Therapeutic AreaFormulary ChoicesCost for 28
(unless otherwise stated)
Rationale for decision / comments
12.2 Drugs acting on the nose
Nasal AllergySymptoms of nasal allergy are usually controlled with nasal corticosteroids and / or oral antihistamines
Nasal steroids
First-line:
Beclometasone - suitable for self-care
Green cross

Fluticasone nasal spray is available as self care from pharmacies as Pirinase
50mcg/spray: £1.93 (200 dose unit)






Beclometasone nasal sprays are available OTC, unbranded versions at less than NHS prescription charge.
Do Not prescribe Beconase Hayfever or Beconase 180 dose preparations as these are significantly more expensive.


Patients can buy fluticasone nasal spray OTC
Second-line:Budesonide
as Rhinocort Aqua®
64mcg/spray: £3.49 (120 dose unit)
Fluticasone Furoate
as Avamys®
27.5mcg/spray: £6.44
(120 dose unit)
Note: Fluticasone propionate nasal sprays are non-formulary.
All patients currently prescribed Fluticasone propionate should be switched to Fluticasone furoate nasal spray Avamys® as significantly more cost-effective.

If necessary to use fluticasone propionate prescribe as brand Nasofan®.
Mometasone50mcg/spray: £2.31 (140 dose unit)
Triamcinolone55mcg/spray: £7.39 (120dose unit)
Dymista® (Fluticasone propionate/azelastine hydrochlor) is non formulary
AnticholinergicsIpratropium21mcg/spray: £6.54
(180 dose unit)
Use Ipratropium only if rhinorhoea is main problem.
Decolonisation of nasal MRSA MupirocinNasal ointment 2%: £4.24 (3g)For use in decolonisation of nasal MRSA, standard regime is tds nasal application for 5 days. Where there is clinical infection, nasal decolonisation treatment should be undertaken in addition to any systemic treatment given
Naseptin®
(Neomycin 0.5% /
Chlorhexidine 0.1%)
Nasal cream £2.24 (15g)Please refer to CCG Management of Infection Guidance MRSA decolonisation policy guide is page 17