Note: General dosing recommendations provided; refer to specific product labeling for dosing instructions. Due to risk of methemoglobinemia, AAP, FDA, and the American Academy of Pediatric Dentistry do NOT recommend use for teething and mouth pain in infants and children <2 years (AAP 2011; AAPD 2012; FDA Safety Announcement 2018).
Dermal irritation (insect bites, minor cuts, scrapes, minor burns, sunburn): Topical: 20% spray, 5% ointment: Children ≥2 years and Adolescents: Apply to affected area 3 to 4 times daily as needed.
Mouth and gum irritation (including fever blisters and cold sores): Topical:
Oral 10% or 20% gel/liquid: Children ≥2 years and Adolescents: Apply thin layer to affected area up to 4 times daily as needed.
Oral 5% spray: Children ≥6 years and Adolescents: Use 1 spray to affected area up to 4 times daily.
Sore throat/mouth, gag reflex suppression:
Oral: Oral lozenge: Children ≥5 years and Adolescents: Allow 1 lozenge to dissolve slowly in mouth; may repeat every 2 hours as needed.
Topical: Note: Consult product labeling for specific dose recommendations.
Oral spray 5%: Children ≥6 years and Adolescents: Use 1 spray to affected area or throat up to 4 times daily.
Oral spray 20%: Children ≥2 years and Adolescents: Spray on affected area or throat up to 4 times daily.
There are no dosage adjustments provided in the manufacturer's labeling.
There are no dosage adjustments provided in the manufacturer's labeling.
(For additional information see "Benzocaine: Drug information")
Note: General dosing guidelines provided; refer to specific product labeling for dosing instructions.
Dermal irritation: Topical (external): Ointment 5%, spray 5% and 20%: Apply to affected area or use 1 spray up to 3 to 4 times daily as needed (frequency may vary by product; also refer to manufacturer's labeling). In cases of bee stings, remove stinger before treatment.
Hemorrhoids: Topical (rectal, external): Ointment 20%: Apply to affected area up to 6 times daily.
Mouth and gum irritation: Topical (oral): Cream 20%, gel 10% or 20%, liquid 10% or 20%, ointment 20%, spray 5%: Apply thin layer to affected area or use 1 spray up to 4 times daily as needed.
Poison ivy/sumac: Topical (external): Spray 5% (Ivy-Rid only): Spray affected area until wet.
Sore throat/mouth: Topical (oral):
Gel, liquid, or spray 20% (Hurricaine products only): Spray on affected area or throat up to 4 times daily.
Lozenge: Allow 1 lozenge to dissolve slowly in mouth; may repeat every 2 hours as needed.
Topical anesthetic: Topical (oral): Gel or spray 20% (Topex products only): Apply a small amount to mucosa to achieve topical anesthesia.
There are no dosage adjustments provided in the manufacturer's labeling.
There are no dosage adjustments provided in the manufacturer's labeling.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Aerosol, External:
Ivy-Rid: 2% (85 g)
Aerosol, Mouth/Throat:
Hurricaine: 20% (57 g) [contains polyethylene glycol, saccharin; mint flavor]
Hurricaine: 20% (57 g) [contains polyethylene glycol, saccharin sodium]
Hurricaine: 20% (57 g) [contains polyethylene glycol, saccharin sodium; wild cherry flavor]
Topex Topical Anesthetic: 20% (57 g [DSC]) [contains alcohol, usp, polyethylene glycol, saccharin sodium; cherry flavor]
Gel, Mouth/Throat:
Anbesol: 10% (9 g [DSC]) [contains benzyl alcohol, brilliant blue fcf (fd&c blue #1), fd&c yellow #10 (quinoline yellow), fd&c yellow #6 (sunset yellow), methylparaben, propylene glycol, saccharin]
Anbesol: 10% (9 g [DSC]) [contains benzyl alcohol, brilliant blue fcf (fd&c blue #1), fd&c yellow #10 (quinoline yellow), fd&c yellow #6 (sunset yellow), methylparaben, propylene glycol, saccharin; cool mint flavor]
Anbesol Maximum Strength: 20% (9 g [DSC]) [contains brilliant blue fcf (fd&c blue #1), fd&c red #40, fd&c yellow #10 (quinoline yellow), methylparaben, saccharin]
Baby Anbesol: 7.5% (9 g)
Benz-O-Sthetic: 20% (15 g [DSC]) [contains benzyl alcohol, saccharin sodium]
Benz-O-Sthetic: 20% (29 g [DSC]) [contains benzyl alcohol, saccharin sodium; bubble-gum flavor]
Benz-O-Sthetic: 20% (29 g [DSC]) [contains benzyl alcohol, saccharin sodium; cherry flavor]
Dentapaine: 20% (11 g)
GoodSense Oral Pain Relief: 20% (14 g) [gluten free; contains polyethylene glycol, saccharin sodium]
Hurricaine: 20% (1.5 g) [contains polyethylene glycol, saccharin sodium; cherry flavor]
Hurricaine: 20% (1 ea, 60 ea, 28.4 g) [contains polyethylene glycol, saccharin sodium; mint flavor]
Hurricaine: 20% (1 ea, 60 ea, 1.5 g, 30 g) [contains polyethylene glycol, saccharin sodium; pina colada flavor]
Hurricaine: 20% (1 ea, 60 ea, 30 g) [contains polyethylene glycol, saccharin sodium; strawberry flavor]
Hurricaine: 20% (1 ea, 60 ea, 1.5 g, 30 g) [contains polyethylene glycol, saccharin sodium; watermelon flavor]
Hurricaine: 20% (1 ea, 60 ea, 5.25 g, 30 g) [contains polyethylene glycol, saccharin sodium; wild cherry flavor]
Instant Oral Pain Relief Max: 20% (14.2 g) [contains polyethylene glycol, saccharin sodium]
LolliCaine: 20% (120 ea) [contains brilliant blue fcf (fd&c blue #1), fd&c red #40, fd&c yellow #10 (quinoline yellow), saccharin sodium]
Zilactin Baby: 10% (9.4 g) [alcohol free, dye free, saccharin free]
Kit, Mouth/Throat:
HurriPak Starter Kit: 20% [contains polyethylene glycol, saccharin sodium]
Liquid, Mouth/Throat:
Anbesol: 10% (12 mL [DSC]) [contains brilliant blue fcf (fd&c blue #1), fd&c yellow #10 (quinoline yellow), fd&c yellow #6 (sunset yellow), methylparaben, saccharin; cool mint flavor]
Anbesol Maximum Strength: 20% (12 mL [DSC]) [contains benzyl alcohol, brilliant blue fcf (fd&c blue #1), fd&c red #40, fd&c yellow #10 (quinoline yellow), methylparaben, polyethylene glycol, propylene glycol, saccharin]
Benz-O-Sthetic: 20% (56 g [DSC]) [contains benzyl alcohol, brilliant blue fcf (fd&c blue #1), fd&c red #40, fd&c yellow #10 (quinoline yellow), polyethylene glycol, propylene glycol, saccharin]
Dent-O-Kain/20: 20% (9 mL [DSC]) [contains benzyl alcohol, brilliant blue fcf (fd&c blue #1), d&c yellow #11 (quinoline yellow ss), fd&c red #40, propylene glycol, saccharin]
Hurricaine: 20% (30 mL) [contains polyethylene glycol, saccharin sodium]
Lozenge, Mouth/Throat:
Bi-Zets/Benzotroches: 15 mg (10 ea [DSC]) [orange flavor]
Cepacol: Benzocaine 15 mg and menthol 2.3 mg (16 ea) [contains fd&c yellow #6 (sunset yellow); tangerine flavor]
Cepacol INSTAMAX: Benzocaine 15 mg and menthol 20 mg (16 ea) [contains fd&c red #40, fd&c yellow #10 (quinoline yellow); cherry flavor]
Cepacol INSTAMAX: Benzocaine 15 mg and menthol 20 mg (16 ea) [sugar free; contains fd&c yellow #6 (sunset yellow); berry flavor]
Ointment, External:
Anacaine: 10% (30 g)
Anbesol Cold Sore Therapy: (9 g) [contains aloe, vitamin e (vit e)]
Foille: 5% (28 g [DSC])
Solution, Mouth/Throat:
Allevacaine: 20% (1 ea, 25 ea) [contains alcohol, usp, polyethylene glycol, saccharin sodium]
Benz-O-Sthetic: 20% (30 mL [DSC]) [contains polyethylene glycol, saccharin]
Hurricaine: 20% (30 mL) [contains polyethylene glycol, saccharin sodium; pina colada flavor]
Hurricaine: 20% (30 mL) [contains polyethylene glycol, saccharin sodium; wild cherry flavor]
HurriCaine One: 20% (2 ea, 25 ea) [contains polyethylene glycol, saccharin sodium]
Kank-A Mouth Pain: 20% (9.75 mL [DSC]) [contains benzyl alcohol, propylene glycol, saccharin sodium]
Stick, External:
Aftertest Topical Pain Relief: 10% (4 mL [DSC]) [contains menthol, propylene glycol]
Strip, Mouth/Throat:
Ora-film: 6% (12 ea) [contains brilliant blue fcf (fd&c blue #1), menthol, methylparaben, propylparaben, tartrazine (fd&c yellow #5)]
Swab, Mouth/Throat:
Benz-O-Sthetic: 20% (2 ea [DSC]) [contains benzyl alcohol, polyethylene glycol, saccharin sodium; cherry flavor]
Hurricane Snap-n-Go: 20% (72 ea) [contains polyethylene glycol, saccharin sodium; wild cherry flavor]
May be product dependent
Note: Some products may contain flammable ingredients, do not use near fire, flame or heat. Some products may stain certain fabrics; avoid contact with clothing or furniture.
Oral gel/solution (topical): Apply with cotton applicator or fingertip to affected area. Children <12 years of age should be supervised during use.
Oral lozenge: Allow to dissolve slowly in mouth. Do not crush, chew, or swallow whole.
Topical ointment: Apply evenly. Do not apply over large areas, deep or puncture wounds, animal bites, or serious burns.
Topical spray: Shake spray well prior to use. Hold 6 to 12 inches from the affected area or may use with extension tube for finer direct application (eg, oral mucosal spray). For application to face (eg, for cold sores), first spray into palm of hand, then touch hand to face; avoid contact with the eyes. Do not apply to deep or puncture wounds, infections, lacerations, or to serious burns. Children <12 years of age should be supervised during use.
Note: Avoid contact with eyes and other mucous membranes. Some spray products may contain flammable ingredients, do not use near fire, flame, or heat. Some products may stain certain fabrics; avoid contact with clothing or furniture. Product-specific application instructions may vary; also refer to manufacturer's labeling.
Topical, external:
Ointment: Apply evenly. For hemorrhoids, when possible, cleanse affected area with mild soap and warm water then thoroughly rinse; gently dry with toilet tissue or soft cloth before applying ointment.
Spray: Shake well prior to use. Hold 6 to 12 inches or as directed from the affected area. For application to face, first spray into palm of hand, then touch hand to face. Do not apply to broken, blistered, or abraded skin.
Topical, oral:
Cream: Apply directly to the gums or to the denture surface that comes in contact with the affected area of the gums; if using with dentures, wait a few minutes then reinsert dentures (may use regular denture adhesive with this product).
Gel/liquid: Apply with cotton applicator or fingertip or as directed to affected area. Allow to remain in place at least 1 minute then spit out. For dental irritation, do not reinsert dentures until irritation or pain is relieved; rinse mouth well before reinserting.
Lozenge: Allow to dissolve slowly in mouth.
Ointment: Apply evenly.
Spray: Shake well prior to use; some products may be used with extension tube for finer direct application; hold extension tube 1 to 2 inches from affected area and spray for ½ second.
Store at room temperature; do not refrigerate. Protect from freezing and humidity.
Spray: Flammable; store away from and do not use near fire, open flame and heat. Contents under pressure; do not puncture or incinerate can. Do not store >48°C (>120°F).
Topical/External: Temporary relief of pain and itching associated with minor cuts, scrapes, minor burns, sunburn, and insect bites (OTC product: Spray 20%, ointment 5%: FDA approved in ages ≥2 years and adults)
Topical/Oral: Temporary relief of pain associated with fever blisters and cold sores (OTC product: Ointment 20%: FDA approved in ages ≥2 years and adults); temporary relief of pain associated with toothache, sore gums, canker sores, braces, minor dental procedures, or dentures (OTC product: Gel/solution [10%, 20%]: FDA approved in ages ≥2 years and adults; Lozenge: FDA approved in ages ≥5 years; Spray 5%: FDA approved in ages ≥6 years and adults); suppression of gag reflex (OTC product: Spray 20%: FDA approved in ages ≥2 years and adults). Note: Although product is available in a gel formulation for relief of pain associated with teething in infants ≥4 months, the FDA, AAP, and American Academy of Pediatric Dentistry do not recommend use due to safety concerns related to increased methemoglobinemia risk in infants and children <2 years of age (AAP 2011a, FDA 2011).
Note: Approved ages and uses for generic products may vary; consult labeling for specific information.
Orabase may be confused with Orinase
KIDs List: Benzocaine, when used in pediatric patients <2 years of age for teething or pharyngitis, is identified on the Key Potentially Inappropriate Drugs in Pediatrics (KIDs) list and should be avoided due to risk of methemoglobinemia (strong recommendation; high quality of evidence) (PPA [Meyers 2020]).
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Frequency not defined.
Central nervous system: Localized burning, stinging sensation
Dermatologic: Contact dermatitis, localized erythema, localized rash, urticaria
Hematologic & oncologic: Methemoglobinemia
Hypersensitivity: Hypersensitivity
Local: Local pruritus, localized edema, localized tenderness
Hypersensitivity to benzocaine, para-aminobenzoic acid (PABA), or any component of the formulation
OTC labeling: When used for self-medication, do not use if you have allergy to local anesthetics (procaine, butacaine, benzocaine, or other "caine" anesthetics). Do not use over deep or puncture wounds, animal bites, infections, serious burns, or lacerations. Do not use products indicated for topical oral use in children <2 years of age or for teething.
Concerns related to adverse effects:
• Methemoglobinemia: Has been reported following topical use, particularly with higher concentration (14% to 20%) spray formulations applied to the mouth or mucous membranes. When applied as a spray to the mouth or throat, multiple sprays (or sprays of longer than indicated duration) are not recommended. Use caution with breathing problems (asthma, bronchitis, emphysema, in smokers), inflamed/damaged mucosa, heart disease, children <6 months of age, and hemoglobin or enzyme abnormalities (glucose-6-phosphate dehydrogenase deficiency, hemoglobin-M disease, NADH-methemoglobin reductase deficiency, pyruvate-kinase deficiency). Alternatives to benzocaine sprays, such as topical lidocaine preparations, should be considered for patients at higher risk of this reaction. The classical clinical finding of methemoglobinemia is chocolate brown-colored arterial blood. However, suspected cases should be confirmed by co-oximetry, which yields a direct and accurate measure of methemoglobin levels. Standard pulse oximetry readings or arterial blood gas values are not reliable. Clinically significant methemoglobinemia requires immediate treatment (Anderson 1988; Cooper 1997; Moore 2004).
Special populations:
• Pediatric: Due to risk of methemoglobinemia, AAP, FDA, and the American Academy of Pediatric Dentistry do NOT recommend use for teething and mouth pain in infants and children <2 years of age (AAP 2011; AAPD 2012; FDA 2018).
Dosage form specific issues:
• Benzyl alcohol and derivatives: Some dosage forms may contain benzyl alcohol; large amounts of benzyl alcohol (≥99 mg/kg/day) have been associated with a potentially fatal toxicity (“gasping syndrome”) in neonates; the “gasping syndrome” consists of metabolic acidosis, respiratory distress, gasping respirations, CNS dysfunction (including convulsions, intracranial hemorrhage), hypotension and cardiovascular collapse (AAP ["Inactive" 1997]; CDC 1982); some data suggests that benzoate displaces bilirubin from protein binding sites (Ahlfors 2001); avoid or use dosage forms containing benzyl alcohol with caution in neonates. See manufacturer's labeling.
• Propylene glycol: Some dosage forms may contain propylene glycol; large amounts are potentially toxic and have been associated hyperosmolality, lactic acidosis, seizures and respiratory depression; use caution (AAP 1997; Zar 2007). See manufacturer’s labeling.
• Rectal ointment: For external use only; do not insert into rectum using fingers or any mechanical device or applicator.
Other warnings/precautions:
• Self-medication (OTC use): When used for self-medication, notify healthcare provider if condition worsens, or does not improve within 7 days; clears up and occurs again within a few days; or if accompanied by additional symptoms (eg, swelling, rash, headache, nausea, vomiting, or fever). Do not use topical products on open wounds; avoid contact with the eyes. Do not use for a prolonged time and/or on large portions of the body.
• Topical application: When topical anesthetics are used prior to cosmetic or medical procedures, the lowest amount of anesthetic necessary for pain relief should be applied. High systemic levels and toxic effects (eg, methemoglobinemia, irregular heartbeats, respiratory depression, seizures, death) have been reported in patients who (without supervision of a trained professional) have applied topical anesthetics in large amounts (or to large areas of the skin), left these products on for prolonged periods of time, or have used wraps/dressings to cover the skin following application.
There is a significant safety risk of methemoglobinemia with benzocaine use. The majority of cases of methemoglobinemia associated with benzocaine use have been in infants and children <2 years of age for treatment of teething and mouth pain; also at greater risk for development are patients with asthma, bronchitis, emphysema, mucosal damage, or inflammation at the application site, heart disease, and malnutrition. The FDA has strengthened their warning against using topical OTC benzocaine for teething pain and are urging manufacturers to stop marketing OTC oral benzocaine products for treatment of teething in infants and children <2 years of age and to add contraindications to use in teething and treatment in infants and children <2 years (FDA Safety Announcement 2018). The use of OTC topical anesthetics (eg, benzocaine) for teething pain is also discouraged by AAP and The American Academy of Pediatric Dentistry (AAP 2011; AAPD 2012). The AAP recommends managing teething pain with a chilled (not frozen) teething ring or gently rubbing/massaging with the caregiver's finger.
Some dosage forms may contain propylene glycol; in neonates large amounts of propylene glycol delivered orally, intravenously (eg, >3,000 mg/day), or topically have been associated with potentially fatal toxicities which can include metabolic acidosis, seizures, renal failure, and CNS depression; toxicities have also been reported in children and adults including hyperosmolality, lactic acidosis, seizures and respiratory depression; use caution (AAP 1997; Shehab 2009).
None known.
Bupivacaine: Local Anesthetics may enhance the adverse/toxic effect of Bupivacaine. Management: Avoid using any additional local anesthetics within 96 hours after insertion of the bupivacaine implant (Xaracoll) or bupivacaine and meloxicam periarticular solution (Zynrelef) or within 168 hours after subacromial infiltration (Posimir brand). Risk C: Monitor therapy
Dapsone (Topical): May enhance the adverse/toxic effect of Methemoglobinemia Associated Agents. Risk C: Monitor therapy
Local Anesthetics: Methemoglobinemia Associated Agents may enhance the adverse/toxic effect of Local Anesthetics. Specifically, the risk for methemoglobinemia may be increased. Risk C: Monitor therapy
Methemoglobinemia Associated Agents: May enhance the adverse/toxic effect of Local Anesthetics. Specifically, the risk for methemoglobinemia may be increased. Risk C: Monitor therapy
Nitric Oxide: May enhance the adverse/toxic effect of Methemoglobinemia Associated Agents. Combinations of these agents may increase the likelihood of significant methemoglobinemia. Risk C: Monitor therapy
Prilocaine: Methemoglobinemia Associated Agents may enhance the adverse/toxic effect of Prilocaine. Combinations of these agents may increase the likelihood of significant methemoglobinemia. Management: Monitor patients for signs of methemoglobinemia (e.g., hypoxia, cyanosis) when prilocaine is used in combination with other agents associated with development of methemoglobinemia. Avoid lidocaine/prilocaine in infants receiving such agents. Risk C: Monitor therapy
Sodium Nitrite: Methemoglobinemia Associated Agents may enhance the adverse/toxic effect of Sodium Nitrite. Combinations of these agents may increase the likelihood of significant methemoglobinemia. Risk C: Monitor therapy
Monitor patients for signs and symptoms of methemoglobinemia such as pallor, fatigue, cyanosis, nausea, muscle weakness, dizziness, confusion, agitation, dyspnea, and tachycardia. The classical clinical finding of methemoglobinemia is chocolate brown-colored arterial blood. However, suspected cases should be confirmed by co-oximetry, which yields a direct and accurate measure of methemoglobin levels. Standard pulse oximetry readings or arterial blood gas values are not reliable. Clinically significant methemoglobinemia requires immediate treatment.
Blocks both the initiation and conduction of nerve impulses by decreasing the neuronal membrane's permeability to sodium ions, which results in inhibition of depolarization with resultant blockade of conduction
Onset: Anesthetic effect: Spray: 15 to 30 seconds.
Absorption: Poor through intact skin; well absorbed from mucous membranes and traumatized skin
Metabolism: Hepatic (to a lesser extent) and plasma via hydrolysis by cholinesterase (Tucker 1986)
Aerosol (Hurricaine Mouth/Throat)
20% (per gram): $0.53
Gel (Baby Anbesol Mouth/Throat)
7.5% (per gram): $0.46
Gel (Hurricaine Mouth/Throat)
20% (per each): $0.82
Gel (LolliCaine Mouth/Throat)
20% (per each): $0.53
Gel (Zilactin Baby Mouth/Throat)
10% (per gram): $0.40
Kit (HurriPak Starter Kit Mouth/Throat)
20% (per mL): $2.00
Lozenge (Cepacol INSTAMAX Mouth/Throat)
15-20 mg (per each): $0.30
Lozenge (Cepacol Mouth/Throat)
15-2.3 mg (per each): $0.30
Ointment (Anacaine External)
10% (per gram): $0.46
Solution (Allevacaine Mouth/Throat)
20% (per each): $10.97
Solution (Hurricaine Mouth/Throat)
20% (per mL): $0.29
Solution (HurriCaine One Mouth/Throat)
20% (per each): $14.21
Strip (Ora-film Mouth/Throat)
6% (per each): $0.28
Swab (Hurricane Snap-n-Go Mouth/Throat)
20% (per each): $0.41
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
