Co-Phenylcaine Forte Spray Special Precautions

Patients with comorbidities should be given a reduced dose.
The use of topical anaesthetic agents in the oral cavity and upper airway tissues may interfere with swallowing and may enhance the danger of aspiration of food or drinks. Numbness of the tongue or buccal mucosa may increase the risk of trauma from hot drinks or biting. For this reason, food or drinks especially hot liquids should not be ingested within 2 hours of using local anaesthetics or until the numbness in the throat and tongue has worn off.
Co-Phenylcaine Forte Spray should be given with caution to patients with hyperthyroidism and cardiovascular disease, especially those suffering from hypertension, severe bradycardia, conduction disturbances or severe digitalis intoxication. A small but transient increase in pulse and blood pressure may occur. Careful and constant monitoring of cardiovascular and respiratory vital signs should be done. Dose must be adjusted when necessary.
Lidocaine is metabolized in the liver and must be given with caution to patients with hepatic insufficiency.
Metabolites of lidocaine may accumulate in patients with renal impairment. Dose must be adjusted when necessary.
Co-Phenylcaine Forte Spray contains sodium metabisulfite, a sulfite that may cause allergic-type reactions including anaphylactic symptoms and life-threatening or less severe asthmatic episodes in certain susceptible people. The overall prevalence of sulfite sensitivity in the general population is unknown and probably low. Sulfite sensitivity is seen more frequently in asthmatic than non-asthmatic people. Co-Phenylcaine Forte Spray must be discontinued and immediate medical attention must be given to susceptible or affected patients.
Patients on medications that may interact with lidocaine and phenylephrine must be closely observed. Dose may be adjusted or reduced when necessary. Careful monitoring of cardiovascular and respiratory vital signs should be done. Patients with epilepsy who are on phenytoin could cause adverse cardiac effects when taken with this medicine should be carefully monitored.
Phenylephrine may interact with monoamine oxidase inhibitors (MAOIs) and can result in blood pressure elevations and hypertensive crisis. In view of this risk, phenylephrine should not be used in patients taking MAOIs or within 2-3 weeks after discontinuation.
Genetic predisposition to malignant hyperthermia and pre-existing abnormal neurological conditions. Patients with existing neurological disorders must be carefully monitored. Increased doses must be avoided.
In patients with cuts or sores in areas of the nose or throat, there is increased risk of absorption of active ingredients that may lead to higher drug level in the blood. Careful examination of the nose and throat areas must be done before the procedure. Precautions must be taken to reduce the risk of rapid systemic absorption such as avoiding use in the presence of severe infection or severely traumatized mucosa in the areas of application.
Phenylephrine carries the risk of inducing closed angle glaucoma. Caution should be exercised in susceptible patients.