Cocaine hydrochloride U.S.P

Category:

  • Local anesthetic

Description:

  • Ester local anesthetic

Indications:

  • Local anesthesia

  • Mucosal anesthesia

Contraindications:

  • Cardiac arrhythmias, coronary artery disease, hypertension, Tourette’s syndrome

  • Cerebrovascular disease, sensitivity to cocaine

Precautions:

  • Pregnancy category C; avoid breast feeding

  • Acutely ill, elderly, or debilitated patients

  • Inflammation or infection at site of application

Adverse Reactions (Side Effects):

  • CNS: agitation, excitement, anxiety, restlessness, apprehension, irritability, hallucinations, psychosis, seizures hyperreflexia, pressured speech, headache, CNS hemorrhage

  • CV: cardiac arrest, MI, PVC’s, heart failure, ventricular fibrillation/tachycardia

  • GI: abdominal pain, bowel ischemia, nausea, vomiting

  • GU: incontinence, renal tubular obstruction

  • MISC: muscle paralysis, nasal congestion, rhinitis, tremor, exophthalmos, fecal incontinence, rhabdomyolysis

Dosage:

Administered topically

  • Adult: 

    • Local or mucosal anesthesia: 

      • Apply 1%-4% solution by means of cotton applicators, packs, sprays, or by instillation. 

  • Child > 6 years: 

    • Local or mucosal anesthesia: 

      • Apply lowest effective dose

      • Do not use solutions greater than 4% due to risk of systemic toxicity; 

      • Do not exceed 1 mg/kg

Special Considerations:

  • Do not apply to eye or administer parenterally

  • Concomitant use of postganglionic blocking agents to control hypertension (guanadrel, guanethidine), sympathomimetics (dobutamine, dopamine, epinephrine), increase risk of cardiac arrhythmias or hypertension.

  • Labetalol (beta-blocker with alpha activity) has been successfully used to treat cocaine-induced hypertension.

Interactions:

  • MAOI’s

  • Cardiac glycosides

  • Cholinesterase inhibitors

  • Halogenated anesthetics

  • Nitrates

  • Sulfonamides

  • Sympathomimetics

  • Thyroid hormones

  • Tricyclic antidepressants

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