Children under 12 years must see a doctor before starting each course of hydrocortisone buccal tablets. For patients who have not responded to other therapies and who would otherwise be considered for Sub Lingual Immunotherapy (SLIT) or a referral to secondary care Medicines which are suitable for initiation and ongoing prescribing within primary care. Primary care prescribers take full responsibility for prescribing and monitoring.

Grey / Non-Formulary: Medicines, which the Nottinghamshire APC has actively reviewed and does not recommend for use at present due to limited clinical and/or cost effective data.

Mode of action video

Clarification from the BNF (March 2017) has confirmed that the dose should be 100,000 units (1ml) FOUR times daily. Ideally by a dentist or dental hygienist linked to the cancer centre, or a member of the medical or nursing team who has received appropriate training

These are not all of the side effects that may occur. If you have questions about side effects, call your doctor. Call your doctor for medical

Advice should be given to brush at least twice a day with a fluoride toothpaste (containing 1,000 ppm fluoride +/- 10%)

Gelclair should be used 3 times a day or as needed. Avoid eating or drinking for at least 30-60 minutes following treatment.Usually use chlorhexidine instead, but hydrogen peroxide is acceptable, especially if anaerobic infection suspected. There is no convincing evidence that antiseptic lozenges and sprays have a beneficial action. Sprays that contain local anaesthetics may cause sensitisation. For patients who do experience nosebleeds use Vaseline to both sides of the nose twice a day ideally before using the spray. A supporting prescribing guideline may be requested which must have been agreed by the relevant secondary care trust DTCs and approved by the Nottinghamshire APC.

If there is not a paediatric dental unit liaising with the cancer centre, there should be clear communication between the cancer centre and the routine dental provider Other versions which can be used for mouth ulcers are dentinox teething gel (0.33% lidocaine) or in extreme circumstance 5% lidocaine ointment. Benzydamine oral rinse (‘Difflam’) is useful where there is painful inflammation of the mouth and throat. The recommended dose is 10-15mL used every 1.5-3 hours. Dilute with an equal volume of water if stinging or numbness occurs. Designated by NHS England to require initiation by or in prior agreement with a Specialist Centre. Continuation where appropriate by hospital (or other secondary care provider)

Available from

SFH information: Replacement for BioXtra. Not from Pharmacy - available from Supply Chain from March 11th 2019 onwards. Higher risk medicines requiring significant regular monitoring which would be initiated by or at the recommendation of a specialist service which may include mental health services, secondary care, tertiary care, community providers, private providers and GPs with a specialist interest.