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Pharmacologic Category
Dosing: Adult
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.
* See Dosage and Administration in AHFS Essentials for additional information.
Dosing: Geriatric
Refer to adult dosing.
Dosing: Renal Impairment: Adult
There are no dosage adjustments provided in the manufacturer's labeling.
Dosing: Hepatic Impairment: Adult
There are no dosage adjustments provided in the manufacturer's labeling.
Dosing: Pediatric
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).
Dosing: Renal Impairment: Pediatric
There are no dosage adjustments provided in manufacturer's labeling.
Dosing: Hepatic Impairment: Pediatric
There are no dosage adjustments provided in manufacturer's labeling.
Use: Labeled Indications
Anesthesia, ocular: Local anesthesia for various ophthalmic procedures requiring rapid, short-acting topical anesthesia, including tonometry, gonioscopy removal of corneal foreign bodies, conjunctival scraping for diagnostic purposes, suture removal from the cornea or conjunctiva, and other short corneal and conjunctival procedures.
* See Uses in AHFS Essentials for additional information.
Administration: 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.
Administration: Pediatric
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.
Storage/Stability
Store at room temperature. Protect from light; keep container closed tightly.
Medication Patient Education with HCAHPS Considerations
What is this drug used for?
• It is used to numb the eye.
Frequently reported side effects of this drug
• Burning
• Stinging
• Redness
Other side effects of this drug: Talk with your doctor right away if you have any of these signs of:
• Vision changes
• Eye pain
• Severe eye irritation
• Signs of a significant reaction like wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat.
Note: This is not a comprehensive list of all side effects. Talk to your doctor if you have questions.
Consumer Information Use and Disclaimer: This information should not be used to decide whether or not to take this medicine or any other medicine. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this medicine. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not specific medical advice and does not replace information you receive from the healthcare provider. You must talk with the healthcare provider for complete information about the risks and benefits of using this medicine.
Contraindications
Hypersensitivity to tetracaine or any component of the formulation.
Warnings/Precautions
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.
* See Cautions in AHFS Essentials for additional information.
Pregnancy Risk Factor
C
Pregnancy Considerations
Animal reproduction studies have not been conducted.
Breast-Feeding Considerations
It is not known if tetracaine (ophthalmic) is present in breast milk. The manufacturer recommends that caution be exercised when administering tetracaine (ophthalmic) to breastfeeding women.
Briggs' Drugs in Pregnancy & Lactation
Adverse Reactions
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)
* See Cautions in AHFS Essentials for additional information.
Allergy and Idiosyncratic Reactions
Metabolism/Transport Effects
None known.
Drug Interactions Open Interactions
Methemoglobinemia Associated Agents: May enhance the adverse/toxic effect of Local Anesthetics. Specifically, the risk for methemoglobinemia may be increased. Risk C: Monitor therapy
Advanced Practitioners Physical Assessment/Monitoring
Check patient for allergies prior to procedure and document allergies to lidocaine, benzocaine, or prilocaine. Instruct patient and family to report any signs of severe reaction, such as shortness of breath; hives; chest tightness; or swelling of the mouth, face, lips, or tongue.
Nursing Physical Assessment/Monitoring
Check patient for allergies prior to procedure and document allergies to lidocaine, benzocaine, or prilocaine. Instruct patient and family to report any signs of severe reaction, such as shortness of breath; hives; chest tightness; or swelling of the mouth, face, lips, or tongue.
Dosage Forms: US
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, 30 mL)
Tetcaine: 0.5% (15 mL [DSC]) [contains chlorobutanol (chlorobutol), edetate 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 disodium]
Generic: 0.5% (1 mL, 2 mL [DSC], 4 mL, 15 mL)
Anatomic Therapeutic Chemical (ATC) Classification
- S01HA03
Generic Available (US)
Yes
Pricing: US
Solution (Altacaine Ophthalmic)
0.5% (per each): $6.25
0.5% (per mL): $0.67
Solution (Tetracaine HCl Ophthalmic)
0.5% (per mL): $3.07
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.
Mechanism of Action
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
Pharmacodynamics/Kinetics
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
Local Anesthetic/Vasoconstrictor Precautions
No information available to require special precautions
Effects on Dental Treatment
No significant effects or complications reported
Effects on Bleeding
No information available to require special precautions
Index Terms
Amethocaine Hydrochloride; Tetracaine HCl; Tetracaine Hydrochloride
References
Anninger W, Forbes B, Quinn G, Schreiner MS. The effect of topical tetracaine eye drops on emergence behavior and pain relief after strabismus surgery. J AAPOS. 2007;11(3):273-276.[PubMed 17383912]
Altacaine (tetracaine) [prescribing information]. Aquebogue, NY: Altaire Pharmaceuticals Inc; January 2018.
Kliegman RM and St. Geme J, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Saunders Elsevier; 2020.
Punyawattanaporn A, Tengtrisorn S, Sangsupawanich P. Pupil dilatation after single and triple doses of mydriatic agent in preterm infants. J Med Assoc Thai. 2009;92(11):1458-1462.[PubMed 19938737]
Tetracaine [prescribing information]. Forth Worth, TX: Alcon Laboratories Inc; October 2016.
TetraVisc (tetracaine) [prescribing information]. Richmond, TX: Ocusoft Inc; January 2010.
TetraVisc Forte (tetracaine) [prescribing information]. Richmond, TX: Ocusoft Inc; August 2009.
Brand Names: International
Amethocaine (JO); Covostet (ZA); Minims Amethocaine Eye Drops (AU); Ophtocain-N (DE); Ponti Ofteno (MX, PE); Tetrakain (SE); Tetrakain Minims (NO); Tvenforz (BE)
Last Updated 4/21/20
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