Cetacaine
From Wikipedia, the free encyclopedia
| Combination of | |
|---|---|
| Benzocaine | Local anesthetic |
| Butamben | Local anesthetic |
| Tetracaine | Local anesthetic |
| Identifiers | |
| CAS Number | |
| ChemSpider |
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Cetacaine is a topical anesthetic that contains the active ingredients benzocaine (14%), butamben (2%), and tetracaine hydrochloride (2%). Cetacaine also contains small amounts of benzalkonium chloride at 0.5% and 0.005% of cetyl dimethyl ethyl ammonium bromide all in a bland water-soluble base.[1] Although Cetacaine has been widely used in the medical and dental fields, it has yet to be officially approved by the FDA.[2][3] Cetacaine is produced by the company Cetylite Industries, Inc. and they provide Cetacaine in three forms: liquid, gel, and spray.[1]
Available forms
Cetacaine is a benzocaine-based anesthetic that also contains other active ingredients that include butamben and tetracaine hydrochloride.[4] The main use for this drug is to produce anesthesia to mucous membranes to numb and help control the pain in that area.[3] The spray form of Cetacaine is also used to help prevent gagging in the patient.[1] The anesthetic effect of Cetacaine can be expected to take effect in about 30 seconds and last between 30–60 minutes depending on location and application amount.[1][2] Cetacaine can and has been used for surgeries that include bronchi, ear, esophagus, larynx, mouth, nose, pharynx, rectal, and vaginal procedures.[3][4] These procedures can include periodontal treatment, pre-probing, pre-scaling/root planning procedures, pre-injection, and laser dentistry.[3]
The dosage should be applied directly to the site where anesthesia is required. The dosage should be modified according to the patient and there has not been a dosage specified for children.[2]
Spray: Cetacaine spray should be applied for only one second and dosage should not exceed an application spray longer than 2 seconds.
Gel: Use a cotton swab to apply 200 mg to the needed area and the dosage should not exceed 400 mg.
Liquid: Apply 200 mg either directly or by using cotton applicator to the location and the dosage should not exceed 400 mg.[1][2][4]
Adverse effects
Cetacaine has been known to cause adverse effects in the patients it has been administered to. These include hypersensitivity in the form of anaphylaxis, dermatitis, erythema, pruritus which can lead to oozing and vesiculation.[4] There have also been accounts of rashes, edema, urticarial and other allergic symptoms as well as methemoglobinemia.[2][5] Other adverse effects can include: tremors, twitching, dizziness, confusion, hypo-tension, vomiting, euphoria, and blurred or double vision.[6]
Pregnancy and breastfeeding
It has not been determined of Cetacaine has any adverse defects on the formation of the fetus or if it is transferred through breastfeeding.[1][6] It is recommended that professional advise should be taken in these regards.[4]
Pharmacology
Mechanism of action
Cetacaine acts quickly in about 30 seconds and can last between 30–60 minutes. This is due to benzocaine causing the immediate anesthetic effect, while butamben and tetracaine hydrochloride causes the extended effect of Cetacaine.[2][4]
The actual mechanism for the onset of anesthesia is unknown, but it is believed that the active ingredients reversibly block nerve conduction therefore causing the numbing sensation. This stabilizes the neuron and prevents signals from being transferred.[2][4]
Pharmacokinetics
The rate of absorption through the skin and after diffusing in and back out of the nerve membrane it is metabolized by plasma cholinesterase and then excreted in urine.[2]
Contraindications
Interactions
Cetacaine can have interaction with other drugs being taken by patients one of the interactions that can lead to methemoglobinemia is the interaction with sodium nitrate as well as prilocaine, which can lead to severe illness or death.[8] As well as others listed on the referenced site.[8]
History
The marketing start date for Cetacaine was January 1, 1960,[2] but benzocaine was first produced in 1890 by German scientist 1890 by Eduard Ritsert.[9] Cetacaine is mainly used in the dental field but has seen use as well in the medical field when dealing with small surgeries on or around mucous membranes.[3] Benzocaine-based anesthetics (which includes Cetacaine) have started to come under scrutiny by the FDA.[10][11] In 2006 the FDA has announced that benzocaine-based anesthetics can cause methemoglobinemia and with that listed warnings and precautions to take when dealing with benzocaine based drugs.[10] The FDA also during this time started to take many Benzocaine based drugs that were not approved off the market and fining those companies they were under.[10]