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cocaine (Rx)Brand and Other Names:Cocaine topical

 
 
 

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

topical solution: Schedule II

  • 4%
  • 10%
more...

Topical Anesthesia

As local anesthetic for accessible mucous membranes (oral, nasal and laryngeal)

1-10% solution: Use lowest dose necessary to produce adequate anesthesia

Do not exceed 1 mg/kg 

Dosing Considerations

Dosage variables include tissue vascularity, anesthetic technique and patient tolerance

Reduce dose for elderly or debilitated patients

Administration

Administer using cotton applicators or packs, instilled into a cavity, or as a spray

Apply only on mucous membranes of mouth, laryngeal, or nasal cavities

Other Indications & Uses

Epistaxis (off-label)

Dosage Forms & Strengths

topical solution: Schedule II

  • 4%
more...

Topical Anesthesia

Use lowest possible effective dose; solutions >4% not recommended because of increased risk/severity of toxicity

Dosing Considerations

Dosage variables include tissue vascularity, anesthetic technique and patient tolerance

Administration

Administer using cotton applicators or packs, instilled into a cavity, or as a spray

Apply only on mucous membranes of mouth, laryngeal, or nasal cavities

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Interactions

Interaction Checker

cocaine and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            Frequency Not Defined

            Anxiety

            Apprehension

            Restlessness

            Nervousness

            Disorientation

            Excitement

            Confusion

            Restlessness

            Tremors, and possibly clonic-tonic convulsions

            Respiratory arrest

            Nausea

            Vomiting

            Chills

            Miosis

            Tinnitus

            Myocardial depression

            Bradycardia

            Cardiac arrhythmias

            Hypotension

            Cardiovascular collapse

            Cardiac arrest

            Palpitation

            Tachycardia

            Anginal pain

            Hypertension (epinephrine-containing solutions)

            Sloughing of corneal epithelium (eg, pitting, clouding, corneal ulceration)

            Serious toxic effects (eg, seizures, cardiac death) have been described following topical cocaine application used to anesthetize minor skin lacerations, especially on the face or scalp (eg, TAC [tetracaine 0.5%, epinephrine (Adrenalin) 1:2000, and cocaine 11.8%]); this risk is greater in pediatrics

            Coronary arteriosclerosis

            Tachyarrhythmia

            Seizure

            Edema

            Status asthmaticus

            Anaphylactoid reactions (sometimes fatal)

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            Warnings

            Contraindications

            Hypersensitivity to ester-type local anesthetics, para-aminobenzoic acid (PABA), or parabens

            Cautions

            Do not administer parenterally or apply to eye

            Do not dilute with epinephrine for topical application as "cocaine mud"

            Serious toxic effects (eg, seizures, cardiac death) have been described following topical cocaine application used to anesthetize minor skin lacerations, especially on the face or scalp (eg, TAC [tetracaine 0.5%, epinephrine (Adrenalin) 1:2000, and cocaine 11.8%]); this risk is greater in pediatrics

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            Pregnancy & Lactation

            Pregnancy Category: C; X (nonmedicinal use)

            Lactation: Enters breast milk; use is contraindicated

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

            more...
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            Pharmacology

            Mechanism of Action

            Acts as local anesthetic by blocking generation/conduction of nerve impulses by reducing sodium permeability and increasing action potential threshold

            Absorption

            Significant absorption from mucosa

            Distribution

            Protein Bound: High

            Metabolism

            Metabolism: Plasma esterases

            Metabolites: Benzoylecgonine and ecgonine methyl ester (major)

            Elimination

            t1/2: 1 hr

            Excretion: Urine (major)

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            Images

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            Formulary

            FormularyPatient Discounts

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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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