Report on Benzocaine Side Effects and Usage
Benzocaine is a local anesthetic and is the active ingredient in many OTC products used to relieve pain in the mouth and gums from a variety of conditions such as teething, canker sores, and irritation of the mouth and gums.
OTC benzocaine products come in the form of sprays, gels, liquids, and lozenges. There are many OTC benzocaine products sold under a verity of brand names. A partial list can be found here.
How does benzocaine Work?
When applied topically to the skin and mucous membranes it interferes with the ability of nerves to both initiate and conduct electrical signals, which blocks the transmission of nerve impulses that carry pain messages. In this way, benzocaine numbs the nerve endings near the surface of the skin that it is applied to.
Before Using Benzocaine
Before using any medication, the potential risks must be weighed against the known benefits of the drug. Here are some of the points to consider:
- Allergies: Tell your doctor if you have ever had an allergic reaction to this medicine or any other medication. Also tell your healthcare professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals.
- Pediatric: Because of the possible toxic effects of benzocaine, its use in children under 2 years of age is not recommended.
- Drug Interactions: Benzocaine has been reported to react with compounds in some sunscreens and hair dyes to produce an allergic reaction. Tell your healthcare professional if you are taking any prescription or nonprescription over-the-counter medicine, especially if you are taking medication that contains nitrates or nitrites. This includes nitroglycerin, Isordil®, Imdur®, Nitro-Bid®, Nitrostat®, or Transderm-Nitro®.
Other Medical Problems: If you have other medical problems that may affect the use of this medicine. Make sure you tell your doctor about any other medical problems, especially if you have one of the following:
- Children under the age of 2 years-Only use under the supervision of your child’s doctor.
- Glucose-6-phosphodiesterase deficiency (a hereditary metabolic disorder affecting red blood cells)
- Heart disease
- Hemoglobin-M disease (a hereditary metabolic disorder affecting red blood cells)
- Infection at or near the place of application
- Large sores, broken skin, or severe injury at the area of application: This may increase the chance of side effects.
- Lung or breathing problems (e.g., asthma, bronchitis, emphysema)
- May increase the risk of developing a serious side effect called methemoglobinemia.
- NADH-methemoglobin reductase deficiency (a hereditary metabolic disorder affecting red blood cells)
- Pyruvate-kinase deficiency (a hereditary metabolic disorder affecting red blood cells) – Use with caution.
- Smokers – Use with caution. May increase the severity of complications from methemoglobinemia (a rare but serious side effect that may occur with the use of this medicine)
If you have any medical condition, consult with your doctor before using benzocaine.
Proper Use of Benzocaine
Use this medication exactly as directed by your doctor. Do not use benzocaine for any other reason without first checking with your doctor.
Unless otherwise directed by your doctor, do not apply this medicine to burns, open wounds, or broken or inflamed skin.
Because this medicine is readily absorbed into the body through the skin it may be more likely than other topical anesthetics to cause unwanted effects if it is used too much or too long.
Always practice good hygiene when applying topical medications: Wash your hands with soap and water before and after using benzocaine.
Keep this medication away from your nose, mouth, and especially your eyes, because it can cause severe eye irritation. If any of the medicine does get into these areas, especially the eyes, flush with water for at least 15 minutes and check with your doctor right away.
Check the package label carefully to see if the product contains alcohol, which is flammable. Do not use any product containing alcohol near a fire or open flame, or while smoking. Also, do not smoke after applying a flammable product until it has completely dried.
If you are using a spray form of benzocaine, do not spray it directly on your face. Instead, use your hand or an applicator (e.g., a cotton swab or a sterile gauze pad) to apply the medicine.
To use the pad or swab form, open the package according to the directions. When treating a bee sting, always remove the stinger if that is possible before using the medicine. Then wipe the pad or swab across the affected skin area.
If you are using the gel or liquid form of benzocaine use it only when needed, but not for more than four times a day.
The appropriate dosage of this medicine will be different for different patients with different conditions. Follow your doctor’s instructions or the directions on the label. If your dosage is different, do not change it unless told to do so by your healthcare provider. The following information includes only the average doses of this medicine.
The amount of medicine you use depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between applications, and the length of time you can safely use this medicine depends on the medical problem for which it is being used.
Stop using this medicine and check with your doctor right away if there is any skin rash, burning, stinging, swelling, or irritation of the skin.
If the condition being treated does not improve within 7 days, or if it becomes worse, check with your doctor.
After applying this medicine to the skin of a child, watch the child carefully to make sure that he or she does not get any of the medicine into his or her eyes or mouth. Serious side effects can result if this medication gets into the mouth or is swallowed, especially in children.
Do not use cosmetics or other skin care products on areas of the skin that have been treated with benzocaine.
Along with the desired effects this medicine may cause some unwanted side effects. There are no common side effects are associated with benzocaine. However, less common side effects are listed below. You may not experience all of these side effects, or even any but if they do occur they may need medical attention and should be reported to your doctor.
A bluish color of the fingernails, lips, skin, palms, or nail beds is known to be a rare side effect of benzocaine.
The rate of Incidence is unknown on the following possible side effects:
- Blistering, burning, crusting, dryness, or flaking of the skin
- Cracking, itching, redness, or stinging of the skin
- Dark urine
- Difficulty with breathing
- Difficulty with walking
- Dizziness or lightheadedness
- Irritation of the nose
- Itching, scaling, severe redness, soreness, or swelling of the skin
- Numbness in hands or feet
- Pale skin
- Rapid heart rate
- Red, sore eyes
- Shortness of breath
- Sore throat
- Unusual bleeding or bruising
- Unusual drowsiness
- Unusual tiredness or weakness
In some patients, other side effects not listed may also occur. If you notice side effects that are not listed, check with your doctor. You may report side effects to the FDA at 1-800-332-1088.
Benzocaine may also cause a serious side-effect called methemoglobinemia; a severe allergic reaction on the skin, which produces large, red, hive-like swellings. Methemoglobinemia is a condition that occurs when something other than oxygen binds to hemoglobin in the blood stream, causing serious, life-threatening problems.
Methemoglobinemia may occur after using the spray, over-the-counter gel, or liquid form of benzocaine. The risk may be increased in infants younger than 4 months of age, elderly patients, or patients with certain inborn defects. This condition has occurred when patients receive too much of the medicine, but can also occur when even small amounts are used. Call your doctor right away if you or your child has the following symptoms after using this medicine: pale, gray, or blue-colored skin, lips, or nails; headache; confusion; lightheadedness; fast heartbeat; shortness of breath; or unusual tiredness or weakness.
Store the medicine in a closed container at room temperature, away from heat, moisture, direct light, and children. Keep from freezing. Do not keep this medicine inside a car where it could be exposed to extreme heat or cold.
Do not use this medication after the expiration date.
The FDA reports a rare, but serious and potentially fatal adverse effect with the use of over-the-counter (OTC) benzocaine gels and liquids applied to the gums or mouth
On April 7, 2011, the U.S. Food and Drug Administration (FDA) warned the public about the use of over-the-counter (OTC) products containing benzocaine, an ingredient used to reduce pain in the mouth and gums. Benzocaine use may cause a rare, but serious condition where the amount of oxygen that can be carried through the blood stream is greatly reduced. This condition is called methemoglobinemia.
The FDA is particularly concerned about the use of OTC benzocaine products in children for relief of pain from teething because of the serious outcomes, including death, that may be associated with methemoglobinemia, as well as the difficulty parents or consumers may have in recognizing the signs and symptoms of methemoglobinemia when using these products at home. Furthermore, symptoms of methemoglobinemia may not always be evident or attributed to the condition.
Parents and caregivers should not use OTC benzocaine products on children under two years of age, except under the advice and supervision of a healthcare professional. If benzocaine products are used, it should be used sparingly and only when needed, but not more than four times a day.
What should parents and caregivers do if they are currently using OTC benzocaine products on children who are teething?
A. Parents, caregivers, and consumers should not use OTC benzocaine products on children under two years of age, except under the advice and supervision of a healthcare professional. Parents and caregivers using OTC benzocaine products on children should closely watch for signs and symptoms of methemoglobinemia. These may include pale, gray or blue colored skin, lips, and nail beds; shortness of breath; fatigue; confusion; headache; lightheadedness; and rapid heart rate. In some cases, symptoms of methemoglobinemia may not always be evident or attributed to the condition. Symptoms usually appear within minutes to one or two hours after using a benzocaine product, and methemoglobinemia can develop after using the product for the first time, as well as after several uses.
Parents and caregivers that suspect a child may have methemoglobinemia should stop using the product and seek medical help immediately by calling 911.
What are alternative methods for reducing pain from teething?
A. The American Academy of Pediatrics’ recommends the following for treating teething pain:
- Give the child a teething ring chilled in the refrigerator.
- Gently rub or massage the child’s gums with your finger to relieve the symptoms of teething in children.
If these methods do not provide relief from teething pain, consumers should contact a healthcare professional to identify other treatments.
- Markman L. Teething: facts and fiction. Pediatr Rev. 2009;30:e59-64.
- American Academy of Pediatrics. Teething: 4 to 7 Months.
OTC Products that Contain Benzocaine
Dent’s Maxi-Strength Toothache
Orajel Medicated Toothache
Orajel Mouth Sore
Orajel Multi-Action Cold Sore
Anbesol Cold Sore Therapy
Dry Socket Remedy
Orajel Ultra Mouth Sore
Anbesol Maximum Strength
Red Cross Canker Sore
Benzocaine Burn Spray
Rid-A-Pain Dental Drops
Boil Ease Maximum Strength
Kanka Soft Brush
Cepacol Sore Throat
Lanacane Maximum Strength
Orabase with Benzocaine
Walgreens Oral Anesthetic Paste
Orajel Denture Plus
Dent’s Extra Strength Toothache
Orajel Maximum Strength
Zilactin Toothache and Gum Pain
*This list is not all-inclusive
What, if any side effects does cetacaine pose if used after expiration date?
AskDocWeb: Cetacaine is a combination drug containing 14% Benzocaine, 2% Butyl Aminobenzoate, and 2% Tetracaine Hydrochloride. Since using any medication after it has expired is not recommended, very little is known or published about the effect of using it past that date.
The most likely side effects are paleness (37%), erythema (30%) abnormal redness of the skin resulting from dilation of blood vessels (as in sunburn or inflammation), burning sensation (17%), and edema (10%), which is swelling from excessive accumulation of serous fluid in tissue.
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Last post November 14, 2016
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