Medicated Sinus Rinses

Particularly if a patient has previously undergone sinus surgery, adding medications to a sinus rinse (like a NeilMed Sinus Rinse bottle, Navage, or a Neti-Pot) can deliver medications directly to the surfaces of the sinuses. These prescriptions may need to be filled by a compounding pharmacy, may require some mixing by the patient, and may not be covered by medical insurance. These are my most commonly used medicated sinus rinses.

Gentamycin

80 mg gentamicin (2 mL of 40 mg/mL) per use

Disp #120 mL of gentamicin (4.8g) (one month supply)

Sig: Add 80 mg (2 mL) to a NeilMed Sinus Rinse solution (May use Neti-Pot or other equivalent device) and irrigate twice daily.

Pharmacist may adjust dispensed concentration, keeping mass per use equivalent.

May combine with another medication (e.g., budesonide, vancomycin)

Note: Gentamycin has no enteral absorption.

Budesonide

Solution option:

Disp #60 ampules (each with 2 mL of budensonide 0.25 mg/mL) (one month supply)

Sig: Add 1 ampule to a NeilMed Sinus Rinse solution (May use Neti-Pot or other equivalent device) and irrigate twice daily.

Powder option:

Disp #60 capsules (each with 0.5 mg budesonide) (one month supply

Sig: Add contents of 1 capsule to a NeilMed Sinus Rinse solution (May use Neti-Pot or other equivalent device) and irrigate twice daily.

Pharmacist may adjust dispensed concentration, keeping mass per use equivalent.

May combine with another medication (e.g., gentamycin, vancomycin)

Note: Some studies report using 1 mg budesonide in a NeilMed Sinus Rinse solution with irrigation once a day.

Vancomycin

Disp # 120 mL of vancomycin (100 mg/mL) (one month supply)

Sig: Add 200 mg (2 mL of 100 mg/mL) to a NeilMed Sinus Rinse solution (May use Neti-Pot or other equivalent device) and irrigate twice daily.

Pharmacist may adjust dispensed concentration, keeping mass per use equivalent.

May combine with another medication (e.g., gentamycin, budesonide).

Note: Vancomycin has low enteral absorption.

Levofloxacin 100 mg/ Budesonide 0.5 mg capsule

Disp: #60 capsules (each with 100 mg levofloxacin and 0.5 mg budesonide) (one month supply)

Sig: Use one capsule opened in a NeilMed Sinus Rinse solution (May use Neti-Pot or other equivalent device) and irrigate twice daily.

Mupirocin 2% cream

Disp: # 22 g tube of 2% Mupirocin cream

Sig: Add 1” ribbon to a NeilMed Sinus Rinse solution, and shake vigorously before use.

Note: Muipirocin cream preferable because the cream is soluble in water and saline, whereas mupirocin ointment is not. Unfortunately, the cream is more expensive than mupirocin ointment.

Itraconazole

Disp: # 60 capsules of 40 mg itraconazole each (one month supply)

Sig: Use one capsule opened in a NeilMed Sinus Rinse solution (May use Neti-Pot or other equivalent device) and irrigate twice daily.

Note: Discomfort or a sense of burning in the nose and sinuses may occur.

Note: Itraconazole exhibits some (limited) enteral absorption.

Amphoteracin B

Disp: #30 ampules of 20 mg Amphoteracin B each

Sig: Add 1 ampule to a NeilMed Sinus Rinse solution (May use Neti-Pot or other equivalent device) and irrigate once daily.

Note: Discomfort or a sense of burning in the nose and sinuses may occur.

Note: Daily topical nasal steroid (e.g. fluticasone) may also be helpful.

Note: Amphoteracin B is not absorbed enterally.

Fluconazole

Disp: # 60 capsules of 100 mg each (one month supply)

Sig: Use one capsule opened in a NeilMed Sinus Rinse solution (May use Neti-Pot or other equivalent device) and irrigate twice daily.

Note: Discomfort or a sense of burning in the nose and sinuses may occur.

Note: Fluconazole does exhibit enteral absorption, with potential for hepatotoxicity.

Provodine-Iodone 10% or Iorinse (ENT formula)

Over-the-c0unter

Sig: Add 1 tsp (5 mL) of Provodine-Iodone 10% or Iorinse (ENT formula) to a NeilMed Sinus Rinse solution, and mix before use.

Note: This antiseptic has activity against bacteria, fungi, and viruses.