BNF for Children (BNFC) 2018-2019

CORTICOSTEROIDS›CORTICOSTEROID

COMBINATIONS WITH ANTI-INFECTIVES

Betamethasone with neomycin

The properties listed below are those particular to the

combination only. For the properties of the components

please consider, betamethasone p. 691 , neomycin sulfate

p. 690.

lINDICATIONS AND DOSE

Nasal infection

▶BY INTRANASAL ADMINISTRATION USING NASAL DROPS

▶Child:Apply 2 – 3 drops 2 – 3 times a day, to be applied

into each nostril

lINTERACTIONS→Appendix 1 : corticosteroids.neomycin

lLESS SUITABLE FOR PRESCRIBINGBetamethasone with

neomycin nasal-drops are less suitable for prescribing;

there is no evidence that topical anti-infective nasal

preparations have any therapeutic value in rhinitis or

sinusitis.

lMEDICINAL FORMS

There can be variation in the licensing of different medicines

containing the same drug.

Ear/eye/nose drops solution

EXCIPIENTS:May contain Benzalkonium chloride, disodium edetate

▶Betnesol-N(RPH Pharmaceuticals AB)

Betamethasone (as Betamethasone sodium phosphate) 1 mg per

1 ml, Neomycin sulfate 5 mg per 1 mlBetnesol-N ear/eye/nose

drops| 10 mlP£ 2. 39 DT = £ 2. 39

3 Nasal inflammation, nasal

polyps and rhinitis

Other drugs used for Nasal inflammation, nasal polyps

and rhinitisDesloratadine, p. 174 .Fexofenadine

hydrochloride, p. 175 .Ketotifen, p. 180 .Rupatadine, p. 177

ANTIHISTAMINES›NON-SEDATING

Azelastine hydrochloride

lINDICATIONS AND DOSE

Allergic rhinitis

▶BY INTRANASAL ADMINISTRATION

▶Child 6–17 years: 1 spray twice daily, to be administered

into each nostril

DOSE EQUIVALENCE AND CONVERSION

▶ 1 spray equivalent to 140 micrograms.

lINTERACTIONS→Appendix 1 : antihistamines, non-

sedating

lSIDE-EFFECTS

▶Common or very commonTaste bitter (if administered

incorrectly)

▶UncommonEpistaxis.nasal complaints

lMEDICINAL FORMS

There can be variation in the licensing of different medicines

containing the same drug.

Spray

▶Rhinolast(Meda Pharmaceuticals Ltd)

Azelastine hydrochloride 140 microgram per

1 actuationRhinolast 140 micrograms/dose nasal spray|

22 mlP£ 10. 50 DT = £ 10. 50

Combinations available:Fluticasone with azelastine,p. 700

ANTIMUSCARINICS

Ipratropium bromide 22-Jan-2018

lINDICATIONS AND DOSE

Rhinorrhoea associated with allergic and non-allergic

rhinitis

▶BY INTRANASAL ADMINISTRATION

▶Child 12–17 years: 2 sprays 2 – 3 times a day, dose to be

sprayed into each nostril

DOSE EQUIVALENCE AND CONVERSION

▶ 1 metered spray of nasal spray = 21 micrograms.

lCAUTIONSAvoid spraying near eyes.bladder outflow

obstruction.cysticfibrosis.susceptibility to angle-closure

glaucoma

lINTERACTIONS→Appendix 1 : ipratropium

lSIDE-EFFECTS

▶Common or very commonGastrointestinal motility disorder

.nasal complaints.throat complaints

▶UncommonCorneal oedema.eye disorders.eye pain.

respiratory disorders.vision disorders

lALLERGY AND CROSS-SENSITIVITYContra-indicated in

patients with hypersensitivity to atropine or its

derivatives.

lPREGNANCYManufacturer advises only use if potential

benefit outweighs the risk.

lBREAST FEEDINGNo information available—manufacturer

advises only use if potential benefit outweighs risk.

lPATIENT AND CARER ADVICEPatients or carers should be

counselled on appropriate administration technique and

warned against accidental contact with the eye (due to risk

of ocular complications).

Driving and skilled tasksManufacturer advises patients and

carers should be counselled on the effects on driving and

performance of skilled tasks—increased risk of dizziness

and vision disorders.

lMEDICINAL FORMS

There can be variation in the licensing of different medicines

containing the same drug.

Spray

EXCIPIENTS:May contain Benzalkonium chloride, disodium edetate

▶Rinatec(Boehringer Ingelheim Ltd)

Ipratropium bromide 21 microgram per 1 doseRinatec

21 micrograms/dose nasal spray| 180 doseP£ 6. 54 DT = £ 6. 54

CORTICOSTEROIDS

Corticosteroids (intranasal) f

IMPORTANT SAFETY INFORMATION

MHRA/CHM ADVICE: CORTICOSTEROIDS: RARE RISK OF CENTRAL

SEROUS CHORIORETINOPATHY WITH LOCAL AS WELL AS SYSTEMIC

ADMINISTRATION (AUGUST 2017)

Central serous chorioretinopathy is a retinal disorder

that has been linked to the systemic use of

corticosteroids. Recently, it has also been reported after

local administration of corticosteroids via inhaled and

intranasal, epidural, intra-articular, topical dermal, and

periocular routes. The MHRA recommends that patients

should be advised to report any blurred vision or other

visual disturbances with corticosteroid treatment given

by any route; consider referral to an ophthalmologist for

evaluation of possible causes if a patient presents with

vision problems.

lCAUTIONSAvoid after nasal surgery (until healing has

occurred).avoid in pulmonary tuberculosis.avoid in the

presence of untreated nasal infections.patients

698 Nasal inflammation, nasal polyps and rhinitis BNFC 2018 – 2019

Ear, nose and oropharynx

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