Kovanaze (tetracaine HCl/oxymetazoline HCl)
Local Anesthetics - Parenteral Nasal Nasal Spray Syringe (EA)
Last reviewed · Source: First Databank (FDB) drug data
Overview
Tetracaine hydrochloride is a long-acting local anesthetic of the ester type.
Tetracaine hydrochloride is used mainly for spinal anesthesia.
Generic name: tetracaine HCl/oxymetazoline HCl
Pronunciation: (TET-ra-kane/OX-i-me-TAZ-oh-leen)
Drug class: Local Anesthetics - Parenteral
Therapeutic class: Mouth-Throat-Dental - Preparations
Reference product & biosimilars
No reference, biosimilar or interchangeable associated with this drug.
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Indications
The following indications are listed for Kovanaze:
- Administration Of Local Anesthesia
Dosing
Tetracaine hydrochloride is administered by subarachnoid injection for spinal anesthesia. Partially used solutions that do not contain preservatives should be discarded. Dosage of tetracaine hydrochloride varies with the anesthetic procedure, the degree of anesthesia required, and individual patient response. Debilitated, geriatric, acutely ill, obstetric patients, and patients with increased intra-abdominal pressure should generally be given low doses. The drug should be administered cautiously to patients with abnormal or low plasma esterase concentrations. The smallest dose and lowest concentration required to produce the desired effect should be used. The patient's blood pressure should be monitored during spinal anesthesia. Resuscitative equipment and drugs which may be required for treatment of adverse reactions should be immediately available when tetracaine is administered. Proper positioning of the patient is extremely important in spinal anesthesia. For specific procedures and techniques of administration, specialized references should be consulted.
For spinal anesthesia, a 1% solution of tetracaine hydrochloride is diluted with an equal volume of CSF immediately prior to administration. Alternatively, each 5 mg of tetracaine hydrochloride powder is dissolved in 1 mL of CSF. The resulting solutions are administered slowly at a rate of approximately 1 mL/5 seconds. When CSF is added to the powder or the 1% solution, some turbidity may result, depending on the pH of the CSF, the amount of drug and diluent, and the temperature of the solution. The cloudiness results from the release of the free base and this process (which is completed within the spinal canal) is essential for activity of the anesthetic.
For anesthesia of the perineum, the usual adult dose of tetracaine hydrochloride is 5 mg. For anesthesia of the perineum and lower extremities, the usual adult dose is 10 mg. For spinal anesthesia extending up to the costal margin, the usual adult dose is 15-20 mg. For low spinal (saddle block) anesthesia in vaginal delivery, 2-5 mg of tetracaine hydrochloride is administered as a hyperbaric solution. Doses greater than 15 mg are rarely required and should be used only in exceptional cases.
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No dosing information is available for this tab.
No dosing information is available for this tab.
Drug interactions
Since the aminobenzoic acid metabolite of tetracaine may antagonize the activity of aminosalicylic acid and sulfonamides, some clinicians have suggested that tetracaine should not be used in patients receiving these drugs.
There are no contraindication interactions for this drug.
Severe Interaction: Action is required to reduce the risk of severe adverse interaction.
Local Anesthetics/Long-Acting Bupivacaine
SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction.
MECHANISM OF ACTION: Concurrent use of other local anesthetics or use of other local anesthetics within 96 hours following long-acting bupivacaine may result in additive neurologic and cardiovascular effects. Use of articaine, benzocaine, bupivacaine, lidocaine, mepivacaine, prilocaine, procaine, ropivacaine, and tetracaine may also increase the risk of methemoglobinemia.(1,2) Non-liposomal bupivacaine may impact the pharmacokinetic and/or physicochemical properties of the liposomal formulation when administered in the same syringe or used simultaneously unless the ratio of mg of non-liposomal bupivacaine to mg of bupivacaine liposomal does not exceed 1:2.(1) Local anesthetics other than bupivacaine may trigger the immediate release of bupivacaine from the liposomal formulation when administered together locally.(1)
CLINICAL EFFECTS: Concurrent or use of local anesthetics with 96 hours of use of long-acting bupivacaine may result in neurologic and cardiovascular toxicity. Use of articaine, benzocaine, bupivacaine, lidocaine, mepivacaine, prilocaine, procaine, ropivacaine, and tetracaine may also result in methemoglobinemia.(1,2) Non-liposomal bupivacaine may impact the pharmacokinetic and/or physicochemical properties of the liposomal formulation when administered in the same syringe or used simultaneously unless the ratio of mg of non-liposomal bupivacaine to mg of bupivacaine liposomal does not exceed 1:2.(1) Local anesthetics other than bupivacaine may trigger the immediate release of bupivacaine from the liposomal formulation when administered together locally.(1)
PREDISPOSING FACTORS: Use of additional agents that are associated with methemoglobinemia may further increase the risk of methemoglobinemia.(1) Patients who are at increased risk of developing methemoglobinemia include those with glucose-6-phosphate dehydrogenase deficiency, congenital or idiopathic methemoglobinemia, cardiac or pulmonary compromise, infants under 6 months of age, and concurrent exposure to oxidizing agents or their metabolites are more susceptible to developing clinical manifestations of the condition. If local anesthetics must be used in these patients, close monitoring for symptoms and signs of methemoglobinemia is recommended.(1)
PATIENT MANAGEMENT: Avoid the use of other local anesthetics within 96 hours following the administration of long-acting bupivacaine. In patients for whom use is required, monitor for neurologic and cardiovascular effects. Also monitor for methemoglobinemia with use of articaine, benzocaine, bupivacaine, lidocaine, mepivacaine, prilocaine, procaine, ropivacaine, and tetracaine.(1,2) Non-liposomal bupivacaine may be administered in the same syringe as bupivacaine liposomal or injected immediately before bupivacaine liposomal as long as the ratio of mg of non-liposomal bupivacaine to mg of bupivacaine liposomal does not exceed 1:2.(1) Lidocaine may be administered 20 minutes or more prior to bupivacaine. It is unknown if other local anesthetics may be used without compromising the release characteristic of bupivacaine liposomal.(1)
DISCUSSION: Concurrent use of other local anesthetics or use of other local anesthetics within 96 hours following long-acting bupivacaine may result in additive neurologic and cardiovascular effects. Use of articaine, benzocaine, bupivacaine, lidocaine, mepivacaine, prilocaine, procaine, ropivacaine, and tetracaine may also increase the risk of methemoglobinemia.(1,2) Non-liposome bupivacaine may impact the pharmacokinetic and/or physicochemical properties of the liposomal formulation when administered in the same syringe or used simultaneously unless the ratio of mg of non-liposomal bupivacaine to mg of bupivacaine liposomal does not exceed 1:2.(1) Local anesthetics other than bupivacaine may trigger the immediate release of bupivacaine from the liposomal formulation when administered together locally. Lidocaine may be administered 20 minutes or more prior to bupivacaine. It is unknown if other local anesthetics may be used without compromising the release characteristic of bupivacaine liposomal.(1)
Moderate Interaction: Assess the risk to the patient and take action as needed.
Intranasal Decongestants/Zavegepant
SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed.
MECHANISM OF ACTION: Intranasal decongestants may decrease the absorption of zavegepant.(1)
CLINICAL EFFECTS: Concurrent administration of intranasal decongestants may result in decreased systemic exposure and effectiveness of zavegepant.(1)
PREDISPOSING FACTORS: None determined.
PATIENT MANAGEMENT: Avoid concurrent use of intranasal decongestants with zavegepant. If concurrent use is unavoidable, use the decongestant at least 1 hour after zavegepant.(1)
DISCUSSION: Intranasal decongestants may lower absorption of zavegepant. This effect has not been clinically evaluated.(1)
Contraindications
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- Methemoglobinemia
- Angle-closure glaucoma
- Benign prostatic hyperplasia
- Glucose-6-phosphate dehydrogenase (g6Pd) deficiency
- Hemolytic anemia from pyruvate kinase and g6PD deficiencies
- Atherosclerotic cardiovascular disease
- Coronary artery disease
- Diabetes mellitus
- Hypertension
- Hyperthyroidism
Adverse reactions
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Less Frequent
- Dizziness
- Headache disorder
- Insomnia
- Nervousness
- Rebound nasal congestion
- Tremor
Rare or Very Rare
- Cardiac arrhythmia
- Hypertension
Less Frequent
- Dry nose
- Nasal passage irritation
- Rhinorrhea
- Sneezing
Rare or Very Rare
- Nausea
- Palpitations
Precautions
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No enhanced messaging available.
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ICD codes
| Code | Type | Description |
|---|---|---|
| Administration of local anesthesia | ||
| 3E00XBZ | ICD10PCS | Introduction of anesthetic agent into skin and mucous membranes, external approach |
| 3E013BZ | ICD10PCS | Introduction of anesthetic agent into subcutaneous tissue, percutaneous approach |
| 3E023BZ | ICD10PCS | Introduction of anesthetic agent into muscle, percutaneous approach |
| 3E093BZ | ICD10PCS | Introduction of anesthetic agent into nose, percutaneous approach |
| 3E097BZ | ICD10PCS | Introduction of anesthetic agent into nose, via natural or artificial opening |
| 3E09XBZ | ICD10PCS | Introduction of anesthetic agent into nose, external approach |
| 3E0B3BZ | ICD10PCS | Introduction of anesthetic agent into ear, percutaneous approach |
| 3E0B7BZ | ICD10PCS | Introduction of anesthetic agent into ear, via natural or artificial opening |
| 3E0BXBZ | ICD10PCS | Introduction of anesthetic agent into ear, external approach |
| 3E0C3BZ | ICD10PCS | Introduction of anesthetic agent into eye, percutaneous approach |
| 3E0C7BZ | ICD10PCS | Introduction of anesthetic agent into eye, via natural or artificial opening |
| 3E0CXBZ | ICD10PCS | Introduction of anesthetic agent into eye, external approach |
| 3E0D3BZ | ICD10PCS | Introduction of anesthetic agent into mouth and pharynx, percutaneous approach |
| 3E0D7BZ | ICD10PCS | Introduction of anesthetic agent into mouth and pharynx, via natural or artificial opening |
| 3E0DXBZ | ICD10PCS | Introduction of anesthetic agent into mouth and pharynx, external approach |
| 3E0E3BZ | ICD10PCS | Introduction of anesthetic agent into products of conception, percutaneous approach |
| 3E0E7BZ | ICD10PCS | Introduction of anesthetic agent into products of conception, via natural or artificial opening |
| 3E0E8BZ | ICD10PCS | Introduction of anesthetic agent into products of conception, via natural or artificial opening endoscopic |
| 3E0F3BZ | ICD10PCS | Introduction of anesthetic agent into respiratory tract, percutaneous approach |
| 3E0F7BZ | ICD10PCS | Introduction of anesthetic agent into respiratory tract, via natural or artificial opening |
| 3E0F8BZ | ICD10PCS | Introduction of anesthetic agent into respiratory tract, via natural or artificial opening endoscopic |
| 3E0G3BZ | ICD10PCS | Introduction of anesthetic agent into upper Gi, percutaneous approach |
| 3E0G7BZ | ICD10PCS | Introduction of anesthetic agent into upper Gi, via natural or artificial opening |
| 3E0G8BZ | ICD10PCS | Introduction of anesthetic agent into upper Gi, via natural or artificial opening endoscopic |
| 3E0H3BZ | ICD10PCS | Introduction of anesthetic agent into lower Gi, percutaneous approach |
| 3E0H7BZ | ICD10PCS | Introduction of anesthetic agent into lower Gi, via natural or artificial opening |
| 3E0H8BZ | ICD10PCS | Introduction of anesthetic agent into lower Gi, via natural or artificial opening endoscopic |
| 3E0J3BZ | ICD10PCS | Introduction of anesthetic agent into biliary and pancreatic tract, percutaneous approach |
| 3E0J7BZ | ICD10PCS | Introduction of anesthetic agent into biliary and pancreatic tract, via natural or artificial opening |
| 3E0J8BZ | ICD10PCS | Introduction of anesthetic agent into biliary and pancreatic tract, via natural or artificial opening endoscopic |
| 3E0K3BZ | ICD10PCS | Introduction of anesthetic agent into genitourinary tract, percutaneous approach |
| 3E0K7BZ | ICD10PCS | Introduction of anesthetic agent into genitourinary tract, via natural or artificial opening |
| 3E0K8BZ | ICD10PCS | Introduction of anesthetic agent into genitourinary tract, via natural or artificial opening endoscopic |
| 3E0L3BZ | ICD10PCS | Introduction of anesthetic agent into pleural cavity, percutaneous approach |
| 3E0M3BZ | ICD10PCS | Introduction of anesthetic agent into peritoneal cavity, percutaneous approach |
| 3E0N3BZ | ICD10PCS | Introduction of anesthetic agent into male reproductive, percutaneous approach |
| 3E0N7BZ | ICD10PCS | Introduction of anesthetic agent into male reproductive, via natural or artificial opening |
| 3E0N8BZ | ICD10PCS | Introduction of anesthetic agent into male reproductive, via natural or artificial opening endoscopic |
| 3E0P3BZ | ICD10PCS | Introduction of anesthetic agent into female reproductive, percutaneous approach |
| 3E0P7BZ | ICD10PCS | Introduction of anesthetic agent into female reproductive, via natural or artificial opening |
| 3E0P8BZ | ICD10PCS | Introduction of anesthetic agent into female reproductive, via natural or artificial opening endoscopic |
| 3E0Q0BZ | ICD10PCS | Introduction of anesthetic agent into cranial cavity and brain, open approach |
| 3E0Q3BZ | ICD10PCS | Introduction of anesthetic agent into cranial cavity and brain, percutaneous approach |
| 3E0R3BZ | ICD10PCS | Introduction of anesthetic agent into spinal canal, percutaneous approach |
| 3E0S3BZ | ICD10PCS | Introduction of anesthetic agent into epidural space, percutaneous approach |
| 3E0T3BZ | ICD10PCS | Introduction of anesthetic agent into peripheral nerves and plexi, percutaneous approach |
| 3E0U3BZ | ICD10PCS | Introduction of anesthetic agent into joints, percutaneous approach |
| 3E0V3BZ | ICD10PCS | Introduction of anesthetic agent into bones, percutaneous approach |
| 3E0W3BZ | ICD10PCS | Introduction of anesthetic agent into lymphatics, percutaneous approach |
| 3E0X3BZ | ICD10PCS | Introduction of anesthetic agent into cranial nerves, percutaneous approach |
| 3E0Y3BZ | ICD10PCS | Introduction of anesthetic agent into pericardial cavity, percutaneous approach |
ICD code information from First Databank (FDB).
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Last reviewed · Source: First Databank (FDB) drug data
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