What is dibucaine ointment used for. How should dibucaine ointment be applied. What are the potential side effects of dibucaine ointment. Who should avoid using dibucaine ointment. How does dibucaine ointment work as a local anesthetic. When should you consult a healthcare provider about using dibucaine ointment. What precautions should be taken when using dibucaine ointment.

Understanding Dibucaine Ointment: A Powerful Local Anesthetic

Dibucaine ointment, also known by its brand name Nupercainal, is a topical medication used to alleviate pain and itching associated with various skin conditions. As a local anesthetic, it works by temporarily numbing the area where it is applied, providing relief from discomfort.

Primary Uses of Dibucaine Ointment

Dibucaine ointment is primarily used for:

• Minor skin irritations
• Hemorrhoids
• Insect bites and stings
• Sunburn
• Minor cuts and burns
• Other skin-related discomforts

Is dibucaine ointment effective for all types of skin irritations. While dibucaine ointment is useful for many minor skin issues, it’s not suitable for all conditions. It’s essential to consult with a healthcare provider for persistent or severe skin problems.

Proper Application and Usage of Dibucaine Ointment

To ensure the safe and effective use of dibucaine ointment, follow these guidelines:

1. Clean the affected area thoroughly before application.
2. Apply a thin film of the ointment to the affected area.
3. Use only as directed on the package label or by your healthcare provider.
4. Do not use more often than recommended.
5. Avoid applying to large areas of the body.
6. Do not use on open wounds or infected areas.

Can dibucaine ointment be used internally. No, dibucaine ointment is for external use only. Never ingest the medication or apply it to mucous membranes, including the eyes, unless specifically instructed by a healthcare professional.

Potential Side Effects and Precautions

While dibucaine ointment is generally safe when used as directed, it can cause side effects in some individuals. Common side effects may include:

• Temporary numbness at the application site
• Mild stinging or burning sensation
• Skin irritation or rash

Are there any serious side effects associated with dibucaine ointment. In rare cases, more severe reactions can occur. Seek immediate medical attention if you experience:

• Severe allergic reactions (swelling of face, lips, tongue)
• Difficulty breathing
• Unusual bleeding at the application site
• Signs of infection (increased redness, warmth, or pus)

Special Considerations for Specific Groups

Certain individuals should exercise caution or avoid using dibucaine ointment altogether:

Pregnant and Breastfeeding Women

If you’re pregnant or breastfeeding, consult your healthcare provider before using dibucaine ointment. While limited data suggest it may be safe, it’s crucial to weigh the potential risks and benefits.

Children

Dibucaine ointment is not approved for use in children. Always consult a pediatrician before applying any topical medication to a child’s skin.

Individuals with Allergies

Those with known allergies to local anesthetics or other ingredients in the ointment should avoid using dibucaine.

How can you determine if you’re allergic to dibucaine ointment. Before applying the ointment to a large area, perform a patch test on a small section of skin and observe for any adverse reactions over 24 hours.

Interactions with Other Medications and Substances

While significant drug interactions with dibucaine ointment are rare, it’s essential to inform your healthcare provider about all medications, supplements, and topical products you’re using. This includes:

• Prescription medications
• Over-the-counter drugs
• Herbal supplements
• Other topical treatments

Can dibucaine ointment be used in conjunction with other topical medications. In most cases, it’s best to avoid applying multiple topical treatments to the same area simultaneously unless directed by a healthcare professional. This helps prevent potential interactions or increased absorption of the medications.

Proper Storage and Disposal of Dibucaine Ointment

To maintain the effectiveness and safety of dibucaine ointment:

• Store at room temperature (between 15-30°C or 59-86°F)
• Keep out of reach of children
• Do not use after the expiration date
• Dispose of unused medication properly

How long can dibucaine ointment be stored after opening. Once opened, dibucaine ointment typically remains effective until the expiration date printed on the packaging, provided it’s stored correctly. However, if you notice any changes in color, consistency, or odor, discard the product immediately.

When to Seek Medical Attention

While dibucaine ointment is effective for minor skin irritations, certain situations warrant professional medical advice:

• Symptoms persist or worsen after several days of use
• The affected area shows signs of infection
• You experience severe or unusual side effects
• You’re unsure about the cause of your skin condition
• You have concerns about using the ointment with other medications

Should you continue using dibucaine ointment if your condition doesn’t improve. If your symptoms don’t show improvement after a few days of use, discontinue the ointment and consult your healthcare provider. They may recommend alternative treatments or further evaluation of your condition.

Understanding the Mechanism of Action

Dibucaine belongs to a class of medications known as local anesthetics. It works by temporarily blocking nerve signals in the skin, which results in numbing of the affected area. This mechanism of action is what allows dibucaine to provide relief from pain and itching.

The Science Behind Local Anesthetics

Local anesthetics like dibucaine function by:

1. Penetrating the skin or mucous membranes
2. Blocking sodium channels in nerve cells
3. Preventing the transmission of pain signals to the brain
4. Providing temporary numbness and relief from discomfort

How long does the numbing effect of dibucaine ointment last. The duration of numbness can vary depending on factors such as the concentration of the ointment, the area of application, and individual response. Typically, the effect lasts for several hours, but it’s important not to rely on the numbness to mask potentially serious conditions.

Comparing Dibucaine to Other Topical Anesthetics

Dibucaine is one of several topical anesthetics available for over-the-counter use. Other common options include:

• Lidocaine
• Benzocaine
• Pramoxine
• Tetracaine

Each of these medications has its own unique properties, strengths, and potential uses. Dibucaine is often chosen for its potency and longer-lasting effects compared to some other options.

Strengths and Limitations of Dibucaine

Dibucaine offers several advantages:

• Powerful numbing effect
• Longer duration of action
• Effective for various skin irritations

However, it also has some limitations:

• Not suitable for use on large areas of skin
• May cause allergic reactions in sensitive individuals
• Not approved for use in children

Is dibucaine ointment more effective than other over-the-counter anesthetics. While dibucaine is potent, its effectiveness compared to other anesthetics can depend on the specific condition being treated and individual response. Consult with a healthcare provider to determine the most appropriate option for your needs.

The History and Development of Dibucaine

Dibucaine, also known as cinchocaine, has a rich history in the field of local anesthetics. It was first synthesized in 1925 by chemists at the Bayer pharmaceutical company. Initially, it was used as a spinal anesthetic, but its use in this capacity declined due to the development of safer alternatives.

Over time, researchers discovered the benefits of dibucaine as a topical anesthetic, leading to its current use in ointments and creams for minor skin irritations and hemorrhoids.

Evolution of Topical Anesthetics

The development of topical anesthetics like dibucaine has revolutionized the treatment of minor skin discomforts. These medications have allowed for:

• At-home management of minor pain and itching
• Reduced need for oral pain medications
• Improved quality of life for those with chronic skin conditions
• Enhanced comfort during minor medical procedures

How has the use of dibucaine changed over time. While initially used as a more invasive anesthetic, dibucaine’s application has shifted primarily to topical use. This change reflects the ongoing research and development in the field of pain management and dermatology.

Future Prospects and Research

The field of topical anesthetics, including dibucaine, continues to evolve. Current and future research focuses on:

• Developing new formulations for improved absorption and efficacy
• Exploring combination therapies with other active ingredients
• Investigating potential new applications for dibucaine
• Enhancing safety profiles and reducing side effects

These ongoing efforts aim to provide more effective and safer options for managing various skin conditions and minor pain.

Potential New Applications

While dibucaine is currently used primarily for minor skin irritations and hemorrhoids, researchers are exploring its potential in other areas, such as:

• Pre-treatment for cosmetic procedures
• Management of chronic skin conditions
• Pain relief in dental procedures
• Veterinary applications

Could dibucaine be used for more serious medical conditions in the future. As research progresses, it’s possible that new applications for dibucaine may be discovered. However, any new uses would require extensive clinical trials and approval from regulatory agencies before becoming available to the public.

The Importance of Responsible Use

While dibucaine ointment can be an effective tool for managing minor skin discomfort, it’s crucial to use it responsibly. Overuse or misuse of topical anesthetics can lead to:

• Increased risk of side effects
• Potential masking of more serious conditions
• Development of skin sensitivity or allergies
• Reduced effectiveness over time

To ensure safe and effective use of dibucaine ointment:

1. Always follow the instructions on the package or as directed by your healthcare provider
2. Use only for the recommended duration
3. Avoid applying to large areas of skin
4. Don’t use on open wounds or infected areas
5. Seek medical advice if symptoms persist or worsen

How can you determine if you’re using too much dibucaine ointment. Signs of overuse may include increased skin irritation, persistent numbness, or systemic effects such as dizziness or irregular heartbeat. If you experience any of these symptoms, discontinue use and consult a healthcare professional immediately.

Natural Alternatives and Complementary Approaches

While dibucaine ointment is effective for many minor skin irritations, some individuals may prefer natural alternatives or complementary approaches. Some options to consider include:

• Aloe vera gel for minor burns and skin irritations
• Witch hazel for hemorrhoids and skin inflammation
• Tea tree oil for insect bites and minor skin infections
• Chamomile or calendula creams for soothing irritated skin
• Cold compresses for reducing pain and inflammation

It’s important to note that while these natural remedies can be effective for some individuals, they may not provide the same level of pain relief as dibucaine ointment. Additionally, natural products can also cause allergic reactions or skin irritation in some people.

Combining Natural Remedies with Dibucaine

In some cases, natural remedies can be used in conjunction with dibucaine ointment to enhance overall relief. However, it’s crucial to:

1. Consult with a healthcare provider before combining treatments
2. Allow sufficient time between applications of different products
3. Monitor for any adverse reactions or interactions
4. Discontinue use if irritation occurs

Can natural remedies be as effective as dibucaine ointment for pain relief. The effectiveness of natural remedies can vary widely depending on the individual and the specific condition being treated. While some people find significant relief from natural alternatives, others may require the more potent numbing effect of dibucaine. It’s always best to discuss options with a healthcare provider to determine the most appropriate treatment approach.

Dibucaine topical ointment

What is this medicine?

Dibucaine (dye byoo kane) is a local anesthetic. It is used to decrease pain and itching from minor skin irritations or hemorrhoids.

This medicine may be used for other purposes; ask your health care provider or pharmacist if you have questions.

COMMON BRAND NAME(S): Nupercainal

What should I tell my health care provider before I take this medicine?

They need to know if you have any of these conditions:

• an unusual or allergic reaction to dibucaine, local anesthetics, other medicines, foods, dyes, or preservatives
• pregnant or trying to get pregnant
• breast-feeding

How should I use this medicine?

This medicine is for external use only. Do not take this medicine by mouth. Do not use this medicine in the eyes. Follow the directions on the package label. Apply a thin film to the affected area. Do not use this medicine more often than directed.

Talk to your pediatrician regarding the use of this medicine in children. This medicine is not approved for use in children.

Overdosage: If you think you have taken too much of this medicine contact a poison control center or emergency room at once.

NOTE: This medicine is only for you. Do not share this medicine with others.

What if I miss a dose?

If you miss a dose, use it as soon as you can. If it is almost time for your next dose, use only that dose. Do not use double or extra doses.

What may interact with this medicine?

Interactions are not expected. Do not use any other skin products on the same area of skin without asking your doctor or health care professional.

This list may not describe all possible interactions. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.

What should I watch for while using this medicine?

Tell your doctor or healthcare professional if your symptoms do not start to get better or if they get worse. See your doctor right away if you get signs of an infection where you use this medicine.

Do not get this medicine in your eyes. If you do, rinse out with plenty of cool tap water.

Do not apply this medicine to areas of skin that are infected, open or damaged. This may increase the amount of medicine that passes through your skin and increase the risk of serious side effects. Do not use more medicine than directed.

Be careful to avoid injury while the area is numb and you are not aware of pain.

What side effects may I notice from receiving this medicine?

Side effects that you should report to your doctor or health care professional as soon as possible:

• allergic reactions like skin rash, itching or hives, swelling of the face, lips, or tongue
• bleeding where used
• rash and irritation where used

Side effects that usually do not require medical attention (report to your doctor or health care professional if they continue or are bothersome):

• numb where used
• stinging where used

This list may not describe all possible side effects. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Where should I keep my medicine?

Keep out of the reach of children.

Store at room temperature between 15 and 30 degrees C (59 and 86 degrees F). Throw away any unused medicine after the expiration date.

NOTE: This sheet is a summary. It may not cover all possible information. If you have questions about this medicine, talk to your doctor, pharmacist, or health care provider.

dibucaine topical

What is the most important information I should know about dibucaine topical?

Follow all directions on your medicine label and package. Tell each of your healthcare providers about all your medical conditions, allergies, and all medicines you use.

What is dibucaine topical?

Dibucaine is an anesthetic, or numbing medicine.

Dibucaine topical (for the skin) is used to treat minor pain and itching caused by minor cuts or burns, insect bites or stings, sunburn, or other skin irritations.

Dibucaine topical is also used to relieve rectal pain and itching caused by hemorrhoids or other rectal irritations.

Dibucaine topical may also be used for purposes not listed in this medication guide.

What should I discuss with my healthcare provider before using dibucaine topical?

You should not use dibucaine topical if you are allergic to it.

Ask a doctor or pharmacist if this medicine is safe to use if you have any type of allergy.

Ask a doctor before using this medicine if you are pregnant or breastfeeding.

If you apply dibucaine topical to your chest, avoid areas that may come into contact with the baby’s mouth.

Do not use this medicine on a child younger than 12 years old without medical advice.

How should I use dibucaine topical?

Use exactly as directed on the label, or as prescribed by your doctor.

Do not take by mouth. Topical medicine is for use only on the skin. Dibucaine topical can cause serious side effects if it gets into the mouth, especially in a child.

It is best to use no more than 1 ounce of dibucaine per day (24 hours). If you use the ointment on a child, use no more than 1/4 of an ounce per day.

Wash your hands before and after applying this medication.

Do not apply this medicine to areas of infection, open wounds, broken skin, burns, or irritated skin.

You may cover the treated skin area with a light bandage or gauze dressing.

For hemorrhoids, apply the ointment to the outside of the rectum after each bowel movement, up to 4 times per day.

Call your doctor if your symptoms do not improve after 7 days of treatment, or if they get worse.

Store at room temperature. Do not freeze. Keep the tube tightly closed when not in use.

What happens if I miss a dose?

Apply the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not apply two doses at one time.

What happens if I overdose?

An overdose of dibucaine topical is not expected to be dangerous. Seek emergency medical attention or call the Poison Help line at 1-800-222-1222 if anyone has accidentally swallowed the medication.

What should I avoid while using dibucaine topical?

Do not get this medicine in your eyes, nose, or mouth. If contact does occur, rinse with water.

Avoid using other medications or skin products on the areas you treat with dibucaine unless your doctor tells you to.

What are the possible side effects of dibucaine topical?

Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Stop using dibucaine topical and call your doctor at once if you have:

• severe burning or stinging;
• rectal bleeding; or
• a rash or other irritation of your skin.

Less serious side effects may be more likely, and you may have none at all.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect dibucaine topical?

Medicine used on the skin is not likely to be affected by other drugs you use. But many drugs can interact with each other. Tell each of your healthcare providers about all medicines you use, including prescription and over-the-counter medicines, vitamins, and herbal products.

Where can I get more information?

Your pharmacist can provide more information about dibucaine topical.

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

Every effort has been made to ensure that the information provided by Cerner Multum, Inc. (‘Multum’) is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum’s drug information does not endorse drugs, diagnose patients or recommend therapy. Multum’s drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2021 Cerner Multum, Inc. Version: 4.01. Revision date: 5/20/2019.

Dibucaine topical ointment

Brand Name: Nupercainal

What is this medicine?

Dibucaine (dye byoo kane) is a local anesthetic. It is used to decrease pain and itching from minor skin irritations or hemorrhoids.

How should I use this medicine?

This medicine is for external use only. Do not take this medicine by mouth. Do not use this medicine in the eyes. Follow the directions on the package label. Apply a thin film to the affected area. Do not use this medicine more often than directed.

Talk to your pediatrician regarding the use of this medicine in children. This medicine is not approved for use in children.

What side effects may I notice from receiving this medicine?

Side effects that you should report to your doctor or health care professional as soon as possible:

• allergic reactions like skin rash, itching or hives, swelling of the face, lips, or tongue
• bleeding where used
• rash and irritation where used

Side effects that usually do not require medical attention (report to your doctor or health care professional if they continue or are bothersome):

• numb where used
• stinging where used

What may interact with this medicine?

Interactions are not expected. Do not use any other skin products on the same area of skin without asking your doctor or health care professional.

What if I miss a dose?

If you miss a dose, use it as soon as you can. If it is almost time for your next dose, use only that dose. Do not use double or extra doses.

Where should I keep my medicine?

Keep out of the reach of children.

Store at room temperature between 15 and 30 degrees C (59 and 86 degrees F). Throw away any unused medicine after the expiration date.

What should I tell my health care provider before I take this medicine?

They need to know if you have any of these conditions:

• an unusual or allergic reaction to dibucaine, local anesthetics, other medicines, foods, dyes, or preservatives
• pregnant or trying to get pregnant
• breast-feeding

What should I watch for while using this medicine?

Tell your doctor or healthcare professional if your symptoms do not start to get better or if they get worse. See your doctor right away if you get signs of an infection where you use this medicine.

Do not get this medicine in your eyes. If you do, rinse out with plenty of cool tap water.

Do not apply this medicine to areas of skin that are infected, open or damaged. This may increase the amount of medicine that passes through your skin and increase the risk of serious side effects. Do not use more medicine than directed.

Be careful to avoid injury while the area is numb and you are not aware of pain.

NOTE:This sheet is a summary. It may not cover all possible information. If you have questions about this medicine, talk to your doctor, pharmacist, or health care provider. Copyright© 2020 Elsevier

Dibucaine Toxicosis in a Dog

Local anesthetics (LAs) cause reversible inhibition of axonal voltage-gated sodium channels inhibiting depolarization and thus neural conduction [1]. Binding to the “inner vestibule” of the sodium channel, LAs inhibit the conformational change required for channel activation [2]. The ability of LAs to cause neural blockade is affected by the nerve fiber type, the sodium channel isoform, and the state of the channel [2]. Blockade is “use dependent” as LAs have a higher affinity for sodium channels in the open or inactivated state as compared to the resting state [3]. Thus, repeated depolarizations increase the fraction of drug-bound channels. Small myelinated axons are most sensitive to LA blockade followed by large myelinated axons with small non-myelinated axons being the least sensitive [2]. In addition to sodium channel blockade, LAs also decrease catecholamine-dependent production of cAMP, block β2-adrenergic receptors, block L-type calcium channels, and may interfere with cellular energy metabolism [4–7].

There are many clinically useful LAs which are classified by an esther or amide link between a hydrophilic amine end and a lipophilic aromatic end. Amide-linked LAs include bupivicaine, dibucaine, lidocaine, prilocaine, and others. Amide-linked LAs can be further divided into aminoacyl or aminoakyl amides, based on the structure of the amide bond [8]. Dibucaine (2-butoxy-N-[2-(diethylamino)ethyl]-4-quinolinecarboxamide), an aminoakyl LA, was first used clinically in 1932 and is also known as cincaine, cinchocaine, sovcain, percaine, and various other names [3]. It is available as an ointment (0.25–1%), cream (0.25–1%), aerosol (0.25–1%), solution (0.25%), or suppository (2%) intended to treat discomfort associated with sunburn, eczema, minor rashes, minor scratches, insect bites, or poison ivy used alone or in combination with other active ingredients to treat pain associated with hemorrhoids or other anorectal disorders [2]. Topical dibucaine ointments are marketed directly to consumers in the USA and are available without prescription. In addition, dibucaine is used in combination with secobarbital sodium as a euthanasia solution for veterinary species in the UK and Ireland and as a preservative-free solution for spinal anesthesia (outside of the USA). An injectable form of dibucaine has been previously approved for use in humans by the FDA but is not commercially available in the USA [9].

For stability, most LAs are formulated as a hydrochloride salt in which the LA is in its water soluble (ionized) form; therefore, intact skin is an effective barrier to absorption [8]. To overcome this barrier, a mixture of lidocaine and prilocaine, both in a pure base (non-ionized) form, with unique physical properties has been developed. This mixture plus an inert vehicle produces a cream (eutectic mixture of local anesthetics or EMLA) that is able to penetrate intact skin and anesthetize dermal and subcutaneous sensory nerve endings [8]. Topical application of a LA on abraded skin or mucous membranes or covering the medication with an occlusive dressing will increase systemic absorption [10]. When injected into a tissue space or after mucosal application, LAs are quickly absorbed systemically and reach peak concentrations in 5 to 25 min [1]. The bioavailability of LAs after mucosal application depends on total dose, mucosal integrity, presence or absence of hyperemia, and contact time [1]. Quick absorption when applied to mucosal membranes, like the oral mucosa, explains the rapid onset of clinical signs in this case.

Once absorbed systemically, amide-linked LAs are metabolized in the liver by cytochrome P450 enzymes [3]. Amide-linked LAs are more slowly metabolized than ester-linked LAs, which are metabolized mainly by plasma esterases. Dibucaine is excreted both in the urine and bile [11]. In rats, unchanged drug has a blood half-life of 11.6 min, and metabolites have a biphasic half-life of 37.7 min and 11.2 h [11]. Major urinary metabolites differ between species [12]. Although the biologic activity of dibucaine metabolites remains unknown, metabolites of other amide-linked LAs are reported to contribute to toxicity [3]. In this case, resolution of neurologic signs was relatively soon after ingestion (60 min), indicative of a short plasma half-life of unchanged drug or drug levels barely reaching that required for intoxication and either clinically insignificant biologic activity or clinically insignificant levels of metabolites.

Local anesthetic toxicity occurs due to unintentional intravascular injection or direct over dosage via peripheral injection or, in rare cases, via topical or oral exposure. The acute oral LD50 of dibucaine was found to be 42 mg/kg in birds, and in a case series of three children who ingested a lethal dose of dibucaine ointment, ingested amounts were estimated to be 15 and 19 mg/kg with one child ingesting an unknown amount [13, 14]. Only one child vomited after ingestion. In the present case, the patient ingested approximately 38 mg/kg of dibucaine although much of the ingested ointment was believed to have been vomited.

Generally, LAs are safe drugs when administered where intended and at appropriate doses, but with over dosage gastrointestinal, neurologic, and cardiac signs can occur. Gastrointestinal signs occur before or after neurologic signs which precede cardiovascular dysfunction [15]. de Jong et al. described one exception in which cats administered subconvulsant doses of bupivicaine and etidocaine consistently had cardiac arrhythmias [16]. Although not reported with dibucaine toxicosis, amide-linked LAs can cause methemoglobinemia, which is most commonly seen with prilocaine [3, 10, 15]. The clinical signs seen in this case are presumed to be the effects of dibucaine. The inactive ingredients found in the ointment can cause gastrointestinal disturbances, which probably requires ingestion of larger amounts than were ingested in this case [17]. In addition, the neurologic signs seen in this case are not reported with any of the inactive ingredients [17].

Drugs that inhibit sodium channels are only able to depress neural tissue activity [18]. The ability of LAs to cause apparent neural excitation (i.e., seizures, twitching) can be explained by the fact that excitatory cortical neurons are more resistant to the effects of LAs than inhibitory cortical neurons [19]. With the blockade of inhibitory cortical neurons, excitatory cortical neurons function unopposed, resulting in neural excitation. In addition to inhibitory cortical neuron blockade, net release of glutamate, a stimulatory amino acid, may also contribute to the initial central nervous system excitation [2]. As drug levels increase, excitatory cortical neurons are also inhibited which, combined with glutamate receptor desensitization and transmitter depletion, eventually leads to CNS depression [2]. In humans, neurologic effects of LA toxicity initially cause numbness of the tongue and mouth followed by lightheadedness, dizziness, tinnitus, vision disturbance, and slurred speech [10, 18]. At higher drug levels, muscle twitching, irrational conversation, and unconsciousness are seen [10, 15, 18]. As drug concentrations continue to increase, neurologic signs progress to seizures, coma, and respiratory arrest [15, 18]. If systemic levels of the LA rise quickly, the early signs of neurologic dysfunction might not be recognized. In children that have ingested lethal doses of dibucaine ointment, neurologic dysfunction presented as some combination of lethargy, ataxia, unconsciousness, and seizures [14]. The neurologic manifestations of dibucaine toxicosis in this case included ptyalism, disorientation, muscle fasciculations, and ataxia. The ptyalism seen in this case could be due to nausea but is more likely due to the numbness of the cheeks and tongue, which is a local and not central nervous system effect [18].

The cardiotoxicity of different LAs varies and is directly related to the LA potency [20]. Deleterious cardiovascular effects of LAs generally require higher drug concentrations than are required to cause neurologic signs [15, 21]. In dogs, after rapid IV administration, the cumulative dose required to cause cardiac depression and death was 3.5, 5.1, 6.7, and 4.1 times the convulsant dose for lidocaine, etidocaine, tetracaine, and bupivicaine, respectively [21]. Local anesthetic intoxication alters the electrophysical and mechanical activity of the myocardium in addition to affecting the peripheral vasculature [22]. In addition to sodium and L-type calcium channel blockade, LAs inhibit catecholamine-dependent cAMP production and might interfere with cellular energy production, contributing to cardiotoxicity [4, 6, 7]. Automaticity in the SA and AV nodes and conduction through the Purkinje fibers and ventricular myocardium are decreased [23, 24]. As a result of the conduction disturbances, susceptibility to reentry arrhythmias is increased [23, 24]. In addition to conduction disturbances, myocardial contractility is decreased, which leads to decreased cardiac output [20, 24]. Early ECG changes include bradycardia, a prolonged P–R interval, and a wide QRS complex [25]. Other ECG changes can include ventricular tachyarrhythmias, asystole, and conduction blocks [26]. After intravenous overdose of bupivicaine, in anesthetized dogs, the most common arrhythmia was a slow idioventricular rhythm with electromechanical dissociation: ventricular tachycardia was seen in two of six dogs [27]. In cats, sub-convulsant doses of LAs caused aberrant intraventricular conduction and nodal and ventricular arrhythmias [16]. The effect of LAs, with the exception of cocaine, on peripheral vasculature is biphasic with subtoxic levels causing vasoconstriction and higher drug levels causing vasodilation [28]. Vasodilation may be caused by nitrous oxide (NO) synthase-dependent NO production induced by LAs [29]. Although vasodilation occurs, a study in dogs found that hypotension was primarily the result of myocardial depression and not a decrease in peripheral vascular resistance [20]. In children that have ingested a lethal dose of dibucaine ointment, cardiovascular effects included wide complex bradycardia which in some cases was irregular, ventricular tachycardia, ventricular fibrillation, and cardiopulmonary arrest [14]. Cardiovascular dysfunction was not detected in the present case as no arrhythmias were seen on ECG and systemic blood pressure was normal. Although myocardial contractility was not assessed via echocardiography, with the absence of hypotension or other signs of cardiovascular dysfunction, myocardial contractility was presumed to be normal. If clinical progression of oral dibucaine toxicosis in dogs is similar to clinical progression in humans, then more severe neurologic signs would be expected before significant cardiovascular dysfunction [14]. It is likely that the presence of neurologic signs without cardiovascular dysfunction is directly related to drug levels, although dibucaine levels were not measured in this case.

In humans, the recommended treatment after ingestion of 1% dibucaine ointment includes consuming two glasses of water and inducing vomition [30]. Vomition was not induced in this case as the patient had previously vomited multiple times. With any LA toxicosis if neurologic or cardiovascular dysfunction is present, immediate treatment is necessary. Maintenance of a patent airway and respiratory support is essential. Studies using cats, dogs, and sheep have shown that LA intoxication is more severe in the presence of acidosis (respiratory or metabolic), hypercarbia, and hypoxia [31–34]. Thus, avoidance of hypoventilation causing respiratory acidosis and hypoperfusion causing metabolic acidosis is key. Seizures can exacerbate hypercapnia and acidosis. Thus, early and appropriate treatment of seizure activity is vital [35, 36]. Seizures can be self limiting but may require a benzodiazepine, propofol, or barbiturate, which usually are effective [3, 26]. If the patient requires artificial ventilation, monitoring end-tidal carbon dioxide concentration and acid–base status via arterial blood gas analysis is recommended. Blood electrolyte levels including potassium should be monitored as hyperkalemia has been shown to increase LA toxicity [37]. Continuous or frequent intermittent monitoring of systemic blood pressure and ECG is also prudent if present cardiopulmonary arrest should be treated with standard cardiopulmonary resuscitation, which historically has been relatively refractory to treatment [26, 38]. The most effective positive ionotrope, vasopressor, or anti-arrhythmic remains unknown, although correction of hypotension and arrhythmias leading to hypoperfusion appears to be essential [16, 31–33]. Kasten et al. described effective cardiovascular resuscitation after bupivicaine overdose in anesthetized dogs using open-chest cardiac massage, bretylium, atropine, epinephrine, and intravenous crystalloid fluids [27]. Hypotension could be treated with epinephrine or norepinephrine, although amrinone was found to be superior to epinephrine at reversing bupivicaine-induced cardiovascular depression in dogs [37, 38]. Amrinone also improved cardiac output, mean arterial pressure, and heart rate in severe bupivicaine intoxication in pigs [38]. Amrinone may be more effective than epinephrine due to its ability to increase cAMP independent of the β-adrenergic receptor. The administration of ephedrine-corrected hypotension and arrhythmias in cats administered supraconvulsant doses of lidocaine [16]. Bradycardia can be treated with atropine or may resolve with the administration of epinephrine, norepinephrine, or amrinone [27, 37, 39]. Further use of LAs as anti-arrhythmics (such as lidocaine) should be avoided, and arrhythmias might be better treated with bretylium, phenytoin, or amiodarone [25, 37–39]. While not readily available to veterinary patients, the Association of Anesthetists of Great Britain and Ireland (AAGBI) recommends considering cardiopulmonary bypass, which has been used successfully in bupivicaine toxicosis [26, 40]. Another novel treatment includes the administration of insulin and glucose with or without potassium, which decreased the time for mean arterial pressure, cardiac output, heart rate, and mixed venous oxygen saturation to improve to prebupivicaine levels, after induced bupivicaine toxicosis in dogs [41]. With oral intoxication, although only anecdotally beneficial, activated charcoal can be administered. Care must be taken to only administer charcoal to a patient with a protected airway (normal gag reflex or tracheal intubation). Charcoal was administered in this case as the patient was conscious with a normal gag reflex.

Lipid infusion in the treatment of LA toxicosis is promising [42]. There are multiple human case reports in which lipid infusion was beneficial in refractory cardiovascular and CNS dysfunction caused by LAs (other than dibucaine) [43, 44]. Prospective controlled studies in dogs and rats show that lipid infusion is beneficial in the treatment of LA toxicosis by greatly improving survival and increasing the dose of LA required to cause intoxication, respectively [45, 46]. Lipid infusion is believed to extract LA from plasma or tissue, counteract myocardial fatty acid oxidation, or both [45, 47]. Dogs administered a toxic dose of bupivicaine were administered a 4 ml/kg bolus of a 20% lipid solution followed by 0.5 mL/kg/min constant rate infusion for 10 min during intrathoracic cardiopulmonary resuscitation [45]. The AAGBI set guidelines for administering lipid emulsion in severe LA toxicosis, which include administering 20% lipid solution (Intralipid®, Fresenius Kabi, Uppsala, Sweden) at 1.5 ml/kg over 1 min followed by 0.25 ml/kg/min over 20 min [26]. If adequate circulation is not restored, repeating two boluses at 5-min intervals (1.5 ml/kg) and administering 0.5 ml/kg/min over 10 min is recommended [26]. Infusion is to be continued until stable and adequate circulation has been restored.

Cinchocaine: Uses, Interactions, Mechanism of Action

DECATYLEN LOZENGE	Cinchocaine hydrochloride (0.03 mg) + Dequalinium chloride (0. 25 mg)	Lozenge	Oral	APEX PHARMA MARKETING PTE. LTD.	1990-06-25	Not applicable	Singapore
FAKTU SUPPOSITORY	Cinchocaine hydrochloride (2.5 mg) + Policresulen (100 mg)	Suppository	Rectal	TAKEDA PHARMACEUTICALS (ASIA PACIFIC) PTE. LTD.	1988-04-26	Not applicable	Singapore
Nupercainal Antiseptic Cream	Cinchocaine (0.5 %) + Domiphen bromide (0.05 %)	Cream	Topical	Glaxosmithkline Inc	1967-12-31	2016-11-29	Canada
Odan Proctomyxin HC	Cinchocaine hydrochloride (0.5 %) + Esculin (1 %) + Framycetin sulfate (1 %) + Hydrocortisone (0.5 %)	Ointment	Rectal	Odan Laboratories Ltd	2001-03-09	2021-08-11	Canada
Odan Proctomyxin HC Suppositories	Cinchocaine hydrochloride (5 mg) + Esculin (10 mg) + Framycetin sulfate (10 mg) + Hydrocortisone (5 mg)	Suppository	Rectal	Odan Laboratories Ltd	2001-01-05	Not applicable	Canada
Proctol Ointment	Cinchocaine hydrochloride (0. 5 %) + Esculin (1 %) + Framycetin sulfate (1 %) + Hydrocortisone (0.5 %)	Ointment	Rectal	Odan Laboratories Ltd	2003-08-06	Not applicable	Canada
Proctol Suppositories	Cinchocaine hydrochloride (5 mg) + Esculin (10 mg) + Framycetin sulfate (10 mg) + Hydrocortisone (5 mg)	Suppository	Rectal	Odan Laboratories Ltd	2004-03-15	Not applicable	Canada
Proctosedyl	Cinchocaine hydrochloride (5 mg) + Esculin (10 mg) + Framycetin sulfate (10 mg) + Hydrocortisone (5 mg)	Suppository	Rectal	Aptalis Pharma Canada Ulc	1997-01-23	2020-05-27	Canada
Proctosedyl	Cinchocaine hydrochloride (0.5 %) + Esculin (1 %) + Framycetin sulfate (1 %) + Hydrocortisone (0.5 %)	Ointment	Rectal	Aptalis Pharma Canada Ulc	2003-04-01	Not applicable	Canada
Proctosedyl Ointment	Cinchocaine hydrochloride (5 mg / g) + Esculin (10 mg / g) + Framycetin sulfate (10 mg / g) + Hydrocortisone (5 mg / g)	Ointment	Rectal	Hoechst Roussel Canada Inc.	1971-12-31	2006-07-28	Canada

Over-the-Counter (OTC) Medications: A Quick Consult Guide to the Evaluation and Management of Toxic Effects and Adverse Reactions | 2001-01-29

Part I: Topical and Non-Systemic Agents

Authors: Richard Y. Wang, DO, FACEP, FACMT, Director, Division of Medical
Toxicology, Rhode Island Hospital, Brown University School of Medicine; Daren D. Girard, MD, Department of Emergency Medicine, Rhode Island
Hospital, Brown University School of Medicine; Alfred Aleguas, PharmD, College of Pharmacy, University of Rhode Island.

Peer Reviewers: Chuck Seamens, MD, FACEP, Assistant Professor of
Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN; and
Stephen Ernest, PharmD, Retail Pharmacist, PharMor, Terre Haute, IN.

Recent advances in consumer marketing have fueled the creation of a proliferation of self-treatment products. These products, known as “over-the-counter” or OTC agents, include traditional remedies, new formulations, and combinations, as well as reduced-strength versions of prescription medications. Examples of OTC formulations of prescription drugs include cimetidine, nonsteroidal anti-inflammatory drugs (NSAIDs), and antihistamines.

In 1998, the American Association of Poison Control Centers Toxic Exposure Surveillance System (AAPCC TESS) registered more than 500,000 exposures to OTC formulations.¹ (See Table 1.)

While the majority of these produced no serious harm, some OTC exposures resulted in significant morbidity and mortality. (See Table 2.)

Table 2. OTC Agents with Reported Clinical Toxicity
AGENT	OTC APPLICATION	CLINICAL MANIFESTATION
Acetaminophen	Analgesic, Antipyretic	Hepatic failure
Antihistamine (h2 receptor)   (diphenhydramine, chlorpheniramine, brompheniramine, doxylamine)	Decongestant Antipruritic Sleep aid	Anticholinergic syndrome
Caffeine	Stimulant	Agitation, seizure Nausea, vomiting Tachydysrhythmia Hypotension, hypertension
Camphor	Rubefacient	Seizures
Dextromethrophan	Antitussive	Altered mental status Hypoventilation
Ethanol	Mouthwash/Germicide	Depressed mental status Hypoventilation Hypoglycemia
Imidazoline (tetrahydrolozine, naphazoline, oxymetazoline, Xylometazoline)	Topical decongestant	Depressed mental status Miosis Hypoventilation Bradycardia Alteration of blood pressure
Inorganic salts   (magnesium, calcium,  aluminum, sodium bicarbonate)	Antacid  Laxative	Dehydration Electrolyte abnormalities
Iodine (Povidone-iodine)	Antiseptic/Germicide Vaginal douche	Nausea, vomiting Abdominal pain Gastrointestinal tract burns
Iron salts (e. g., ferrous sulfate, ferrous gluconate, etc.)	Mineral supplement	Nausea, vomiting, abdominal pain Gastrointestinal bleeding Metabolic acidosis Hypotension Decreased mental status
Local anesthetics (benzocaine, dibucaine, dyclonine, lidocaine)	Topical analgesic	Depressed mental status Seizure Bradycardia Methemoglobinemia
Loperamide	Antidiarrheal	Depressed mental status Hypoventilation
Nonsteroidal anti-inflammatory agents  (ibuprofen, ketoprofen, naproxen)	Analgesic  Anti-inflammatory Antipyretic	Gastrointestinal distress CNS depression
Permethrin	Pediculocide	Hypersensitivity
Pyrethrin	Scabicide	Keratitis
Quartenary ammonium compounds (alkyldimehtylbenzylammonium chlorides)	Antiseptic/Germicide	Nausea, vomiting Abdominal pain Gastrointestinal tract burns
Salicylate	Analgesic  Antipyretic  Rubefacient  Keratolytic	Nausea, vomiting Tinnitus Altered mental status Mixed acid/base disorder Pulmonary edema
Sympathomimetics  (ephedrine, psuedoephedrine, phenylephrine,  phenylpropanolamine)	Decongestant  Appetite suppressant	Sympathomimetic syndrome

The recent withdrawal of phenylpropanolamine-containing flu remedies suggests increasing vigilance in review of OTC products to prevent toxicity. As a result, it is important that emergency health care providers be familiar with these agents so they can optimize care for their patients. With these issues in focus, this detailed review outlines the clinical manifestations and management of important OTC exposures caused by various routes of administration. Part I of this two-part series will review topical preparations.— The Editor

Dermatologic Preparations: Topical Products

Dermatologic preparations include formulations of creams, ointments, gels, liquids, and aerosols; the principal difference among these products is the base or vehicle. Vehicles determine the rate of absorption at the site of action. Creams are water-in-oil emulsions and permit absorption into the subdermal and subcutaneous layers. Ointments are hydrophobic mixtures, usually hydrocarbon based (e.g., petrolatums), and are intended to remain at the site of application, with minimal absorption. Gels are water-based vehicles, allowing rapid dissolution and absorption.

Inadvertent ingestion of any of the vehicles may produce toxic effects similar to mild anionic and nonionic surfactants (e.g., soaps), which produce both emetic and laxative effects. Although toxicity is unusual during therapeutic use, applying these agents to large areas of abraded or denuded skin increases the amount of vehicle absorbed, as well as the potential for symptoms.² Increasing absorption with occlusive dressings, repeat application, or application to a large percentage of body surface area also may lead to toxicity.

Rubefacients. Rubefacient preparations are intended to produce mild local irritation, creating an increase in blood flow, and subsequently, erythema. The result of this process is the sensation of warmth. Camphor and menthol combinations are traditional formulations that have been around for decades. (See Table 3.)

A druggist’s handbook, circa 1877, identifies 10 different formulas using various combinations.³ Typically, camphor and menthol are mixed together to form an eutectic mixture that is then incorporated into a vehicle, commonly petrolatum. The concentrations of camphor and menthol range from 2% to 5% and 1% to 16%, respectively.⁴ Camphor is still available, however, in a solid, block form, usually in a 1-ounce size.⁴

Toxicity is characterized initially by gastrointestinal (GI) symptoms, including: nausea, vomiting, and abdominal distress. More significant exposures may demonstrate such central nervous system (CNS) effects as delirium, excitement, and seizures. Onset of symptoms usually occurs within 5-20 minutes and peaks within 90 minutes. Camphor is readily absorbed, and death has occurred from ingestion of as little as 1 gram.⁵

Menthol is the major constituent of peppermint oil. It also causes such gastrointestinal symptoms as nausea, vomiting, and abdominal pain. After a significant exposure (i.e., pure peppermint oil or a large ingestion of high concentration product), CNS effects, including ataxia, drowsiness, or coma, may be seen.⁶ Acute toxic effects from ingestion of small amounts are unlikely given the available formulations, but significant toxicity may occur with ingestion of even a small amount of either agent in its pure form. Trivial (a mouthful or less) ingestions of the combination forms are treated by dilution, in conjunction with observation for local oral and GI irritant effects.

Capsaicin. Another counter irritant ingredient approved for OTC use is capsaicin. Previously available in prescription strengths of 0.025% and 0.075%, it was converted to OTC status in 1990.⁷ Used in combination with camphor and menthol in 0.025% concentrations, capsaicin is derived from capsicum oleoresin, the irritant oil from the pepper plants of the Solanacae family. The clinical effects range from a feeling of warmth to burning, depending on the concentration applied.⁸ Ingestion of the agent causes nausea and vomiting secondary to gastric irritation. Treatment consists of dilution or irrigation; symptoms abate after 30-60 minutes.

Ingredients in various rubefacient products include eucalyptol, thymol, cajput oil, and turpentine. They are present in very low concentrations and their toxicity is limited to minor irritation in the amounts available.

Topical Analgesics. Topical analgesics are used for muscle or joint pain. Like rubefacients, these agents are counter irritants, stimulating circulation and a feeling of warmth. Topical analgesics usually contain methyl salicylate (e.g., oil of wintergreen), or other salt forms of salicylate (e.g., trolamine salicylate). Commonly used in combination with other ingredients, especially camphor and menthol, the concentration of methyl salicylate may be as high as 35%.⁹ Oil of wintergreen contains approximately 98 gm/100 mL of methyl salicylate, and the purified oil can be highly toxic; in fact, an ingestion of as little as 7 gm (7.5 mL) has produced significant morbidity in a 2-year-old child.¹⁰ Since methyl salicylate is the methyl ester form of salicylate, symptoms of salicylate intoxication can be seen with ingestion or chronic application of more concentrated products.

Keratolytics. Other formulations that use concentrated salicylates include the keratolytics. These agents produce desquamation of the skin and are used as wart and corn removers. These products contain salicylic acid in concentrations ranging from 17% to 40% in liquid, solution, gel, patch, plaster, and cream form. The creams utilize the higher concentrations, with the liquid, gel, and solution products limited to less than 30%.¹¹ The liquid formulations commonly use flexible collodion (e.g., nitrocellulose) as a vehicle. These products can produce oral irritation, or potentially a burn if they have prolonged contact with skin. Nitrocellulose is water resistant and may cause adherence to mucus membranes. Due to the high concentrations of salicylate available in these OTC formulations, significant or chronic misuse can result in intoxication. Patient management includes monitoring serum salicylate levels, initiating urinary alkalinization, and hemodialysis, as would be indicated in salicylate poisoning.

Local Anesthetics. Topical anesthetics are used for local analgesia on intact dermis and to treat pruritic conditions such as insect bites, plant poisonings, eczema, and minor burns. These agents interrupt nerve impulse conduction by altering cell membrane ion flux, and as a result, produce an anesthetic effect. Most local anesthetic agents are poorly absorbed through intact dermis, but readily absorbed through the mucous membranes. Abraded skin augments the effectiveness of local anesthetics by increasing absorption. Anesthetic agents are classified according to their structure. Most agents belong to one of two classes: 1) benzoate esters; or 2) amides. Benzoate esters include benzocaine, tetracaine, and butamben picrate. The amides are dibucaine and lidocaine. Another topical anesthetic agent, pramoxine, is structurally unique.

Adverse effects of local anesthetics during therapeutic use include local irritation, burning, sloughing, interaction between other drugs, and hypersensitivity reactions.^12,13 The toxicity of these agents affects the cardiovascular, neurologic, and hematologic systems. Cardiac dysrhythmias, seizures, and coma can be seen with severe toxicity. Additionally, benzocaine and lidocaine can produce methemoglobinemia.¹⁴

Lidocaine is available in gel, cream, ointment, liquid, and spray formulations. OTC preparations are limited to concentrations of 2.5% or less. Oral ingestions of 5-30 mL of a 2-4% viscous lidocaine solution have resulted in seizures in children.^15-17 Lidocaine has the potential to produce systemic effects, and repeated applications can lead to accumulation of the drug and its metabolites. It should be used with caution in patients who are taking Class I antiarrhythmic agents (e.g., tocainanide, mexilitene), due to a potential for synergism.

Lidocaine is readily absorbed if ingested, and it may accumulate in patients with hepatic impairment. Systemic effects, which can be seen with toxic plasma levels, include seizures, metabolic acidosis, heart block, bradycardia, hypotension, and methemoglobinemia. Very young patients, as well as patients with G6PD-deficiency, are more susceptible to methemoglobinemia.¹⁸ General treatment is supportive; methylene blue is used to treat methemoglobinemia.

Benzocaine is available in creams, ointments, lotions, sprays, and liquids in concentrations ranging from 0.5% to 20%. It also is available in several combination products with menthol, phenol, camphor, alcohol, and antiseptic agents. Benzocaine’s principal toxic effect is methemoglobinemia. It does not produce the CNS or cardiovascular effects observed with lidocaine.¹⁹ Methemoglobinemia may be dose-related or idiosyncratic. Onset is usually within 20-60 minutes of application. Clinical symptoms of methemoglobinemia are related to the percentage of hemoglobin involved; dyspnea and tachycardia are present at high methemoglobin levels.²⁰ Methemoglobinemia is treated with methylene blue.

Dibucaine is available in cream or ointment forms in 0.5% or 1% concentrations. It is a potent amide-type anesthetic and can cause seizures and dysrhythmias in children, leading to fatality.²¹ Photosensitivity and allergic dermatitis also have occurred with therapeutic use.^22,23 Pramoxine is available in creams, lotions, gels, and a spray, all of which are available in a 1% concentration. Its reported systemic toxicity is low, and the incidence of hypersensitivity reactions to pramoxine is less than that of other local anesthetics.¹³

Topical Anti-Infectives. Topical anti-infective agents include antibiotics such as neomycin, polymixin B, and bacitracin zinc; and antifungal agents such as clotrimazole, miconazole, undecyclenic acid derivatives, tolnaftate, and gentian violet. Anti-infective agents are available in formulations that include creams, ointments, gels, lotions, and powders. They are used to treat various minor infections. The relative toxicity of any of these agents is low; toxic effects from ingestion are limited to the GI tract, principally diarrhea, especially with the non-absorbable antibiotics. Hypersensitivity reactions are always possible, although the incidence of systemic reactions from ingestion is very low.

Corticosteroid. Topical corticosteroids are used for treatment of inflammatory and pruritic conditions. They are used alone or in combination with an antibiotic or antifungal agent. The only available OTC topical corticosteroid is hydrocortisone. It is available in creams, ointments, and lotions in 0.5% and 1% concentrations. The relative toxicity of hydrocortisone, even when large amounts (a mouthful) are ingested, is minimal. Dermal absorption occurs with topical application and hypothalamic-pituitary-adrenal axis suppression is possible, especially if an occlusive dressing is applied over a large surface area, or with chronic application over large areas of abraded skin.²⁴

Soaps. Soaps for personal use are comprised almost entirely of anionic and nonionic surfactants. The balance of ingredients depends upon the particular form (liquid, bar, shampoo, etc.), and may include such additives as perfumes, stabilizers, and antibacterial agents. Used for personal cleaning and disinfecting, the number and variety of products available are staggering. Fortunately, the toxicity of soaps, whether liquid or solid, is very low. However, they are irritating to all mucus membranes—nasal, ocular, oral, rectal, and vaginal. Ingestion of even small amounts usually produces immediate emesis.²⁵ Treatment is symptomatic, with irrigation of exposed, irritated areas. Dilution is recommended with ingestion, and resolution of symptoms occur within minutes.

Lotions. Hand and body lotions are comprised of emulsions of oil in water or water in oil. As such, their toxic potential is low. High viscosity, a desirable property in a lotion, minimizes the aspiration potential on ingestion. Ingestion of significant amounts can cause emesis and also can have a laxative effect similar to that of other emollient laxatives (e.g., mineral oil or glycerine). Additives, such as perfumes, preservatives, stabilizers, emulsifiers, and thickeners, are present in negligible amounts. Ocular exposures cause irritation and conjunctival inflammation, and treatment should include dilution and irrigation, with ophthalmologic referral if prolonged or significant irritation occurs.

Acne Preparations. Acne preparations use benzoyl peroxide or sulfur as antibacterial agents. Benzoyl peroxide also has keratolytic and irritant effects and is available in creams, gels, or lotions in concentrations ranging from 2.5% to 20%. Likewise, sulfur has a keratolytic effect and is commonly available as either precipitated sulfur or colloidal sulfur in concentrations of 0.5-10%. Patient tolerance may limit the concentration of product applied.

The relative toxicity of acne preparations is low. Ocular and GI irritation can occur with significant exposures to either benzoyl peroxide or sulfur compounds.²⁶ Superficial corneal opacification may occur with benzoyl peroxide in concentrations greater than 5%.²⁷ Irrigation and dilution are recommended for these exposures, with ophthalmologic referral for persistent eye irritation. Make up or cosmetic products include mascaras, lipsticks, facial cremes, blushes, eye shadows, etc. Although multiple ingredients are involved, they are considered non-toxic.

Zinc Oxide. Zinc oxide is used for the treatment of diaper rash, abrasions, burns, and minor skin irritations. When used for the treatment of diaper rash, it forms a protective barrier against further irritation. It is available as an ointment in concentrations of 20% and is very often combined with other ingredients (e.g., zinc oxide and calamine for the treatment of poison ivy). Its systemic toxicity is low and needs no GI decontamination other than dilution.²⁸

Poison Ivy Products. There are numerous products available for the symptomatic treatment of poison ivy exposure. These are all combination products, with the relative toxicity of each determined by its specific ingredients. They employ astringent agents such as calamine and zinc oxide, local anesthetic agents (e.g., benzocaine, pramoxine), antipruritic agents (e.g., diphenhydramine), and counterirritants (e.g., menthol, phenol, and camphor). They come in creams, ointments, and lotions. Their relative toxicity is low. Diphenhydramine in combination with calamine has caused severe anticholinergic toxicity in children and is no longer available OTC.^29,30

Pediculocides/Scabicides. These products are used for the treatment of Sarcoptes scabiei (scabies) and Pediculus capitus, pubis, and humanus (head, pubic, or body lice, respectively), and their nits or eggs. The OTC products available for these conditions contain pyrethrins or permethrin, a synthetic pyrethroid, and piperonyl butoxide. Pyrethrins are obtained from the chrysanthemum plant, and are extremely effective against many insects. Hypersensitivity to the chrysanthemum plant, or any member of the Asteracaea (daisy) family, is a contraindication to the use of pyrethrin/pyrethroid-containing products. Permethrin is available as a 5% prescription cream for the treatment of scabies or a 1% cream rinse for the treatment of lice. Combination products containing pyrethrins and piperonyl butoxide are available OTC in concentrations ranging from 0.1% to 0.3%, and 2% to 4%, respectively. These are formulated into liquids, gels, and shampoos.

The relative toxicity of pyrethrins and pyrethroids is low; hypersensitivity is the primary concern.³¹ Serious systemic hypersensitivity reactions are rare.³² A fatality attributed to an asthma attack that was precipitated by the use of a pyrethrin-based dog shampoo has been reported.³² CNS symptoms have occurred, especially in children exposed to the more potent pyrethroids.³³ It has been suggested that children are less able to metabolize pyrethrins efficiently, making them more susceptible to symptoms of toxicity, especially with application to large areas of skin. CNS depression and stimulation and dizziness, as well as periorbital paresthesias and dysesthesias have been reported.^33,34 Seizures have occurred with accidental and intentional exposure to products containing higher concentrations of pyrethrins/pyrethroids. No case reports could be found in the primary literature documenting these CNS effects after exposure to the OTC-strength topical products.³⁵

Ocular exposure with subsequent corneal damage can result from the use of shampoo containing pyrethrin.³⁶ Irritation and contact dermatitis can be seen, especially with chronic, prolonged exposure; severe allergic reactions have been reported.³⁷ Treatment is primarily symptomatic and supportive. Thorough irrigation is indicated for dermal and ocular exposures. Fluorescein staining to assess corneal patency is indicated if there is continued eye pain after adequate irrigation.

Antiseptics and Germicidals. Antiseptics and germicidals are used to clean and disinfect cuts and abrasions and to cleanse an area prior to a medical procedure, such as intravenous catheter insertion or phlebotomy. OTC products available for this use are identical to those used in the hospital setting, with the exception of hexachlorophene. The use of this agent has declined with the discovery of its neurotoxic potential. Products available OTC for antisepsis and disinfection comprise agents containing mercury and iodine compounds, quaternary ammonium compounds, and chlorhexidine gluconate.

When mercury is used, it is in the organic form of merbromin or thiomerosal. Mercurochrome contains 2% merbromin, which is 24-27% mercury and 18-22% bromine. It is available as an aqueous solution and has very limited bacteriostatic activity. Thiomerosal (merthiolate) is comprised of 49% organically bound mercury. Although more effective than merbromin, thimerosal shares the disadvantage of poor tissue penetration and tissue fixation and therefore has limited bacteriostatic activity.³⁸ Thiomersal is available in solutions, tinctures (with a vehicle containing as much as 50% alcohol), and sprays.

The toxicity of mercury compounds is low with normal or recommended use. Ingestion of merbromin (mercurochrome) or thimerosal (merthiolate) causes nausea and vomiting. Serious poisoning is unlikely, due to the small volumes available in OTC formulations and the relatively low mercury content. Applications to large areas of abraded skin or frequent or prolonged use could potentially lead to absorption and mercury poisoning (mercurialism). This syndrome is characterized by acrodynia (pain and erythema of the palms and soles), polyneuritis, irritability, diaphoresis, and GI symptoms, especially anorexia.³⁹ The most common toxicity from application of these OTC preparations is sensitization, either from the mercury or thio radical (in merthiolate). This is evidenced by erythematous, papular, and vesicular lesions where applied.

Treatment depends on the extent of poisoning. Dermal reactions are managed supportively and resolve after discontinuation of use. More serious systemic poisonings may require chelation with British Anti-Lewisite (BAL, dimercaprol), dimercaptosuccinic acid (DMSA), or D-penicillamine after initial stabilization.⁴⁰ This degree of poisoning is not expected with common misuse of OTC mercurials and requires consultation with a regional poison control center or medical toxicologist.

Iodine. Iodine is an effective and inexpensive germicidal, with low tissue toxicity. Iodine compounds include solutions, tinctures, and povidone-iodine, a water soluble complex. The solutions of iodine contain free-iodine and potassium iodide for increased solubility. The tinctures are composed of free-iodine, potassium iodide, sodium iodide for increased miscibility, and alcohol. Tinctures come in strengths of 2% and 7% iodine. Povidone-iodine complexes contain 9-12% iodine and are available as 5% creams; 10% gels; 4-10% ointment; 10% solutions in aerosols, perineal washes, saturated gauze pads, and swabs; and a 0.5% mouthwash.

Iodine’s toxicity is related to its corrosive nature. Local inflammatory reactions can occur secondary to the application of strong tincture to wounds. Upon ingestion, symptoms of vomiting, hypotension, and circulatory collapse can occur, though death is rare following acute exposure.⁴¹ Iodine is rapidly inactivated by the presence of food in the stomach, particularly starches. In the vomiting patient, iodine ingestion is suggested by a blue colored emesis (due to the conversion of iodine to iodide). Serious systemic symptoms have occurred after irrigation of wounds with iodine compounds.⁴² These include hypothyroidism, renal failure, metabolic acidosis, leukopenia, and hemolysis.⁴³ Estimates of the mean lethal dose range from 2 to 4 grams of free iodine.⁴⁴

Treatment is primarily symptomatic and supportive. Induction of emesis is, and lavage may be, contraindicated with ingestion of concentrated solutions, due to iodine’s corrosive nature. Although iodine is adsorbed by activated charcoal, the presence of charcoal in the gut limits the endoscopist’s ability to assess the extent of caustic injury.⁴⁵ Cornstarch (15 gm/ 500 mL water) is a better alternative for limiting gut iodine absorption. Starch converts iodine to iodide and then binds to the iodide salt. Further evaluation of the corrosive injury must be performed, including timely esophagoscopy.

Quaternary ammonium compounds are cationic surfactants comprised of mixtures of alkyldimethylbenzylammonium chlorides with alkyl chains varying in length from C₈H₁₇ to C₁₈H₃₇. The aqueous solutions are used for cleansing of skin, mucous membranes, and wounds; irrigation of bladder, urethra, body cavity; and vaginal douching. Quaternary ammonium compounds are effective against bacteria, some viruses, protozoa, and fungi and have a sustained duration of action.⁴⁶ Composition of product is usually expressed in percentages of alkyl chain length, but this is less important than the concentration of the mixture. Concentrations of greater than 7% are potentially corrosive.

At lower concentrations, local irritation is the only adverse effect.⁴⁷ Dilute solutions used for irrigation and antisepsis can be more irritating to inflamed or abraded skin and sensitization has occurred.⁴⁸ Nausea, vomiting, and diarrhea are expected after trivial ingestions of even dilute solutions. Gastrointestinal tract burns have been reported with small volume ingestions of concentrated solutions.⁴⁹ CNS depression progressing to coma, seizures, and shock also have been reported after ingestion of concentrated solutions.⁵⁰ Serious corneal injury may occur with ocular exposure to concentrated solutions.⁵¹

Treatment depends on the concentration and circumstances of the exposure. Ingestion of small amounts of dilute solutions is managed with dilution and observation alone; more concentrated solutions are diluted and evaluated in a health care facility for potential GI tract burns. Emesis is contraindicated, as is gastric lavage, due to the caustic nature of this agent and the potential for pulmonary aspiration from rapid CNS deterioration and loss of protective airway reflexes. Treatment consists of dilution, supportive care, and hospital admission as needed for esophagoscopy.

References

1. Litovitz TL, Klein-Schwartz W, Caravati EM, et al. 1998 Annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med 1999;17:435-487.

2. Lie RL, Vermeer BJ, Edelbroek PM. Severe lidocaine intoxication by cutaneous absorption. J Am Acad Dermatol 1990;23:1026-1028.

3. Nelson JH. A Druggists Handbook of Private Formulas, 5th ed. Cleveland, OH; 1880:102-127.

4. Drug Facts and Comparisons, 54th ed. St. Louis, MO: Facts and Comparisons; 2000:1718.

5. Smith AG, Margolis G. Camphor poisoning. Am J Pathol 1954;30:857.

6. Eickholt TH, Box RH. Toxicities of peppermint and pycnanthemum albescens oil, fam. Labiateae. J Pharm Sci 1965;54:1071-1072.

7. Product Infomation: Zostrix, capsaicin. GenDerm Corporation, Lincolnshire, IL, 1997.

8. Tominack RL, Spycker DA. Capsicum and capsaicin—A review: Case report to the use of hot peppers in child abuse. J Toxicol Clin Toxicol 1987;25:591-601.

9. Chan TYK. Medicated oils and severe salicylate poisoning: Quantifying the risk based on methyl salicylate content and bottle size. Vet Hum Tox 1996;38:133-134.

10. MacCready RA. Methyl salicylate poisoning: A report of five cases. N Engl J Med 1943;228:155-156.

11. Drug Facts and Comparisons, 54th ed. St. Louis, MO: Facts and Comparisons; 2000:1663-1664.

12. Altman RS, Smith-Coggins R, Ampel LL. Local Anesthetics. Ann Emerg Med 1985;14:1209-1217.

13. Fisher AA. Allergic reactions to topical (surface) anesthetics with reference to the safety of tronothane (pramoxine hydrochloride). Cutis 1980;25:584-591.

14. Bun D, Doughty A. Methaemoglobinemia follows lignocaine. Lancet 1974;2:971.

15. Bowman S, Francillo R, Gibbons W. Correspondence: CNS toxicity after ingestion of topical lidocaine. N Engl J Med 1982;306:426-427.

16. Rothstein P, Dornbusch J, Shaywitz BA. Prolonged seizures associated with the use of viscous lidocaine. J Pediatr 1982;101:461-463.

17. Sakai R, Lattin J. Lidocaine ingestion. Am J Dis Child 1980; 134:323.

18. Olson ML, McEvoy GK. Methemoglobinemia induced by local anesthetics. Am J Hosp Pharm 1981;38:89-93.

19. Rodriguez LF, Smolik LM, Zbehlik AJ. Benzocaine-induced methemoglobinemia: Report of a severe reaction and review of the literature. Ann Pharmacother 1994;28:643-649.

20. Eldadah M, Fitzgerald M. Methemoglobinemia due to skin application of benzocaine. Clin Pediatr 1993;32:687-688.

21. Dayan P, Litovitz TL, Crouch BI, et al. Fatal accidental dibucaine poisoning in children. Ann Emerg Med 1996;28:442-445.

22. Horio T. Photosensitivity reaction to dibucaine: Case report and experimental induction. Arch Dermatol 1979;115:986-987.

23. Lee AY. Allergic contact dermatitis from dibucaine in Proctosedyl ointment with cross-sensitivity. Contact Dermatitis 1998;39:261.

24. Cornell RC, Stoughton RB. The use of topical steroids in psoriasis. Dermatol Clin 1984;2:397-409.

25. Coppack RW, Mostrom MS, Lillie LE. The toxicology of detergents, bleaches, antiseptics, and disinfectants in small animals. Vet Hum Tox 1988;30:463-473.

26. Lin AN, Reimer RJ, Carter DM. Sulfur revisited. J Am Acad Dermatol 1988;18:553-558.

27. Jackson EM. Editorial: Benzoyl peroxide: An old dog with new problems. J Toxicol Cutan Ocul Toxicol 1986;5:161-163.

28. Anonymous. Position statement: Gastric lavage (cathartics, ipecec syrup, single-dose activated charcoal). American Academy of Clinical Toxicology/European Association of Poison Centres and Clinical Toxicologists. Clin Toxicol 1997;35:711-719.

29. Tomlinson G, Helfael M, Wiedermann BL, et al. Diphenhydramine toxicity mimicking Varicella encephalitis. Ped Infect Dis J 1987; 6:220-221.

30. Goetz CM, Lopez G, Dean BS, et al. Accidental childhood death from diphenhydramine overdosage. Am J Emerg Med 1990;8:321-322.

31. Culver CA, Malina JJ, Talbert RL. Probable anaphylactoid reaction to a pyrethrin pediculocide shampoo. Clin Pharm 1988;7:846-849.

32. Wax PM, Hoffman RS. Fatality associated with inhalation of a pyrethrin shampoo. Clin Toxicol 1994;32:457-460.

33. He F, Wang S, Liu L, et al. Clinical manifestations and diagnosis of acute pyrethroid poisoning. Arch Toxicol 1989;63:54-58.

34. Le Quesne PM, Maxwell UC, Butterworth ST. Transient facial sensory symptoms following exposure to synthetic pyrethroids: A clinical and electrophysiological assessment. Neurotoxicol 1980;2:1-11.

35. He F. Synthetic pyrethroids. Toxicol 1994;91:43-49.

36. Grant WM, ed. Toxicology of the Eye, 4th ed. Springfield, IL; Thomas: 1993:39.

37. Lisi P. Sensitization risk of pyrethroid insecticides. Contact Dermatitis 1992;26:349-350.

38. Harvey SC. Antiseptics and disinfectants; fungicides and ectoparasiticides. In: Gilman AG, Goodman L, Gilman A, eds. The Pharmacological Basis of Therapeutics. 6th ed. New York: Macmillan; 1980:976.

39. Warkany J, Husband DM. Acrodynia and mercury. J Pediatr 1953; 42:365.

40. Fournier L, Thomas G, Garnier R, et al. 2,3-dimercaptosuccunic acid acid treatment of heavy metal poisoning in humans. Med Toxicol 1988;3:499-504.

41. Kurt TL, Morgan ML, Hnilica V, et al. Fatal iatrogenic iodine toxicity in a nine-week-old infant. Clin Toxicol 1996;34:231-234.

42. Campistol JM, Abad C, Nogue C, et al. Acute renal failure in a patient treated by continuous povidone-iodine mediastinal irrigation. J Cardiovasc Surg 1988;29:410-412.

43. Lavelle KJ, Doedens DJ, Kleit SA, et al. Iodine absorption in burn patients treated topically with povidone-iodine. Clin Pharmacol Ther 1975;17:355-372.

44. Therapeutics Index. In: Gosselin RE, Smith RP, Hodge HC, eds. Clinical Toxicology of Commercial Products. 5th ed. Baltimore: Williams and Wilkins; 1984:213-214.

45. Anonymous. Position statement: Single dose activated charcoal. American Acadeny of Clinical Toxicology; European Association of Poison Centres and Clinical Toxicologists. Clin Toxicol 1997;35:721-736.

46. Harvey SC. Antiseptics and disinfectants; fungicides and ectoparasiticides. In: Gilman AG, Goodman L, Gilman A, eds. The Pharmacological Basis of Therapeutics. 6th ed. New York: Macmillan; 1980:978-979.

47. Coulston F, Drobeck HF, Mielens ZE, et al. Toxicology of benzalkalonium chloride given orally in milk or water to rats and dogs. Toxicol Appl Pharmacol 1961;3:584-594.

48. Bernstein JA, Stauder T, Bernstein DI, et al. A combined respiratory and cutaneous hypersensitivity syndrome induced by work exposure to quaternary amines. J Allergy Clin Immunol 1994;94:257-259.

49. Wilson JT, Burr IA. Benzalkalonium chloride poisoning in infant twins. Am J Dis Child 1975;129:1209-1209.

50. Van Berkel M, De Wolff FA. Survival after acute benzalkalonium chloride poisoning. Human Toxicol 1988;7:191-193.

Proctol – Uses, Side Effects, Interactions

How does this medication work? What will it do for me?

This medication is a combination product that is used for the reduction of swelling, pain, and inflammation of hemorrhoids and other rectal lesions. It is also used to treat proctitis, fissures, cryptitis, pain following rectal surgery, and rectal itching.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. As well, some forms of this medication may not be used for all of the conditions discussed here. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

What form(s) does this medication come in?

Ointment
Each gram of translucent ointment contains hydrocortisone 5 mg, dibucaine (cinchocaine) HCl 5 mg, framycetin sulfate 10 mg, and esculin 10 mg in a petrolatum ointment base. Nonmedicinal ingredients: anhydrous lanolin and white petrolatum.

Suppositories
Each white to off-white torpedo-shaped suppository contains hydrocortisone 5 mg, dibucaine (cinchocaine) HCl 5 mg, framycetin sulfate 10 mg, and esculin 10 mg in a triglyceride base. Nonmedicinal ingredients: methylparaben, propylparaben, and triglyceride.

How should I use this medication?

Ointment: For treatment of the outside area of the anus, apply a small quantity to the affected area morning and evening and after each bowel movement. For internal application, attach the rectal cannula (the plastic attachment that is included with the medication) to the tube opening, gently insert to the full extent inside the anus, and squeeze the tube gently from the lower end while withdrawing.

Suppositories: Insert one suppository into the rectum morning and evening and after each bowel movement.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is important to take this medication exactly as prescribed by your doctor. If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication at room temperature and keep it out of the reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Who should NOT take this medication?

Do not take this medication if you:

• are allergic to any ingredients of the medication
• have tuberculosis or a fungal or viral infection

What side effects are possible with this medication?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

• burning upon application of medication (especially if the mucus membrane is not intact)

Although most of the side effects listed below don’t happen very often, they could lead to serious problems if you do not seek medical attention.

Stop taking the medication and seek immediate medical attention if any of the following occur:

• symptoms of a severe allergic reaction:
  • difficulty breathing
  • hives
  • skin blisters
  • sores or pain in the mouth or eyes
  • swelling of the mouth or throat

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Are there any other precautions or warnings for this medication?

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Absorption: Prolonged use of this medication or applying it to open skin or wounds could promote the absorption of this medication into the blood circulation. This can produce effects similar to those seen after taking oral corticosteroid medications for long periods of time. Symptoms could include depression, headache, mood swings, rounding of the face, slow healing of wounds, swelling of the feet or lower legs, trouble sleeping, and unusual hair growth. Check with your doctor as soon as possible if any of these symptoms occur.

Medical treatment: Advise all doctors of the previous use of hydrocortisone.

Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: This medication may pass into breast milk. If you are a breast-feeding mother and are using this medication, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

What other drugs could interact with this medication?

Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications that you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

All material copyright MediResource Inc. 1996 – 2021. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/drug/getdrug/Proctol

Lyoxazin 01 instructions for use: indications, contraindications, side effects – description Lyoxazin 01 Gel for topical application (17196)

Use with caution in patients with epilepsy, as well as bradycardia, impaired conduction in the heart, impaired liver function and severe shock, especially when absorption of a significant amount of the drug can be expected when large areas of tissue are treated with high doses.

It is important not to allow lidocaine to enter the airways (risk of aspiration).

Application to the mucous membrane of the cheeks carries a risk of dysphagia and subsequent aspiration, especially in children. If the sensitivity of the tongue and the mucous membrane of the cheeks is impaired, the risk of biting them increases.

Lidocaine is well absorbed through mucous membranes (especially in the trachea) and damaged skin. This should be taken into account, especially when treating large areas of tissue in children.

In cases of use in surgical operations in the pharynx or nasopharynx, it should be noted that lidocaine, suppressing the pharyngeal reflex, enters the larynx and trachea and suppresses the cough reflex, which can lead to bronchopneumonia.This is especially important in children, as they are more likely to have a swallowing reflex. Therefore, the spray is not recommended for local anesthesia before tonsillectomy and adenotomy in children under 8 years of age.

Care should be taken when applying lidocaine to damaged mucous membranes and / or infected areas.

In lower doses, it should be used in debilitated and elderly patients, in acute diseases, as well as in children – in accordance with age and general condition.

Influence on the ability to drive vehicles and mechanisms

During the period of treatment, care must be taken when driving vehicles and engaging in other potentially hazardous activities that require increased concentration of attention and speed of psychomotor reactions.

instructions for use, analogs, composition, indications

Talk to your doctor or pharmacist before using Lidocaine Spray.
– It is important not to allow lidocaine to enter the respiratory tract (risk of aspiration).
– Application to the pharynx requires special attention.
– Application to the mucous membrane of the cheeks is accompanied by the risk of dysphagia (swallowing disorder) and subsequent aspiration. If the sensitivity of the tongue and the mucous membrane of the cheeks is impaired, the risk of biting them increases.
– Lidocaine is well absorbed through mucous membranes (oral cavity, gums) and damaged or infected skin.
– If you are taking medications for the treatment of arrhythmias (heart rhythm disturbances), such as amiodarone, you need close medical supervision.Your healthcare provider may decide if your heart needs to be monitored.
– The drug should be used with caution in patients with epilepsy, heart rhythm disturbances, heart disease, impaired liver or kidney function and severe shock, since in such conditions you may be more sensitive to the active substance. In this case, you should use smaller doses or consult your doctor.
– If you know that you or one of your relatives suffers from a rare disease of the blood pigment – porphyria.
– Lower doses should be used in debilitated and elderly patients, in acute diseases, as well as in children – in accordance with age and general condition.
– During the application of the Lidocaine spray, the bottle should be kept as vertical as possible.
– The spray should not come into contact with the eyes.
Pediatric use
– Application to the mucous membrane of the cheeks is accompanied by the risk of impaired swallowing and subsequent aspiration (inhalation), especially in children.If the sensitivity of the tongue and the mucous membrane of the cheeks is impaired, the risk of biting them increases.
– Lidocaine is well absorbed through mucous membranes (oral cavity, gums) and damaged or infected skin. This is especially important if the child has a hypersensitivity to lidocaine. In this case, you should use lower doses or consult a doctor.
– In children under 2 years of age, Lidocaine spray is recommended to be applied with a cotton swab dipped in the preparation.
– Lidocaine blocks the cough reflex, which can cause pneumonia.This should be taken into account, as children swallow more often than adults.

Lidocaine Spray contains ethanol and propylene glycol
The product contains a small amount of ethanol (alcohol): less than 100 mg in each serving.
Each serving of this drug contains approximately 10.5 mg of propylene glycol.

lidocaine ointment for epilation pain relief

lidocaine ointment for epilation pain relief

lidocaine ointment for epilation pain relief

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What is lidocaine ointment for epilation pain relief?

I have a lot of hair on my body, especially on my legs.What have I not tried, what means. But I stopped at DepiLight phytospray. There is nothing complicated in using, you just need to shake the can and apply the product to the areas. Then I wait 10 minutes and carefully, with pressure, delete. The skin is clean, and most importantly, I noticed that after the third application, the hairs were noticeably reduced.

Effect of lidocaine ointment for epilation pain relief

Using the DepiLight photospray should make the depilation process simple and painless, because the product creates the effect of photoepilation and is suitable for use on any part of the body.The unique composition of the spray not only reliably removes unwanted hairs, but also moisturizes the skin and has a soothing effect.

Expert opinion

Everything that is written about the depilation photospray on the websites is the truth. I checked it myself – bought me his daughter. First of all, this procedure is absolutely painless, the skin after it is smooth and tender. There is an effect, I say for sure. Now you do not need to go to a beautician about depilation and endure pain.The only drawback of this product is a small bottle, but the manufacturers promise that gradually the hair follicle is destroyed and the hair will stop growing, so you still have to order a couple of bottles.

How to order

In order to place an order for an ointment with lidocaine for anesthesia epilation, you must leave your contact information on the site. The operator will contact you within 15 minutes. Will clarify all the details with you and we will send your order. In 3-10 days you will receive the parcel and pay for it upon receipt.

Customer Reviews:

Anya

Depilight Spray works in conjunction with a light source. The fact is that it contains special components that, interacting with light and oxygen, soften the hair structure, which contributes to the softening of the hair structure and its complete (or almost complete) painless removal. How does Depilight work? What allows him to remove hair so effectively (according to the manufacturers)? The point is in the special elements, which I will try to make out in more detail, to what extent it will turn out.Firstly, these are the depilatory components themselves, which are responsible for depilation. They contain PHOTOLYASE and other so-called. light-sensitive enzymes created from algae extracts. Under the influence of light, they dissolve the structure of unwanted hair and allow you to get rid of them, if not forever, then for a long time. And most importantly, it is quite painless. To soften the skin, filling the space of the follicles, emollients are used. This is achieved due to the presence of liquid particles of passion flower in them.The soothing ingredients in the face of compounds such as D-panthenol allow the skin to recover faster from unwanted hair loss. At the same time, the likelihood of irritation is practically excluded.

Masha

Using the photo spray DepiLight for depilation, you will avoid many of the troubles that occur after hair removal. You will not need to repeat the treatments every two to three weeks. You will not have thickened or ingrown hairs in place of the removed ones. You do not have to heal pustules and eliminate foci of irritation.You will not experience even the slightest pain during and after the procedure.

This remedy is much better than wax depilation, and I always suffered with wax. With this spray, hair removal is greatly simplified. Firstly, there is no discomfort, and secondly, the procedure itself is much faster than with wax, and thirdly, this option ideally removes hair to the very root, after this spray, they even grow much slower than usual, a very cool thing. Where to buy lidocaine ointment for epilation pain relief? Everything that is written about the depilation photospray on the websites is the truth.I checked it myself – bought me his daughter. First of all, this procedure is absolutely painless, the skin after it is smooth and tender. There is an effect, I say for sure. Now you do not need to go to a beautician about depilation and endure pain. The only drawback of this product is a small bottle, but the manufacturers promise that gradually the hair follicle is destroyed and the hair will stop growing, so you still have to order a couple of bottles.

Lidocaine is a local anesthetic used for pain relief before.Lidocaine ointment. Cream for pain relief for depilation with lidaicoin not. A good anesthetic cream for deep freeze bikini hair removal. The anesthetic gel contains a B vitamin, he. Epilation is a painful and unpleasant hair removal procedure. … Anesthetic depilation ointment belongs to the category of primary anesthesia. … Maria P. Excellent pain relief for hair removal. Local anesthesia is a lifesaver for people with hypersensitivity. A safe product will help to reduce the sensitivity of the skin – as a result, the pain caused by depilation and epilation of the bikini area will be less noticeable.Design of the article: Oleg Lozinsky. Video about. Lidocaine Ointment: Anesthetic depilation cream. Sugaring, wax depilation are painful procedures, because during their implementation the hair is removed along with the bulb, and most of them are located on the nerve endings. There are a number of pain relievers available to reduce discomfort. It is applied externally for local anesthesia of some kind. … The main ingredients – prilocaine and lidocaine – are local anesthetics from the group. Considering that for a cosmetic procedure like hair removal you will need at least 10-15 grams of ointment, it makes sense to buy a whole package.Emla’s ointment ”. Review of pain relieving ointments with lidocaine names. Lidocaine ointment (the instruction tells in detail in what cases it is impossible. Almost all creams and ointments intended for anesthesia during epilation contain lidocaine. For example, Emla cream consists of lidocaine and. The main methods of anesthesia for deep bikini epilation. type of depilation – sugaring, waxing or. The composition of the ointment includes Lidocaine, which provides powerful tissue anesthesia. Because of this, the cream is often used for laser and electrolysis.Today, you can buy an anesthetic and cooling cream with lidocaine and anesthesia for hair removal at a completely inexpensive price practically in. Lidocaine is considered to be the most effective pain reliever. Works very well at removing unwanted hair c. The composition of anesthetic preparations for depilation and hair removal. … Lidocaine for hair removal. Lidocaine is a local anesthetic synthesized back in 1943. … The ointment is used to relieve pain when depilating the bikini area, underarms and legs.Use this remedy on the face with caution and avoid. Lidocaine for hair removal. Lidocaine is a local anesthetic synthesized back in 1943. … The ointment is used to relieve pain when depilating the bikini area, underarms and legs. Apply this remedy on the face with caution, avoid contact with mucous membranes. It should be applied to the skin at a minimum. Online store Everything for depilation. Delivery in Moscow and all over Russia. Discounts! · Express delivery. Pickup point. Individual approach. Verified brands · Seller: ESTETIST LLC.Address: 129110, Mo …

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The use of the DepiLight photospray should make the depilation process simple and painless, because the product creates the effect of photoepilation and is suitable for use on any part of the body. The unique composition of the spray not only reliably removes unwanted hairs, but also moisturizes the skin and has a soothing effect.

lidocaine ointment for epilation pain relief

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How to use lidocaine ointment?

Lidocaine ointment is a medicine that is applied directly to the outer surfaces of the body.It is used to treat pain and itching due to minor skin irritation and rashes. It is also used as a local anesthetic to treat minor pain in the mouth and throat. The methods of administration depend primarily on the condition to be treated and the location.

For skin conditions such as sunburn, minor scratches and rashes, the lidocaine ointment should first be applied to a sterile gauze pad, directly from the container, usually some type of squeeze tube.This prevents contamination of the remaining ointment. Then the ointment should be gently applied in a circular motion to the affected area. You do not need to rub in the ointment until it is completely absorbed. Simply rub it to the surface. Minor cuts and other skin lesions can also be treated this way.

Although the ointment can be absorbed into the skin, lidocaine ointment is not usually used on intact skin. It won’t help bruise pain, for example. Only skin surface conditions such as sunburn and rashes will be affected.Lidocaine ointment is effective in treating pain and itching, and therefore may be useful for treating insect bites and conditions such as shingles. In all cases, the gauze pad application method is preferred.

When used in the mouth, lidocaine ointment should be applied using a sterile swab. Apply the ointment directly to the swab from the tube. Dry the surface to be treated as thoroughly as possible and apply the ointment quickly. This will help the ointment stick and be absorbed.It may be helpful to use cotton balls to absorb saliva until the ointment is absorbed and has an effect.

The use of oral lidocaine ointment requires some special considerations. This can numb the affected area and thus increase the risk of accidentally biting the patient or their tongue or inside the cheek. It can also interfere with swallowing. For these reasons, food or drink, chewing gum or candy should not be consumed or consumed for at least one hour after use.

As with any medication, you must follow the instructions that come with the lidocaine ointment. or follow your doctor’s instructions for using it. Some people may be allergic to the medicine, and some other medical conditions may interfere with its use, so it is important to carefully read any information that accompanies the medicine

OTHER LANGUAGES

Advice for use in decubitus ulcers

Tips for using Stellanin Ointments

1. In the presence of purulent discharge, it must be removed before dressing. Rinse with boiled water or furacillin solution, after cleansing, thoroughly blot the surface of the bedsores with a gauze swab.

2. The use of hydrogen peroxide, solution of potassium permanganate, silver preparations, proteolytic enzymes and preparations containing blood components (actovegin, solcoseryl, derinat) with simultaneous use is extremely undesirable, because these compounds neutralize Stellanin.

3. If the dressing is stuck, before dressing it can be soaked in boiled water (not peroxide!)

4. For the treatment of pressure sores with a weeping surface, with purulent discharge, as well as on mucous membranes, Stellanin-PEG is used, it contains polyethylene glycol, due to which this drug perfectly dries pressure sores, extracts pus and exudate from the depth of the wound.

IMPORTANT! Stellanin-PEG solidifies upon cooling, and melts at a temperature close to the temperature of the human body.Due to this property, the drug spreads well over the entire wound surface, filling its irregularities, wound channels, fistulous passages. Therefore, it is recommended to slightly warm the tube before use, otherwise the ointment hardened at a low temperature will not be squeezed out, and the package will be damaged. After application, the tube of Stellanin-PEG must be well closed with a cap and stored in the cold to avoid leaks.

Stellanin ointment has other physical properties and is perfectly preserved at room temperature, is used on bedsores without purulent discharge, adheres well to the skin, does not spread when heated and does not require mandatory storage in the refrigerator.Dressings with Stellanin ointment do not stick to the wound, they are easily removed when bandaging.

5. Ointments Stellanin and Stellanin-PEG can be used both under a bandage and in the form of tampons and applications. After applying Stellanin, the gauze bandage must be secured with a plaster, mesh bandage or in any convenient way.

6. The best results are obtained with a two-time dressing regimen (morning and evening), with abundant fluid release, you can change the dressings more often.

7. Application of Stellanin Ointment to large bedsores can cause pain. They can be removed with a local anesthetic such as lidocaine. You can use an aerosol or a less expensive solution in ampoules. Before using the ointment, moisten the surface of the bedsores with Lidocaine, after 4-5 minutes you can painlessly apply Stellanin.

Further, Vyacheslav Kolesnikov, Kaliningrad, shares his experience in the treatment of pressure ulcers, the author’s style and spelling are preserved:

12 October 2017

My mother is 87 years old, diabetes of the 2nd degree. “Lying and non-walking” since May 2015, bilateral ischemic stroke. Trophic ulcers of the right and left legs of the legs (the wounds were weeping, appeared at the end of 2016), as well as a trophic heel, foot, bedsore on the lower back, back of the head. He began treatment with Stelanin PEG in February 2017. Every morning and at night, baths: treatment of trophic lesions with foam from laundry soap. Buy sponges for children, lather the sponge until a copious foam forms and (very carefully) wash my wound with this foam.After this, the wounds should dry and then the application of Stelanin Peg ointment. He refused the bandages. There is a surgical patch on sale. He covered the wounds with a sterile napkin and fixed them with a plaster on top. Periodically, surgically (using a disposable scalpel and tweezers to remove necrosis and purulent deposits – pain relief: Lidocaine (spray) treats the wound and after 4 – 5 minutes necrosis can be removed (of course, it is better for the surgeon to do this). Necrosis can also be “broken” with using Himotypsin, making a solution with novocaine or dist.water (making periodic lotions). For example: make lotions throughout the day as it dries. Then again, baths with foam from laundry soap and Stelanin Peg ointment. Any wound needs oxygen for granulation – if possible, apply ointment and leave open the wounds. Stelanin used ointment if the surface of the wound was dry, and also treated the beginning manifestation of pressure ulcers as soon as he noticed redness. Every morning and evening (in order not to accumulate fluid in the lungs) I do a slight “slap”, namely: I fold my palm with a boat and slap it on the back for 10-15 seconds, and then in the chest area.For the discharge of macrota from the lungs after eating, take an Ambroxol + tablet and bromhexine. Periodically, once every 2 days (at night) I rub the back, arms and leg muscles with camphor alcohol. Currently, my mother, sitting in a gurney, eats herself with her right and left hand, and the results of my treatment with the ointment are in the photo. Thank you very much and a deep bow to those people who created this ointment and is distributing it! ”
Throughout the treatment, V.Kolesnikov took photographs to record changes in the condition of the wounds, some of them are presented below.

Attention, then shocking content.

Left shin

Right heel

Right Calf

Allergen c82 – lidocaine / xylocaine, IgE

Allergy to this drug occurs quite often and can manifest itself as a skin rash, urticaria (on the skin and mucous membranes), itching and such severe allergic reactions as angioedema, anaphylactic shock.Determination of specific immunoglobulin E to this allergen in an increased amount indicates the presence of sensitization of the body to it.

The study is carried out only for the 1st type of allergic reactions. A negative test result cannot guarantee that there is no other type of allergic reaction.

Synonyms Russian

Specific class E immunoglobulins for lidocaine / xylocaine.

Synonyms English

Lidocaine / Xylocaine, IgE; Specific IgE to Lidocaine (Xylocaine) in Serum.

Research method

Enzyme-linked immunosorbent assay (ELISA).

Units

IU / ml (international unit per milliliter).

What kind of biomaterial can be used for research?

Venous blood.

How to properly prepare for the study?

• Do not smoke within 30 minutes prior to examination.

General information about the study

Lidocaine is an amide drug used for local and regional anesthesia, as well as an antiarrhythmic agent.Available as a solution for injection, eye drops, spray or gel. Other trade names of the drug registered in Russia include Xylocaine, Versatis, Gelikain, Dineksan, Luan. It is part of the combined preparations Otyrelax, Folikap, Lidochlor, Instillagel, Anauran, Emla, Akriol Pro, Kamistad, Kalmyreks, Dentinox, Procto-Glivenol.

Lidocaine acts more intensively and longer (up to 75 minutes) than novocaine, but the duration of its action is shorter than that of bupivacaine.When epinephrine is added to lidocaine, the anesthetic effect increases to 2 hours. It can be used for all types of local anesthesia, including superficial, infiltration, conduction, epidural, spinal, intraligamentary during surgical interventions, painful manipulations, endoscopic and instrumental studies in all surgical areas of medicine, including gynecology, otorhinolaryngology, ophthalmology, dentistry, as well as neurology, radiology.The drug can be administered parenterally, applied using sprays or in the form of plates for pain in vertebral lesions, myositis, postherpetic neuralgia. In cardiology, lidocaine is administered intravenously and is used to relieve paroxysms of ventricular tachycardia and ventricular arrhythmias, including myocardial infarction and heart surgery.

Like the vast majority of drugs, lidocaine can have side effects on various organs and systems, for example, in the form of pressure reduction, headache, nausea, vomiting, respiratory arrest, confusion, methemoglobinemia, as well as allergic reactions and anaphylactic shock.

The exact prevalence of allergic reactions to local anesthetics is unknown, but among all the side effects caused by anesthetic drugs, immune reactions are extremely rare – no more than 1% of cases. Most of the adverse reactions are associated with an overdose of the drug, its toxic effect, the presence of additional substances in the drug (for example, epinephrine, sulfites, parabens, antibiotics).

From a clinical and pathogenetic point of view, allergic reactions to drugs are divided into immediate (within one hour from taking the drug) and delayed (several hours – two days) types.Allergic reactions of immediate type to lidocaine include urticaria, edema at the injection site, bronchospasm, anaphylactic shock. When applying the drug to the skin, contact urticaria is possible. Delayed-type reactions include local or widespread eczema, fixed erythema pigmentosa.

No cross-allergic reactions between lidocaine and other amide anesthetics have been reported at present.

What is the research used for?

• Diagnosis of immediate allergic reactions to lidocaine;
• selection of local anesthetic for patients with a history of allergic reactions to anesthetic drugs.

When is the study ordered?

• When planning the administration of lidocaine to patients with a history of allergic reactions to anesthetic drugs;
• when examining children and adults with allergic reactions or anaphylactic shock after using lidocaine.

What do the results mean?

Reference values ​​

Reasons for a positive result:

• Immediate hypersensitivity to lidocaine / xylocaine.

Reasons for a negative result:

• absence of IgE sensitization to this allergen;
• Long-term limitation or exclusion of contact with the allergen.

A little about local anesthesia | Dynasty H

When visiting a dentist, people of any age are concerned only with one question: “Will it hurt?”

• Local anesthesia is available to solve this problem in dentistry.Local anesthesia.
  In this case, anesthesia is carried out only in the area where the intervention is planned. In this case, the patient is conscious.
  Carpool syringes are now used for local anesthesia, into which the cartridges with anesthetic solution are directly placed. The needles for carpool anesthesia are many times thinner than conventional disposable syringes, which means that the injection will not be as painful.

Articaine-based anesthetics are considered the most modern.This active substance is used in such anesthetics as Ultracaine, Ubistezin, etc. Anesthetics of the articaine series are superior in effectiveness to all the known Lidocaine (1.5-2 times) and Novocaine (5-6 times).

A big advantage of articaine-based anesthetics is that they also work when an inflammation area needs to be anesthetized. If we compare their action with other substances in this case, then novocaine practically ceases to work, and the activity of lidocaine decreases markedly.

Most anesthetics, in addition to the main anesthetic component, articaine, etc., also contain vasoconstrictor substances – adrenaline or epinephrine. The latter components, due to vasoconstriction in the injection site, can reduce the washout of the anesthetic, and this leads to an increase in the strength and duration of anesthesia.

Also used in dentistry is a drug made on the basis of Mepivacaine 3% – Scandonest. It does not contain any vasoconstrictor components or preservatives.Scandonest is used mainly only in patients at risk who cannot be treated with anesthetics with epinephrine and epinephrine, as well as in patients with bronchial asthma.

• What if you are afraid of anesthesia?

So, in order to reduce the discomfort from the injection, you can ask the doctor to pre-use an anesthetic spray to numb the mucous membrane at the injection site (most often Lidocaine spray is used).

There are also drugs that can help reduce fear and anxiety before going to the dentist.Of the non-prescription drugs, Afobazol can be distinguished, which is especially convenient for those who need to make several trips to the dentist.). The drug has a good sedative / anti-anxiety effect, but it does not cause drowsiness. Since Afobazol is drunk in a course (1 pack for 20 days), you need to start drinking the drug 5-7 days before the visit to the dentist – in this case, the effect will be higher.

You can also use tinctures of valerian, motherwort, corvalol, valocardin.It is also advisable to take these drugs in a course, starting a few days before the visit to the doctor. Care should be taken to use this type of sedatives for drivers and people whose work requires increased attention, since they have a hypnotic effect.