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BNSSG Paediatric Joint Formulary

12.3 Drug acting on the oropharynx

Last edited: 15-04-2024

First line drugs Second line drugs Specialist drugs Secondary care drugs

12.3 Drug acting on the oropharynx

Glycopyrronium bromide (Sialanar®) (TLS Amber 3 months) (SCP click here)

  • For hypersalivation in children with Motor Neurone Disease patients and children and young people with neurological conditions
  • Specify brand when prescribing - Sialanar®. 320microgram glycopyrronium is equivalent to 400microgram glycopyrronium bromide

Botulinum toxin type A (TLS Red)

  • For hypersalivation in children with neurological disability

See Botulinum Toxin Pathways page for more information.


12.3.1 Treatment of dry mouth

See UKMI – Saliva substitutes: Choosing and prescribing the right product


Artificial Saliva Products

Artificial saliva spray (Glandosane®) (TLS Green)

Alternative: (TLS Blue)

Artificial saliva spray (AS Saliva Orthana®)

Specific indication:

Saliva replacement gel (Biotene Oralbalance®) (TLS Blue)

  • Sicca syndrome and palliative care
  • Biotene Oralbalance® is also available for use on advice of Speech & Language Therapy

Salivix® pastilles (TLS Blue)



Pilocarpine tablets (TLS Blue)

  • Specialist use only


12.3.2 Oral hygiene

Chlorhexidine 0.2% mouthwash (TLS Green)

Chlorhexidine 1% dental gel (TLS Green)

Hydrogen peroxide mouthwash 6% (TLS Green)

  • Hydrogen peroxide mouthwash solution needs to be diluted prior to use

Hydrogen peroxide mouthwash 1.5% (TLS Green)

Mouthwash solution tablet (TLS Green)


Sucralfate liquid (oral) (TLS Red) 

  • For treatment of oral mucositis for oncology and haematology patients


12.3.4 Oral ulceration and inflammation


Hydrocortisone 2.5mg muco-adhesive buccal tablets (TLS Green)

Beclomethasone soluble tablets (unlicensed) (TLS Green)


Non-steroidal Anti-inflammatory Drugs  

Benzydamine 0.15% oral rinse or spray (Difflam®) (TLS Green)



Choline salicylate gel (Bonjela®) (TLS Green)

Specific indication:

Gelclair® (TLS Blue)

  • Haematology, Oncology and Palliative care use only for pain associated with mucositis


12.3.5 Oropharyngeal bacterial infections


12.3.6 Oropharyngeal fungal infections

Nystatin oral suspension

  • Nystatin suspension should be continued for 48 hours after lesions have resolved
  • Consider systemic treatment with oral fluconazole

Miconazole oral gel