Ophthalmic anesthesia (eg retinopathy of prematurity examination): Limited data available: Ophthalmic solution: Instill 1 drop as needed. Note: Some experts have recommended use to reduce stress and discomfort for infants undergoing eye exams (Kliegman 2020; Punyawattanaporn 2009); in adults, doses are separated by 5 to 10 minutes and the maximum number of doses (3 to 5 doses) is dependent on procedure length; fewer doses may be required in neonates; instill initial drop just prior to procedure/evaluation.
Note: Approval in pediatric patients may vary by products; refer to product-specific labeling.
Ophthalmic anesthesia: Infants, Children, and Adolescents: Ophthalmic solution: Instill 1 drop as needed. Note: In adult patients, doses are separated by 5 to 10 minutes and the maximum number of doses (3 to 5 doses) is dependent on procedure length; fewer doses may be required in young infants; instill initial drop just prior to procedure/evaluation (Anniger 2007; Kliegman 2020; manufacturer's labeling).
There are no dosage adjustments provided in manufacturer's labeling.
There are no dosage adjustments provided in manufacturer's labeling.
(For additional information see "Tetracaine (ophthalmic): Drug information")
Anesthesia, ocular: Ophthalmic: Instill 1 to 2 drops in affected eye(s) as needed. For tonometry and other procedures of short duration, instill just prior to evaluation. For minor surgical procedures, instill every 5 to 10 minutes for up to a maximum of 3 doses. For prolonged anesthesia, instill every 5 to 10 minutes for up to a maximum of 5 doses.
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
Solution, Ophthalmic, as hydrochloride:
Altacaine: 0.5% (12 ea, 15 mL [DSC], 30 mL)
Tetcaine: 0.5% (15 mL [DSC]) [contains chlorobutanol (chlorobutol), edetate (edta) disodium]
TetraVisc: 0.5% (12 ea [DSC], 5 mL [DSC]) [contains benzalkonium chloride]
TetraVisc Forte: 0.5% (12 ea [DSC], 5 mL [DSC]) [contains benzalkonium chloride, edetate (edta) disodium]
Generic: 0.5% (1 mL, 4 mL, 5 mL, 15 mL)
Yes
Ophthalmic: For ophthalmic use only. Apply drops to conjunctiva of affected eye(s); avoid contact of bottle tip with skin or eye; patients should not touch the eye for 10 to 20 minutes after instillation of anesthetic drop due to potential for accidental injury from poor sensitivity.
Ophthalmic: For topical ophthalmic use only; not for injection or intraocular use. Do not use intracamerally (may lead to damage of the corneal endothelial cells). To avoid contamination, do not touch dropper tip to any surface. Instruct patient to avoid touching eye for 10 to 20 minutes following administration.
Store at room temperature. Protect from light; keep container closed tightly.
Local anesthesia for ophthalmic procedures requiring rapid and short-acting anesthetic activity (FDA approved in pediatric patients [age not specified] and adults); local anesthesia for ophthalmic procedures of short duration (eg, tonometry, gonioscopy), minor ophthalmic surgical procedures (eg, removal of corneal foreign bodies, suture removal), and for various diagnostic purposes (eg, conjunctival scrapings) (FDA approved in adults). Note: Approval in pediatric patients may vary by products; refer to product-specific labeling.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
Frequency not defined: Ophthalmic: Chemosis, conjunctival erythema (transient), lacrimation, photophobia, transient burning or stinging in the eyes
<1%, postmarketing, and/or case reports: Hypersensitivity reaction (corneal)
Hypersensitivity to tetracaine or any component of the formulation.
Concerns related to adverse effects:
• Hypersensitivity: Immediate type allergic corneal reactions, characterized by epithelial keratitis/filament formation, necrotic epithelium sloughing, stromal edema, descemetitis, and iritis, have been reported rarely. Use with caution in patients with known allergies; if signs of sensitivity develop, discontinue use.
Disease-related concerns:
• Cardiac disease: Use with caution in patients with cardiac disease.
Special populations:
• Contact lens wearers: Some formulations may contain benzalkonium chloride, which may be adsorbed by soft contact lenses; remove contacts prior to administration and wait at least 15 minutes before reinserting.
Other warnings/precautions:
• Administration: For topical ophthalmic use only; not for injection or intraocular use. Do not use intracamerally (may lead to damage of the corneal endothelial cells). The anesthetized eye should be protected from irritation, foreign bodies, and rubbing to prevent inadvertent damage.
• Prolonged use: Prolonged and continuous use is not recommended (diminished duration of anesthesia, delayed healing, and severe keratitis may occur). Prolonged use or abuse may also lead to corneal epithelial toxicity, manifesting as epithelial defects, which may progress to permanent corneal damage.
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
Methemoglobinemia Associated Agents: May enhance the adverse/toxic effect of Local Anesthetics. Specifically, the risk for methemoglobinemia may be increased. Risk C: Monitor therapy
Animal reproduction studies have not been conducted.
Ester local anesthetic blocks both the initiation and conduction of nerve impulses by decreasing the neuronal membrane's permeability to sodium, potassium, and other ions, which results in inhibition of depolarization with resultant blockade of conduction
Onset of action: Anesthetic: Within 30 seconds
Duration of action: 10 to 20 minutes
Metabolism: Hepatic; detoxified by plasma esterases to aminobenzoic acid
Excretion: Urine
Solution (Altacaine Ophthalmic)
0.5% (per each): $6.25
0.5% (per mL): $0.48
Solution (Tetracaine HCl Ophthalmic)
0.5% (per mL): $3.50
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