Category:

• Local anesthetic

Description:

• Ester local anesthetic

Indications:

• Local anesthesia

• Mucosal anesthesia

Contraindications:

• Cardiac arrhythmias, coronary artery disease, hypertension, Tourette’s syndrome

• Cerebrovascular disease, sensitivity to cocaine

Precautions:

• Pregnancy category C; avoid breast feeding

• Acutely ill, elderly, or debilitated patients

• Inflammation or infection at site of application

Adverse Reactions (Side Effects):

• CNS: agitation, excitement, anxiety, restlessness, apprehension, irritability, hallucinations, psychosis, seizures hyperreflexia, pressured speech, headache, CNS hemorrhage

• CV: cardiac arrest, MI, PVC’s, heart failure, ventricular fibrillation/tachycardia

• GI: abdominal pain, bowel ischemia, nausea, vomiting

• GU: incontinence, renal tubular obstruction

• MISC: muscle paralysis, nasal congestion, rhinitis, tremor, exophthalmos, fecal incontinence, rhabdomyolysis

Dosage:

Administered topically

• Adult: 

  • Local or mucosal anesthesia: 

    • Apply 1%-4% solution by means of cotton applicators, packs, sprays, or by instillation. 

• Child > 6 years: 

  • Local or mucosal anesthesia: 

    • Apply lowest effective dose

    • Do not use solutions greater than 4% due to risk of systemic toxicity; 

    • Do not exceed 1 mg/kg

Special Considerations:

• Do not apply to eye or administer parenterally

• Concomitant use of postganglionic blocking agents to control hypertension (guanadrel, guanethidine), sympathomimetics (dobutamine, dopamine, epinephrine), increase risk of cardiac arrhythmias or hypertension.

• Labetalol (beta-blocker with alpha activity) has been successfully used to treat cocaine-induced hypertension.

Interactions:

• MAOI’s

• Cardiac glycosides

• Cholinesterase inhibitors

• Halogenated anesthetics

• Nitrates

• Sulfonamides

• Sympathomimetics

• Thyroid hormones

• Tricyclic antidepressants