Version May 2024
Spinal anesthesia: Injection: Note: Dosage varies with the anesthetic procedure, the degree of anesthesia required, and the individual patient response; it is administered by subarachnoid injection for spinal anesthesia.
Perineal anesthesia: 5 mg.
Perineal and lower extremities: 10 mg.
Anesthesia extending up to costal margin: 15 mg; doses up to 20 mg may be given, but are reserved for exceptional cases.
Low spinal anesthesia (saddle block): 2 to 5 mg.
No dosage adjustment provided in manufacturer’s labeling.
No dosage adjustment provided in manufacturer’s labeling.
Refer to adult dosing.
(For additional information see "Tetracaine (spinal): Pediatric drug information")
Spinal anesthesia: Limited data available:
Note: Dosage varies with the anesthetic procedure, the degree of anesthesia required, and the individual patient response; doses presented are a reference point (Coté 2019). Doses to be administered by subarachnoid injection for spinal anesthesia. The dose required to produce spinal anesthesia decreases with increasing age; isobaric or hyperbaric 1% solution has been used (Coté 2019).
Age-directed dosing:
Infants <12 weeks: Subarachnoid injection: 0.75 to 1 mg/kg; typically administered as a hyperbaric solution (eg, 1% tetracaine solution mixed in dextrose 10% solution) with or without epinephrine (Coté 2019).
Infants ≥12 weeks to Children <2 years: Subarachnoid injection: 0.3 to 0.4 mg/kg.
Children ≥2 years and Adolescents: Subarachnoid injection: 0.2 to 0.3 mg/kg not to exceed the maximum doses shown below.
Weight-directed dosing:
5 to 15 kg: Subarachnoid injection: 0.3 to 0.4 mg/kg; should not exceed the maximum doses shown below (Coté 2013; Miller 2009).
>15 kg: Subarachnoid injection: 0.2 to 0.3 mg/kg; should not exceed the maximum doses shown below (Coté 2013; Miller 2009).
Maximum doses: Subarachnoid injection: Should not exceed usual procedure-specific adult doses:
Perineal anesthesia: 5 mg.
Perineal and lower extremities: 10 mg.
Anesthesia extending up to the costal margin: 15 mg; doses up to 20 mg may be given but are reserved for exceptional cases.
Low spinal anesthesia (saddle block): 2 to 5 mg.
There are no dosage adjustments provided in the manufacturer's labeling.
There are no dosage adjustments provided in the manufacturer's labeling.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Frequency not defined. Adverse effects listed are those characteristics of local anesthetics. Systemic adverse effects are generally associated with excessive doses or rapid absorption.
Cardiovascular: Hypotension
Central nervous system: Chills, dizziness, drowsiness, loss of consciousness, nervousness, seizure
Dermatologic: Urticaria
Gastrointestinal: Nausea, vomiting
Hematologic & oncologic: Methemoglobinemia
Hypersensitivity: Anaphylaxis, hypersensitivity reaction
Neuromuscular & skeletal: Tremor
Ophthalmic: Blurred vision, miosis
Otic: Tinnitus
Hypersensitivity to tetracaine, ester-type anesthetics, aminobenzoic acid, or any component of the formulation; injection should not be used when spinal anesthesia is contraindicated
Concerns related to adverse effects:
• Methemoglobinemia: Has been reported with local anesthetics; clinically significant methemoglobinemia requires immediate treatment along with discontinuation of the anesthetic and other oxidizing agents. Onset may be immediate or delayed (hours) after anesthetic exposure. Patients with G6PD deficiency, congenital or idiopathic methemoglobinemia, cardiac or pulmonary compromise, exposure to oxidizing agents or their metabolites, or infants <6 months of age are more susceptible and should be closely monitored for signs and symptoms of methemoglobinemia (eg, cyanosis, headache, rapid pulse, shortness of breath, lightheadedness, fatigue).
Disease-related concerns:
• Cardiovascular disease: Use with caution in patients with cardiovascular disease, including rhythm disturbances, shock, or heart block.
• Decreased plasma esterase levels: Use with caution in patients with abnormal or decreased levels of plasma esterases.
• Hyperthyroidism: Use with caution in patients with hyperthyroidism.
Special populations:
• Acutely ill patients: Use with caution in acutely ill patients; dose reduction may be required.
• Debilitated patients: Use with caution in debilitated patients; dose reduction may be required.
• Older adult: Use with caution in the elderly; dose reduction may be required.
• Obstetric patients: Use with caution in obstetric patients; dose reduction may be required.
• Patients with increased intra-abdominal pressure: Use with caution in patients with increased intra-abdominal pressure; dose reduction may be required.
Dosage form specific issues:
• Trained personnel: Dental practitioners and/or clinicians using local anesthetic agents should be well-trained in diagnosis and management of emergencies that may arise from the use of these agents. Resuscitative equipment, oxygen, and other resuscitative drugs should be available for immediate use.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution, Injection, as hydrochloride [preservative free]:
Generic: 1% (2 mL)
Yes
Solution (Tetracaine HCl Injection)
1% (per mL): $45.51
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
Before injection, withdraw syringe plunger to make sure injection is not into vein or artery.
Subarachnoid injection: May administer as an isobaric or hyperbaric solution by experienced individuals only. Before injection, withdraw syringe plunger to make sure injection is not into vein or artery (Coté 2019).
Spinal anesthesia: For the production of spinal anesthesia for procedures requiring 2 to 3 hours
None known.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.
BUPivacaine: Local Anesthetics may enhance the adverse/toxic effect of BUPivacaine. Management: Avoid using any additional local anesthetics within 96 hours after insertion of the bupivacaine implant (Xaracoll) or bupivacaine and meloxicam periarticular solution (Zynrelef) or within 168 hours after subacromial infiltration (Posimir brand). Risk C: Monitor therapy
BUPivacaine (Liposomal): Local Anesthetics may enhance the adverse/toxic effect of BUPivacaine (Liposomal). Management: Liposomal bupivacaine should not be administered with local anesthetics, but may be administered 20 minutes or more after lidocaine. Avoid all local anesthetics within 96 hours after administration of liposomal bupivacaine. Risk X: Avoid combination
Hyaluronidase: May enhance the adverse/toxic effect of Local Anesthetics. Risk C: Monitor therapy
Methemoglobinemia Associated Agents: May enhance the adverse/toxic effect of Local Anesthetics. Specifically, the risk for methemoglobinemia may be increased. Risk C: Monitor therapy
Neuromuscular-Blocking Agents: Local Anesthetics may enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Risk C: Monitor therapy
Technetium Tc 99m Tilmanocept: Local Anesthetics may diminish the diagnostic effect of Technetium Tc 99m Tilmanocept. Management: Avoid mixing and simultaneously co-injecting technetium Tc 99m tilmanocept with local anesthetics. This interaction does not appear to apply to other uses of these agents in combination. Risk C: Monitor therapy
Animal reproduction studies have not been conducted.
It is not known if tetracaine (systemic) is excreted in breast milk. The manufacturer recommends that caution be exercised when administering tetracaine (systemic) to nursing women.
Ester local anesthetic blocks both the initiation and conduction of nerve impulses by decreasing the neuronal membrane's permeability to sodium ions, which results in inhibition of depolarization with resultant blockade of conduction
Duration of action: 1.5 to 3 hours
Metabolism: Hepatic; detoxified by plasma esterases to aminobenzoic acid
Excretion: Urine
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