Dosage Forms
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) [contains chlorobutanol (chlorobutol), edetate disodium]
TetraVisc: 0.5% (12 ea, 5 mL) [contains benzalkonium chloride]
TetraVisc Forte: 0.5% (12 ea, 5 mL) [contains benzalkonium chloride, edetate disodium]
Generic: 0.5% (1 mL, 2 mL [DSC], 4 mL [DSC], 15 mL)
Pharmacology
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
Pharmacokinetics/Pharmacodynamics
Metabolism
Hepatic; detoxified by plasma esterases to aminobenzoic acid
Excretion
Urine
Onset of Action
Anesthetic: Within 30 seconds
Duration of Action
10 to 20 minutes
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.
Contraindications
Hypersensitivity to tetracaine or any component of the formulation.
Dosage and Administration
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.
Dosing: Geriatric
Refer to adult dosing.
Dosing: Pediatric
Ophthalmic anesthesia: Infants, Children, and Adolescents: Ophthalmic solution: Instill 1 drop as needed; 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 young infants; instill initial drop just prior to procedure/evaluation
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.
Storage
Store at room temperature. Protect from light; keep container closed tightly.
Drug Interactions
Methemoglobinemia Associated Agents: May enhance the adverse/toxic effect of Local Anesthetics. Specifically, the risk for methemoglobinemia may be increased. Monitor therapy
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)
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.
Pregnancy
Pregnancy Risk Factor
C
Pregnancy Considerations
Animal reproduction studies have not been conducted.
Patient Education
- Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)
- Patient may experience burning, stinging, or redness. Have patient report immediately to prescriber vision changes, eye pain, or severe eye irritation (HCAHPS).
- Educate patient about signs of a significant reaction (eg, 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. Patient should consult prescriber for additional questions.
Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients.
