BNF for Children 2011-2012

BNFC 2011–2012 12.2.1 Drugs used in nasal allergy 539AntihistaminesAZELASTINE HYDROCHLORIDESide-effects irritation of nasal mucosa; bitter taste (ifapplied incorrectly)Indication and doseTreatment of allergic rhinitis for dose, see underpreparationRhinolast c (Meda) ANasal spray, azelastine hydrochloride 140 micrograms(0.14 mL)/metered spray. Net price 22 mL(157-spray unit with metered pump) = £10.45Excipients include sodium edetateDoseChild 5–18 years apply 140 micrograms (1 spray) intoeach nostril twice dailyNote Preparations of azelastine hydrochloride can be sold tothe public for nasal administration in aqueous form (otherthan by aerosol) for the treatment of seasonal allergic rhinitisor perennial allergic rhinitis in children over 5 years, subjectto max. single dose of 140 micrograms per nostril, max. dailydose of 280 micrograms per nostril, and a pack size limit of36 dosesCorticosteroidsNasal preparations containing corticosteroids have auseful role in the prophylaxis and treatment of allergicrhinitis (see notes above). They are also used for thesymptomatic treatment of adenoidal hypertrophy.Cautions Corticosteroid nasal preparations should beavoided in the presence of untreated nasal infections,and also after nasal surgery (until healing has occurred);they should also be avoided in pulmonary tuberculosis.Systemic absorption may follow nasal administrationparticularly if high doses are used or if treatment isprolonged; for cautions and side-effects of systemiccorticosteroids, see section 6.3.2. The risk of systemiceffects may be greater with nasal drops than with nasalsprays; drops are administered incorrectly more oftenthan sprays. The height of children receiving prolongedtreatment with nasal corticosteroids should be monitored;if growth is slowed, referral to a paediatricianshould be considered.Side-effects Local side-effects include dryness, irritationof nose and throat, and epistaxis. Nasal ulcerationhas been reported, and occurs commonly with nasalpreparations containing fluticasone furoate or mometasonefuroate. Nasal septal perforation (usually followingnasal surgery) occurs very rarely. Raised intra-ocularpressure or glaucoma may occur rarely. Headache,smell and taste disturbances may also occur. Hyperactivity,sleep disturbances, anxiety, depression, andaggression have been reported. Hypersensitivity reactions,including bronchospasm, have also been reported.BECLOMETASONE DIPROPIONATE(Beclomethasone Dipropionate)Cautions see notes aboveSide-effects see notes aboveIndication and doseProphylaxis and treatment of allergic andvasomotor rhinitisChild 6–18 years apply 100 micrograms (2sprays) into each nostril twice daily; max. total400 micrograms (8 sprays) daily; when symptomscontrolled, dose reduced to 50 micrograms (1spray) into each nostril twice dailyBeclometasone (Non-proprietary) ANasal spray, beclometasone dipropionate 50 micrograms/meteredspray. Net price 200-spray unit =£2.52Brands include Nasobec Aqueous cBeconase c (A&H) ANasal spray (aqueous suspension), beclometasonedipropionate 50 micrograms/metered spray. Net price200-spray unit with applicator = £2.19Excipients include benzalkonium chloride, polysorbate 80BETAMETHASONE SODIUMPHOSPHATECautions see notes aboveSide-effects see notes aboveLicensed use licensed for use in children (age rangenot specified by manufacturer)Indication and doseNon-infected inflammatory conditions of nosefor dose, see under preparationsEye section 11.4.1Ear section 12.1.1Betnesol c (UCB Pharma) ADrops (for ear, eye, or nose), betamethasone sodiumphosphate 0.1%, net price 10 mL = £2.23Excipients include benzalkonium chloride, disodium edetateDosenose, instil 2–3 drops into each nostril 2–3 times dailyVistamethasone c (Martindale) ADrops (for ear, eye, or nose), betamethasone sodiumphosphate 0.1%. Net price 5 mL = £1.02, 10 mL =£1.16Excipients include benzalkonium chloride, disodium edetateDosenose, instil 2–3 drops into each nostril twice dailyBUDESONIDECautions see notes above; interactions: Appendix 1(corticosteroids)Side-effects see notes aboveIndication and doseSee under preparations12 Ear, nose, and oropharynx