Benzocaine

Has been reported following topical use, particularly with higher concentration (14% to 20%) spray formulations applied to the mouth or mucous membranes. When applied as a spray to the mouth or throat, multiple sprays (or sprays of longer than indicated duration) are not recommended. Use caution with breathing problems (asthma, bronchitis, emphysema, in smokers), inflamed/damaged mucosa, heart disease, children Special populations:

Due to the heightened risk of methemoglobinemia, not recommended for use in patients Dosage form specific issues:

Some dosage forms may contain benzyl alcohol; large amounts of benzyl alcohol (≥99 mg/kg/day) have been associated with a potentially fatal toxicity (“gasping syndrome”) in neonates; the “gasping syndrome” consists of metabolic acidosis, respiratory distress, gasping respirations, CNS dysfunction (including convulsions, intracranial hemorrhage), hypotension and cardiovascular collapse (AAP ["Inactive" 1997]; CDC 1982); some data suggests that benzoate displaces bilirubin from protein binding sites (Ahlfors 2001); avoid or use dosage forms containing benzyl alcohol with caution in neonates. See manufacturer’s labeling.

Some dosage forms may contain propylene glycol; large amounts are potentially toxic and have been associated hyperosmolality, lactic acidosis, seizures and respiratory depression; use caution (AAP 1997; Zar 2007). See manufacturer’s labeling. Other warnings/precautions:

When used for self-medication, notify healthcare provider if condition worsens, or does not improve within 7 days; clears up and occurs again within a few days; or if accompanied by additional symptoms (eg, swelling, rash, headache, nausea, vomiting, or fever). Do not use topical products on open wounds; avoid contact with the eyes. Do not use for a prolonged time and/or on large portions of the body.

When topical anesthetics are used prior to cosmetic or medical procedures, the lowest amount of anesthetic necessary for pain relief should be applied. High systemic levels and toxic effects (eg, methemoglobinemia, irregular heartbeats, respiratory depression, seizures, death) have been reported in patients who (without supervision of a trained professional) have applied topical anesthetics in large amounts (or to large areas of the skin), left these products on for prolonged periods of time, or have used wraps/dressings to cover the skin following application.