Adult: As 0.5% or 1% tetracaine hydrochloride eye drop solution: Instil 1 drop onto the eye(s) as needed. Doses may vary depending on the type of procedure, individual product or between countries. Refer to product-specific guidelines for detailed dosing instructions.
Topical/Cutaneous Topical anaesthesia
Adult: For percutaneous local anaesthesia before venepuncture or venous cannulation: As 4% tetracaine base gel: Apply up to approx 5 g (5 tubes) to the centre of the desired site to be anaesthetised then cover with an occlusive dressing. Doses may be applied at separate sites at a single time. Remove the gel and dressing after 30 minutes (for venepuncture) or 45 minutes (for venous cannulation) and prepare the site with an antiseptic wipe in the normal manner. Application may be repeated after a minimum of 5 hours if necessary. Max cumulative dose: Approx 7 g (7 tubes) in 24 hours. Child: For percutaneous local anaesthesia before venepuncture or venous cannulation: As 4% tetracaine base gel: >1 month to <5 years Apply up to approx 1 g (1 tube) to the desired site to be anaesthetised then cover with an occlusive dressing. Doses may be applied at separate sites at a single time. Remove the gel and dressing after 30 minutes (for venepuncture) or 45 minutes (for venous cannulation) and prepare the site with an antiseptic wipe in the normal manner. Application may be repeated after a minimum of 5 hours if necessary. Max cumulative dose: Approx 2 g (2 tubes) in 24 hours; ≥5 years Same as adult dose.
Contraindications
Hypersensitivity to tetracaine or other ester-type local anaesthetics. Premature or full-term infants (<1 month). Topical: Application to highly vascular, inflamed, or traumatised surfaces, broken skin, mucous membranes, eyes or ears.
Special Precautions
Ophthalmic: Patient with cardiac disease. Not recommended for prolonged and continuous use. Not for inj, intraocular, or intracameral use. Topical: Patient with epilepsy. Not for use to provide anaesthesia before immunisation. Pregnancy and lactation.
Adverse Reactions
Significant: Ophthalmic: Corneal epithelial toxicity that may lead to corneal damage (prolonged use). Rarely, immediate allergic corneal reactions (e.g. epithelial keratitis or filament formation, necrotic epithelium sloughing, stromal oedema, descemetitis, and iritis). Topical: Methaemoglobinaemia, may lower seizure threshold; hypersensitivity reactions. Eye disorders: Corneal disorders (e.g. superficial punctuate keratitis, oedema); transient burning or stinging sensation, eye irritation or pain, conjunctival erythema (transient). Rarely, lacrimation, photophobia, chemosis. General disorders and administration site conditions: Topical: Application site erythema, oedema, pruritus. Rarely, application site vesicles.
Ophthalmic: This drug may cause transient blurring of vision, if affected, do not drive or operate machinery. Remove soft contact lenses prior to instillation of eye drops and wait at least 15 minutes before reinsertion. Do not touch or rub the eye(s) for at least 10-20 minutes after administration as accidental injuries may occur due to eye insensitivity.
Monitoring Parameters
Ophthalmic: Monitor for signs of hypersensitivity reactions after instillation. Topical: Monitor vital signs and patient safety before, during, and after application.
Action
Description: Tetracaine is an ester-type local anaesthetic. It inhibits the initiation and conduction of nerve impulses by blocking Na ion influx across the axon membrane. This activity results in the prevention of depolarisation, thereby inhibiting nerve conduction.
Synonym: amethocaine. Onset: Ophthalmic: Within 30 seconds. Duration: Ophthalmic: 10-20 minutes. Topical: 4-6 hours. Pharmacokinetics: Metabolism: Hydrolysed by plasma pseudocholinesterases to p-aminobenzoic acid. Excretion: Via urine.
Chemical Structure
Tetracaine Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 5411, Tetracaine. https://pubchem.ncbi.nlm.nih.gov/compound/Tetracaine. Accessed July 27, 2021.
Storage
Ophthalmic solution: Store between 2-25°C. Do not freeze. Protect from light. Topical gel: Store between 2-8°C. Do not freeze. Protect from heat. Storage recommendations may vary among individual products or between countries (refer to specific product guidelines).
S01HA03 - tetracaine ; Belongs to the class of local ophthalmologic anesthetics. D04AB06 - tetracaine ; Belongs to the class of topical anesthetics used in the treatment of pruritus.
References
Ametop Gel 4% w/w (Alliance Pharmaceuticals Limited). MHRA. https://products.mhra.gov.uk. Accessed 30/06/2021.Anon. Tetracaine (Ophthalmic). Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 30/06/2021.Anon. Tetracaine (Topical). Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 30/06/2021.Anon. Tetracaine Hydrochloride (EENT). AHFS Clinical Drug Information [online]. Bethesda, MD. American Society of Health-System Pharmacists, Inc. https://www.ahfscdi.com. Accessed 30/06/2021.Bausch & Lomb (NZ) Ltd. Minims Tetracaine Hydrochloride, Eye Drops Solution 0.5% and 1% data sheet 30 November 2018. Medsafe. http://www.medsafe.govt.nz. Accessed 30/06/2021.Buckingham R (ed). Tetracaine. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 30/06/2021.Joint Formulary Committee. Tetracaine. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 30/06/2021.Minims Tetracaine Hydrochloride 0.5% w/v Eye Drops, Solution (Bausch & Lomb UK Limited). MHRA. https://products.mhra.gov.uk. Accessed 30/06/2021.Minims Tetracaine Hydrochloride 1% w/v Eye Drops, Solution (Bausch & Lomb UK Limited). MHRA. https://products.mhra.gov.uk. Accessed 30/06/2021.Tetracaine Hydrochloride Solution (Alcon Laboratories, Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 30/06/2021.
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