines; it has no effect on other nasal symptoms. In seasonal allergic rhinitis (e.g. hay fever), treatment should begin 2 to 3 weeks before the season commences Ear, nose and oropharynx and/or exposure to the allergen. Montelukast p. 284 is less effective than topical nasal corticosteroids but can be used in patients with seasonal allergic rhinitis and concomitant asthma. h Corticosteroids g Topical nasal corticosteroid preparations should be avoided in the presence of untreated nasal infections, after nasal surgery (until healing has occurred), and in pulmonary tuberculosis. Systemic absorption may follow nasal administration particularly if high doses are used or if treatment is prolonged. The extent of absorption varies between steroids; mometasone furoate p. 1272 and fluticasone p. 1271 have negligible systemic absorption, others have modest absorption, whilst betamethasone p. 1270 has high systemic absorption and should only be used short-term. The growth of children receiving treatment with corticosteroids should be monitored; especially in those receiving corticosteroids via multiple routes. h Nasal polyps g Patients presenting with nasal polyps should initially be reviewed by an ear, nose and throat specialist. Nasal polyps may be treated with topical nasal corticosteroids (drops or spray). There may be a higher risk of side-effects with use of nasal drops compared to nasal spray due to greater systemic absorption and incorrect administration of drops. To reduce the risk, the drops must be administered with the patient in the ’head down’ position. A short course of a systemic corticosteroid can provide symptomatic relief but effects may be temporary and its use is rare due to concerns of systemic side-effects. If systemic corticosteroids are given, they should be used in combination with topical nasal corticosteroids. h Pregnancy g If a pregnant woman cannot tolerate the symptoms of allergic rhinitis, treatment may be given. h Although the safety of nasal corticosteroids in pregnancy has not been established through clinical trials, only minimal amounts of nasal corticosteroids are systemically absorbed. Beclometasone dipropionate p. 1270, budesonide p. 1271, and fluticasone are widely used in asthmatic pregnant women; fluticasone has the lowest systemic absorption when used intra-nasally. g Decongestants are not recommended however, some antihistamines and sodium cromoglicate may be used. h Topical nasal decongestants The nasal mucosa is sensitive to changes in atmospheric temperature and humidity and these alone may cause slight nasal congestion. g Sodium chloride 0.9% given as nasal drops, spray, or irrigation may relieve nasal congestion. Steam inhalation may help to relieve congestion but care should be taken to avoid scalding (see under Aromatic inhalations, cough preparations and systemic nasal decongestants p. 311). Symptoms of nasal congestion associated with allergic rhinitis, the common cold, and sinusitis may be relieved by the short-term use (usually not longer than 7 days) of decongestant nasal drops and sprays. h These all contain sympathomimetic drugs which exert their effect by vasoconstriction of the mucosal blood vessels which in turn reduces oedema of the nasal mucosa. Their use, especially with longer durations, can give rise to rebound congestion (rhinitis medicamentosa) on withdrawal, due to a secondary vasodilatation with a subsequent temporary increase in nasal congestion. This in turn tempts the further use of the decongestant, leading to a vicious cycle of events; tolerance with reduced effect may also be seen with excessive use. g Non-allergic watery rhinorrhoea often responds to treatment with nasal antimuscarinic ipratropium bromide. h Nasal preparations for infection Nasal staphylococci g Elimination of organisms such as staphylococci from the nasal vestibule can be achieved by the use of antimicrobial preparations such as chlorhexidine with neomycin cream (Naseptin ®) p. 1268. A nasal ointment containing mupirocin p. 1269 is available if Naseptin ® is unsuitable or ineffective. In hospitals or in care establishments, mupirocin nasal ointment can be used for the eradication of nasal carriage of meticillin-resistant Staphylococcus aureus (MRSA). h For information on eradication of MRSA, consult local infection control policy. See also management of MRSA p. 612. Nasal congestion SYMPATHOMIMETICS › VASOCONSTRICTOR
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The patient should lie with the affected ear uppermost for 5 to 10 minutes after a generous amount of the softening remedy has been introduced into the ear. l LESS SUITABLE FOR PRESCRIBING Urea-hydrogen peroxide ear drops are less suitable for prescribing.
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(consult product literature)
First-line fragment. Read the complete Indications and Dose section above.
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