tetracaine (Rx)

Brand and Other Names:Tetcaine, tetracaine ophthalmic
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Dosing & Uses

AdultPediatric

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

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Interactions

Interaction Checker

and tetracaine

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    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            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)

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                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)

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                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

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                Pregnancy & Lactation

                Pregnancy Category: C

                Lactation: Not known if excreted in breast milk; use caution

                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.

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                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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                Patient Handout

                A Patient Handout is not currently available for this monograph.
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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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                Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.