13.0 EAR AND NOSE PRODUCTS

ACETIC ACID

Dosage Form: Ear drops [P] 1 %

Recommended Dose: 4-6 drops in the affected ear every 2-3 hours.

Indications: Treatment of external otitis and prevention of Swimmer’s Ear.

BECLOMETHASONE DIPROPIONATE

Dosage Form: Nasal spray 50 mcg/dose (££,I)

Recommended Dose: Nasal inhalation: One puff into each nostril three times daily with a maximum of: 20 puffs daily for adults and 10 puffs daily for paediatrics. Oral inhalation: Adult: 2 puffs, 3-4 times a day. Severe case: Initial dose may be doubled. On improvement, dosage adjusted according to response. Child: 1-2 puffs, 3-4 times a day.

Indications: Allergic rhinitis, vasomotor rhinitis, nasal polyps, bronchial asthma, chronic obstructive bronchitis.

Contra-Indications: Untreated nasal infection, haemorrhagic-diathesis or history of recurrent nasal bleeding. Hypersensitivity to beclomethasone and first trimester of pregnancy.

Special Precautions: If infection of respiratory tract, nassal passages or paranasal sinuses occurs during treatment, antibacterial therapy should be promptly instituted.

BENZOIN, STORAX MENTHOL WITH EUCALYPTUS OIL INHALATION [Tincture Benzoin Co]

Dosage Form: Tincture for inhalation (£,II)

Recommended Dose: As directed for local use.

Indications: As an inhalation in brochitis and acute laryngitis.

CHLORAMPHENICOL

Dosage Form: Ear drop 5% (II)

Recommended Dose: 2-3 drops tds-qid.

Indications: Bacterial infection in otitis externa.

Special Precautions: Caution in presence of perforations of the tympanic membrane. Avoid prolonged use.

DESMOPRESSIN ACETATE

Dosage Form: Nasal drops 0.1 mg/ml (S/R); Nasal spray 10 mcg/metered spray (££,I)

Recommended Dose: 10-20 mcg daily or bd. Child: 5-10 mcg daily or bd. To be instilled intranasally using a graduated plastic tube filled from a bottle.

Indications: Diagnosis and treatment of cranial diabetes insipidus.

Special Precautions: Should not be administered to dehydrated or overhydrated patients until water balance is adequately restored; in presence of nasal infection or rhinorrhoea.

EPHEDRINE

Dosage Form: Nasal drops [P] 0.5% (£,II)

Recommended Dose: 2 drops tds. Max use for 1 week.

Indications: Nasal decongestion.

Special Precautions: Avoid excessive use, caution in infants under 3 months.

FUSAFUNGINE

Dosage Form: Nasal spray 1% (£££,I)

Recommended Dose: With nasal adapter: 4 metered doses in each nostril 4 times a day. With oral adapter: 4 metered doses 4 times a day. Child above 2 yrs: according to age.

Indications: Rhinitis, rhinopharyngitis, sinusitis, sore throat, tonsilitis, bronchitis, respiratory complications of influenza and pre and post instrumental investigations.

Special Precautions: Asthma.

HYDROGEN PEROXIDE 1.5%

Dosage Form: Ear drops 5 vol. (£,II)

Recommended Dose: 1-2 drops to be instilled as required.

Indications: For removal of ear wax.

ICHTHAMMOL 10% IN GLYCERIN

Dosage Form: Ear drops [P] 10% (£,II)

Recommended Dose: 2-3 drops tds-qid.

Indications: For inflammatory conditions of the external ear.

MOMETASONE FUROATE

Dosage Form: Nasal spray 50 mcg/spray (I*) ORL

Recommended Dose: For treating seasonal and perennial allergic rhinitis, usual dose is 2 sprays in each nostril once daily. If used for seasonal allergic rhinitis, initiation of treatment 2 to 4 weeks before exposure to the allergen is recommended. Symptom improvement occurs 1-2 days after starting treatment, and maximum benefit occurs within 1-2 weeks.

Indications: Treatment of seasonal and perennial allergic rhinitis.

Contra-Indications: Hypersensitivity to mometasone.

Special Precautions: a) May cause hypothalamic-pituitary-adrenal axis suppression, Cushing’s Syndrome, hyperglycemic or glycosuria, especially in patients with liver failure. b) Children are more susceptible to systemic absorption and toxicity. c) Discontinue if local irritation develops. d) Avoid use in uncontrolled infection. e) Avoid contact with eyes and surrounding areas. f) After prolong use of systemic corticosteroids, switching to nasal mometasone may result in signs of adrenal insufficiency. g) Mometasone may increase the risk of serious or fatal infection in individuals exposed to viral illness such as chicken pox or measles. h) May cause nasal Candida infections. k) Ocular herpes simplex. l) May cause glaucoma or cataracts. m) Avoid until wound heals after nasal surgery, nasal trauma, or nasal ulcers. n) Active or quiescent tuberculosis. o) Untreated fungal, bacterial, systemic viral infections.        

OFLOXACIN

Dosage Form: Ear Drops 0.3% (3 mg/ml)

Recommended Dose: NAME="G05S05"For the treatment of otitis externa: Child: Five drops (0.25 mL, 0.75 mg ofloxacin) instilled into the affected ear twice daily for ten days. Adult: Ten drops (0.5 mL, 1.5 mg ofloxacin) instilled into the affected ear twice daily for ten days. Acute Otitis Media in Pediatric with Tympanostomy Tubes: Five drops (0.25 mL, 0.75 mg ofloxacin) instilled into the affected ear twice daily for ten days. NAME="G05S15"Chronic Suppurative Otitis Media with Perforated Tympanic Membranes: Adult: Ten drops (0.5 mL, 1.5 mg ofloxacin) instilled into the affected ear twice daily for fourteen days.

Indications: Otitis Externa due to Staphylococcus aureus and Pseudomonas aeruginosa, Chronic Suppurative Otitis Media with perforated tympanic membranes due to Staphylococcus aureus, Proteus mirabilis, and Pseudomonas aeruginosa. Acute Otitis Media with tympanostomy tubes due to Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis,  and  Pseudomonas aeruginosa  .

Contra-Indications: History of hypersensitivity to ofloxacin, to other quinolones, or to any of the components in this medication.

Special Precautions: NAME="C05S05"If the infection is not improved after one week, cultures should be obtained to guide further treatment. If otorrhea persists after a full course of therapy, or if two or more episodes of otorrhea occur within six months, further evaluation is recommended to exclude an underlying condition such as cholesteatoma, foreign body, or a tumor.

OXYMETAZOLINE HYDROCHLORIDE

Dosage Form: Nasal drops: Adult 0.05%, Paediatric 0.025%, Nasal spray: 0.05% (££,I)

Recommended Dose: 1-3 drops, 2-3 times daily in each nostril. Spray bd in each nostril.

Indications: Nasal decongestant in acute rhinitis, sinusitis, nasopharingitis, Eustachian salpingitis.

Contra-Indications: Hypersensitivity to oxymethazoline.

Special Precautions: Avoid prolonged use; caution in patients with hypertension, cardiac disease.

POLYMYXIN B SULPHATE + NEOMYCIN SULPHATE + HYDROCORTISONE

Dosage Form: Ear drops 10, 000 u + 3, 400 u + 10 mg (Otosporine) (££,II)

Recommended Dose: 3 drops instilled into affected ear tds-qid. External auditory meatus and canal to be thoroughly cleaned and dried before each application but soap should not be used as the antibiotics may be inactivated by it.

Indications: Treatment of bacterial infection and inflammation of the external auditory meatus.

Special Precautions: Should not be used if the ear drum is perforated, avoid prolonged use.

SODIUM BICARBONATE

Dosage Form: Ear drops [P] 5% (£,II)

Recommended Dose: 2-3 drops tds-qid.

Indications: For removal of ear wax.

TRIAMCINOLONE ACETONIDE + NEOMYCIN + GRAMICIDIN + NYSTATIN

Dosage Form: Ear drops (Kenacomb) 0.1% + 0.25% + 0.025% +100,000 Units / gram (££,I)

Recommended Dose: 2-3 drops tds-qid.

Indications: Treatment of bacterial infection and inflammation of the external auditory meatus.

Special Precautions: Should not be used if the ear drum is perforated. Avoid prolonged use.

TRIPOLIDINE HYDROCHLORIDE WITH PSEUDOEPHEDRINE HYDROCHLORIDE

Dosage Form: Tablet 2.5 mg/60 mg (¢¢,II), Syrup 1.2 mg/30 mg in 5 ml (££,II)

Recommended Dose: Adults (over 12 years) 1 tablet or 10 ml every 4-6 hrs. Child: every 4-6 hrs. Infants up to 12 months: 2.5 ml. 1-5 yrs: 5 ml. 6-12 yrs: 5-7.5 ml.

Indications: Nasal and respiratory congestion, common cold, acute sinusitis, allergic rhinitis and other allergic conditions.

Contra-Indications: Concurrent treatment with MAO inhibitors and within 2 weeks of stopping treatment.

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