Dosing & Uses
Dosage Forms & Strengths
injectable solution
- 1%
powder for injection
- 20mg
ophthalmic solution
- 0.5%
Spinal Anesthesia
High, median, low & saddle: 0.2%-0.3% solution
For perineum: 5 mg/dose
For lower extremities: 10 mg/dose
For saddle block: 2-5 mg/dose
Prolonged (2-3 hours): 1% solution
For spinal: 1% solution diluted 1:1 in CSF, administered at 1 mL per 5 seconds
Doses of >15 mg are rarely required, and should only be used in exceptional cases
Ophthalmic
Short term anesthesia: 1-2 gtt into affected eye just prior to evaluation
Minor surgical procedure: 1-2 gtt into affected eye q5-10min
Prolonged surgical procedure: 1-2 gtt into affected eye q5-10min; not to exceed 5 doses
Safety & efficacy not established
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (0)
Serious - Use Alternative (1)
- bupivacaine implant
tetracaine, bupivacaine implant. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid additional local anesthetic administration within 96 hr following bupivacaine implantation. If use of additional local anesthetics is unavoidable based on clinical need, monitor for neurologic and cardiovascular effects related to local anesthetic systemic toxicity.
Monitor Closely (24)
- acetaminophen
tetracaine, acetaminophen. Other (see comment). Use Caution/Monitor. Comment: Monitor for signs of methemoglobinemia when methemoglobin-inducing drugs are coadministered.
- acetaminophen IV
tetracaine, acetaminophen IV. Other (see comment). Use Caution/Monitor. Comment: Monitor for signs of methemoglobinemia when methemoglobin-inducing drugs are coadministered.
- acetaminophen rectal
tetracaine, acetaminophen rectal. Other (see comment). Use Caution/Monitor. Comment: Monitor for signs of methemoglobinemia when methemoglobin-inducing drugs are coadministered.
- amyl nitrite
tetracaine, amyl nitrite. Other (see comment). Use Caution/Monitor. Comment: Monitor for signs of methemoglobinemia when methemoglobin-inducing drugs are coadministered.
- bupivacaine implant
tetracaine, bupivacaine implant. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Local anesthetics may increase the risk of developing methemoglobinemia when concurrently exposed to drugs that also cause methemoglobinemia.
- chloroquine
tetracaine, chloroquine. Other (see comment). Use Caution/Monitor. Comment: Monitor for signs of methemoglobinemia when methemoglobin-inducing drugs are coadministered.
- dapsone
tetracaine, dapsone. Other (see comment). Use Caution/Monitor. Comment: Monitor for signs of methemoglobinemia when methemoglobin-inducing drugs are coadministered.
- hyaluronidase
hyaluronidase, tetracaine. Other (see comment). Use Caution/Monitor. Comment: Hyaluronidase hastens the onset of local analgesia and reduces swelling, but increases systemic absorption of anesthetic. This decreases the duration of action and increases incidence of systemic reaction.
- isosorbide dinitrate
tetracaine, isosorbide dinitrate. Other (see comment). Use Caution/Monitor. Comment: Monitor for signs of methemoglobinemia when methemoglobin-inducing drugs are coadministered.
- isosorbide mononitrate
tetracaine, isosorbide mononitrate. Other (see comment). Use Caution/Monitor. Comment: Monitor for signs of methemoglobinemia when methemoglobin-inducing drugs are coadministered.
- nitrofurantoin
tetracaine, nitrofurantoin. Other (see comment). Use Caution/Monitor. Comment: Monitor for signs of methemoglobinemia when methemoglobin-inducing drugs are coadministered.
- nitroglycerin IV
tetracaine, nitroglycerin IV. Other (see comment). Use Caution/Monitor. Comment: Monitor for signs of methemoglobinemia when methemoglobin-inducing drugs are coadministered.
- nitroglycerin PO
tetracaine, nitroglycerin PO. Other (see comment). Use Caution/Monitor. Comment: Monitor for signs of methemoglobinemia when methemoglobin-inducing drugs are coadministered.
- nitroglycerin sublingual
tetracaine, nitroglycerin sublingual. Other (see comment). Use Caution/Monitor. Comment: Monitor for signs of methemoglobinemia when methemoglobin-inducing drugs are coadministered.
- nitroglycerin topical
tetracaine, nitroglycerin topical. Other (see comment). Use Caution/Monitor. Comment: Monitor for signs of methemoglobinemia when methemoglobin-inducing drugs are coadministered.
- nitroglycerin transdermal
tetracaine, nitroglycerin transdermal. Other (see comment). Use Caution/Monitor. Comment: Monitor for signs of methemoglobinemia when methemoglobin-inducing drugs are coadministered.
- nitroglycerin translingual
tetracaine, nitroglycerin translingual. Other (see comment). Use Caution/Monitor. Comment: Monitor for signs of methemoglobinemia when methemoglobin-inducing drugs are coadministered.
- nitroprusside sodium
tetracaine, nitroprusside sodium. Other (see comment). Use Caution/Monitor. Comment: Monitor for signs of methemoglobinemia when methemoglobin-inducing drugs are coadministered.
- phenobarbital
tetracaine, phenobarbital. Other (see comment). Use Caution/Monitor. Comment: Monitor for signs of methemoglobinemia when methemoglobin-inducing drugs are coadministered.
- phenytoin
tetracaine, phenytoin. Other (see comment). Use Caution/Monitor. Comment: Monitor for signs of methemoglobinemia when methemoglobin-inducing drugs are coadministered.
- primaquine
tetracaine, primaquine. Other (see comment). Use Caution/Monitor. Comment: Monitor for signs of methemoglobinemia when methemoglobin-inducing drugs are coadministered.
- quinine
tetracaine, quinine. Other (see comment). Use Caution/Monitor. Comment: Monitor for signs of methemoglobinemia when methemoglobin-inducing drugs are coadministered.
- sulfadiazine
tetracaine, sulfadiazine. Other (see comment). Use Caution/Monitor. Comment: Monitor for signs of methemoglobinemia when methemoglobin-inducing drugs are coadministered.
- sulfisoxazole
tetracaine, sulfisoxazole. Other (see comment). Use Caution/Monitor. Comment: Monitor for signs of methemoglobinemia when methemoglobin-inducing drugs are coadministered.
Minor (0)
Adverse Effects
Frequency Not Defined
Anxiety
Restlessness
Nervousness
Dizziness
Blurred vision
Conjunctival redness
Lacrimation
Photophobia
Tremors
Twitching
Drowsiness
Unconsciousness
Respiratory arrest
Nausea/vomiting
Chills
Tinnitus
Myocardial depression
Hypotension
Cardiac arrest
Tremors
Anaphylactoid reactions (sometimes fatal)
Warnings
Contraindications
Hypersensitivity to aminobenzoic acid, sulfites, parabens, or any components of preparation
Spinal anesthesia
Cautions
Use preservative-free preparations for spinal or epidural anesthesia
Some formulations may contain sulfites
Use caution in decreased levels of plasma esterases, hyperthyroidism, cardiovascular disease (heart block, rhythm disturbances, shock)
Use caution in the elderly, debilitated patients, obstetrics, or patients with intraabdominal pressure
DO NOT use solutions with epinephrine in distal areas of body (eg, digit, nose, ear, etc)
Addition of vasoconstrictor, epinephrine, will promote local hemostasis, decrease systemic absorption, and increase duration of action
Ophthalmic solution
- Indicated for administration under direct supervision of a healthcare provider; ophthalmic solution is not intended for patient self-administration
- Not for injection or intraocular use; do not use intracamerally as it may lead to damage to the corneal endothelial cells
- Prolonged use or abuse may lead to corneal epithelial toxicity and may manifest as epithelial defects which may progress to permanent corneal damage
- Patients should not touch the eye for at least 10-20 minutes after using anesthetic as accidental injuries can occur due to insensitivity of the eye
Pregnancy & Lactation
Pregnancy
There are no adequate and well-controlled studies in pregnant women; animal developmental and reproductive toxicity studies with tetracaine hydrochloride have not been reported in the published literature
No human data on effect of the drug on fertility available
Lactation
There are no data to assess whether the drug is excreted in human milk or to assess its effects on milk production/excretion; developmental and health benefits of breastfeeding should be considered along with mother’s clinical need for therapy and any potential adverse effects on the breastfed child from therapy or from underlying maternal condition
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.Pharmacology
Mechanism of Action
Local anesthetics prevent generation/conduction of nerve impulses by reducing sodium permeability & increasing action potential threshold
Pharmacokinetics
Duration: the greater the degree of vasodilation produced by the local anesthetic, the faster the rate of absorption and shorter the duration of action (bupivacaine has a long duration of action)
Protein Bound: Highly
Metabolism: Liver
Metabolites: Ester- & amide-type local anesthetics
Excretion: Urine (principally)
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Formulary
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