Lidocaine and Tetracaine

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Overview

What is Lidocaine and Tetracaine?

Lidocaine and tetracaine cream 7% / 7% is a topical local anesthetic cream that forms a pliable peel on the skin when exposed to air. The drug formulation is an emulsion in which the oil phase is a 1:1 eutectic mixture of lidocaine 7% and tetracaine 7%. The eutectic mixture has a melting point below room temperature and therefore both local anesthetics exist as a liquid oil rather than as crystals.

The net weight of lidocaine is 2.1 g and of tetracaine is 2.1 g per 30 g tube.

Lidocaine, an amide local anesthetic, is chemically designated as acetamide,2-(diethylamino)-N-(2,6-dimethylphenyl) and has an octanol:water partition ratio of 182 at pH 7.3.

The molecular weight of lidocaine is 234.3, and the molecular formula is CHNO. The structural formula is:

Tetracaine, an ester local anesthetic, is chemically designated as 2-dimethylaminoethyl 4-n-butyl-aminobenzoate and has an octanol:water partition ratio of 5370 at pH 7.3. The molecular weight of tetracaine is 264.4, and the molecular formula is CHNO. The structural formula is:

Each gram of lidocaine and tetracaine cream contains lidocaine 70 mg and tetracaine 70 mg in a 1:1 eutectic mixture and it also contains the following inactive ingredients: dibasic calcium phosphate, methylparaben, petrolatum, polyvinyl alcohol, propylparaben, purified water, and sorbitan monopalmitate.

What does Lidocaine and Tetracaine look like?

What are the available doses of Lidocaine and Tetracaine?

Cream: 70 mg of lidocaine and 70 mg of tetracaine per gram (7%; 7%).

What should I talk to my health care provider before I take Lidocaine and Tetracaine?

How should I use Lidocaine and Tetracaine?

Lidocaine and tetracaine cream is indicated for use on intact skin in adults to provide topical local analgesia for superficial dermatological procedures such as dermal filler injection, pulsed dye laser therapy, facial laser resurfacing, and laser-assisted tattoo removal.

Apply only to intact skin. ()

Do not exceed the recommended dose of drug or duration of application. ()

Recommended duration of application ():

What interacts with Lidocaine and Tetracaine?

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What are the warnings of Lidocaine and Tetracaine?

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What are the precautions of Lidocaine and Tetracaine?

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What are the side effects of Lidocaine and Tetracaine?

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What should I look out for while using Lidocaine and Tetracaine?

Known history of sensitivity to lidocaine or tetracaine, or local anesthetics of the amide or ester type. ()

Para-aminobenzoic acid (PABA) hypersensitivity. ()

What might happen if I take too much Lidocaine and Tetracaine?

Application of 59 g of lidocaine and tetracaine cream over 400 cm for up to 120 minutes to adults produces peak plasma concentrations of lidocaine of 220 ng/mL. Toxic levels of lidocaine (>5000 ng/mL) cause CNS toxicity, including the risk of seizure. Signs of CNS toxicity may start at plasma concentrations of lidocaine as low as 1000 ng/mL, and the risk of seizures generally increases with increasing plasma levels. Very high levels of lidocaine can cause respiratory arrest, coma, decreases in cardiac output, total peripheral resistance and mean arterial pressure, ventricular arrhythmias and cardiac arrest.

Tetracaine is associated with a profile of systemic CNS and cardiovascular adverse events similar to lidocaine, although toxicity associated with tetracaine is thought to occur at lower doses compared to lidocaine. The toxicity of co-administered local anesthetics is thought to be at least additive. In the absence of massive topical overdose or oral ingestion, other etiologies for the clinical effects or overdosage from other sources of lidocaine, tetracaine or other local anesthetics should be considered. The management of overdosage includes close monitoring, supportive care and symptomatic treatment. Dialysis is of negligible value in the treatment of acute overdosage of lidocaine or tetracaine.

How should I store and handle Lidocaine and Tetracaine?

Store at 20° to 25°C (68° to 77°F) [See USP Controlled Room Temperature]. Dispense in a tight container.Half-tablets (scored ursodiol 500 mg tablets broken in half) maintain acceptable quality for up to 28 days when stored in the current packaging (bottles) at 20° to 25°C (68° to 77°F). Due to the bitter taste, the halved segments should be stored separately from the whole tablets [].Store at 20° to 25°C (68° to 77°F) [See USP Controlled Room Temperature]. Dispense in a tight container.Half-tablets (scored ursodiol 500 mg tablets broken in half) maintain acceptable quality for up to 28 days when stored in the current packaging (bottles) at 20° to 25°C (68° to 77°F). Due to the bitter taste, the halved segments should be stored separately from the whole tablets [].Lidocaine and tetracaine cream (70 mg of lidocaine and 70 mg of tetracaine in 1 gram), 7% / 7%, appears smooth and white to off-white and is available as the following:NDC 71800-631-15 30 gram tubeNDC 71800-631-04 - 120gm (4, 30gm Tube in 1 Carton)NDC 71800-631-08 - 240gm (8, 30gm Tube in 1 Carton)Lidocaine and tetracaine cream (70 mg of lidocaine and 70 mg of tetracaine in 1 gram), 7% / 7%, appears smooth and white to off-white and is available as the following:NDC 71800-631-15 30 gram tubeNDC 71800-631-04 - 120gm (4, 30gm Tube in 1 Carton)NDC 71800-631-08 - 240gm (8, 30gm Tube in 1 Carton)Lidocaine and tetracaine cream (70 mg of lidocaine and 70 mg of tetracaine in 1 gram), 7% / 7%, appears smooth and white to off-white and is available as the following:NDC 71800-631-15 30 gram tubeNDC 71800-631-04 - 120gm (4, 30gm Tube in 1 Carton)NDC 71800-631-08 - 240gm (8, 30gm Tube in 1 Carton)Lidocaine and tetracaine cream (70 mg of lidocaine and 70 mg of tetracaine in 1 gram), 7% / 7%, appears smooth and white to off-white and is available as the following:NDC 71800-631-15 30 gram tubeNDC 71800-631-04 - 120gm (4, 30gm Tube in 1 Carton)NDC 71800-631-08 - 240gm (8, 30gm Tube in 1 Carton)

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Clinical Information

Chemical Structure

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Clinical Pharmacology

Lidocaine is an amide-type local anesthetic agent and tetracaine is an ester-type local anesthetic agent. Both lidocaine and tetracaine block sodium ion channels required for the initiation and conduction of neuronal impulses which, in certain instances, results in local anesthesia. When applied to intact skin, lidocaine and tetracaine cream provides local dermal analgesia by the release of lidocaine and tetracaine from the peel into the skin.

Non-Clinical Toxicology

Known history of sensitivity to lidocaine or tetracaine, or local anesthetics of the amide or ester type. ()

Para-aminobenzoic acid (PABA) hypersensitivity. ()

Clonidine may potentiate the CNS-depressive effect of alcohol, barbiturates or other sedating drugs. Narcotic analgesics may potentiate the hypotensive effects of clonidine. Tricyclic antidepressants may antagonize the hypotensive effects of clonidine. The effects of tricyclic antidepressants on clonidine's analgesic actions are not known.

Beta-blockers may exacerbate the hypertensive response seen with clonidine withdrawal. Also, due to the potential for additive effects such as bradycardia and AV block, caution is warranted in patients receiving clonidine with agents known to affect sinus node function or AV nodal conduction, e.g., digitalis, calcium channel blockers, and beta-blockers.

There is one reported case of a patient with acute delirium associated with the simultaneous use of fluphenazine and oral clonidine. Symptoms resolved when clonidine was withdrawn and recurred when the patient was rechallenged with clonidine.

Epidural clonidine may prolong the duration of pharmacologic effects of epidural local anesthetics, including both sensory and motor blockade.

Overexposure

Risk of Secondary Exposure to Children and Pets

Methemoglobinemia

Anaphylactic Reactions

Eye Irritation

The following adverse reactions are described elsewhere in the labeling:

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Reference

This information is obtained from the National Institute of Health's Standard Packaging Label drug database.
"https://dailymed.nlm.nih.gov/dailymed/"

While we update our database periodically, we cannot guarantee it is always updated to the latest version.

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Professional

Clonazepam Description Each single-scored tablet, for oral administration, contains 0.5 mg, 1 mg, or 2 mg Clonazepam, USP, a benzodiazepine. Each tablet also contains corn starch, lactose monohydrate, magnesium stearate, microcrystalline cellulose, and povidone. Clonazepam tablets USP 0.5 mg contain Yellow D&C No. 10 Aluminum Lake. Clonazepam tablets USP 1 mg contain Yellow D&C No. 10 Aluminum Lake, as well as FD&C Blue No. 1 Aluminum Lake. Chemically, Clonazepam, USP is 5-(o-chlorophenyl)-1,3-dihydro-7-nitro-2H-1,4-benzodiazepin-2-one. It is a light yellow crystalline powder. It has the following structural formula: C15H10ClN3O3 M.W. 315.72

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Interactions

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