Benzocaine (Orajel) - Dosage, Indications, Brands

By reducing the neuronal membrane's permeability to sodium ions, benocaine prevents both the conduction and initiation of neuronal impulses.

  • Topical use:

    • Dermal irritation:

      • It is used as ointment 5%, spray 5% and 20%
      • It has been used to treat minor skin irritations, cuts, sunburn, scrapes, small burns, and insect bites temporarily relieve discomfort and itching.
      • Moreover, it is applied to treat minor burns, scrapes, and cuts to avoid infection.
    • Poison ivy/sumac:

      • Spray 5% (Ivy-Rid only):

        • It is used to temporarily relieve the pain and itching brought on by poison oak, sumac, and poison ivy.

  • Topical oral use:

    • Mouth and gum irritation:
      • Ointment 20%:

        • It is used to provide short-term pain relief for cold sores and fever blisters.
      • Gel 10% and 20%, lozenge, spray 5%, liquid 10% and 20%:

        • It is used to treat small oral and gum injuries produced by dentures or orthodontic devices, as well as pain associated with sore gums, a sore throat, toothaches, canker sores, braces, and minor dental treatments.
        • Due to safety concerns over the increased risk of methemoglobinemia in newborns and young children (under the age of two), it is not advised.
  • Sore throat/mouth, gag reflex suppression:

    • Spray 20%:
      • It is used topically to parts of the mouth or mucous membranes.
      • It is used to provide momentary relief from slight discomfort and pain associated with sore throats and mouths.
      • Moreover, it is utilised to momentarily reduce the gag reflex.

  • Topical anesthetic:

    • Gel or liquid 20% (Topex only):
      • Prior to local anaesthetic injections, scaling, and prophylaxis, it is used as a topical anaesthetic on the oral mucosa.
      • When taking impressions, it is utilised to ease the discomfort that comes with it.

Benzocaine Dose in Adults

Dosage in the treatment of Dermal irritation:

  • Topical (external):

    • Spray 5% and 20%, ointment 5%:
      • When needed, apply to the afflicted area or use 1 spray every 6 hours.
      • Bee stings should be treated without the stinger present first.

Dosage in the treatment of Mouth and gum irritation:

  • Topical (oral):

    • Gel 10% or 20%, liquid 10% or 20%, ointment 20%, spray 5%:
      • Use one spray up to four times daily as necessary, or apply a thin layer to the affected region.


Use in the Poison ivy/sumac:

  • Topical (external):

    • Spray 5% (Ivy-Rid only):
      • Spray until the afflicted area is moist.

Use in the treatment of Sore throat/mouth, gag reflex suppression:

  • Topical (oral):
    • Lozenge:

      • Let one lozenge to dissolve entirely in the mouth.
      • If necessary, it can be repeated every two hours.
    • Spray 20%:

      • Benz-O-Sthetic:
      • Spray it twice to three times, or as needed.
      • Repeat for bigger areas if necessary.
    • Hurricaine:

      • Spray up to four times per day on the neck or afflicted area.

Use in the treatment of Topical anesthetic:

  • Topical (oral):

    • Gel or liquid 20% (Topex only):
      • To cause topical anaesthetic, apply a little amount to the mucosa.

Benzocaine Dose in Children

  • Due to risk of methemoglobinemia, AAP, FDA, and the American Academy of Pediatric Dentistry does NOT recommend use for teething and mouth pain in infants and children  younger than 2 years

Use in the treatment of Dermal irritation (insect bites, minor cuts, scrapes, minor burns, sunburn):

  • Topical:

    • 20% spray, 5% ointment:

      • Children ≥2 years and Adolescents:
        • 3 to 4 times a day, if necessary, it is applied to the affected region.

Use in the treatment of Mouth and gum irritation (including fever blisters and cold sores):

  • Topical:

    • Oral 10% or 20% gel/liquid:

      • Children ≥2 years and Adolescents:
        • Up to 4 times a day, as needed, a thin layer is applied to the affected area.
      • Oral 5% spray:

        • Children ≥6 years and Adolescents:
          • Spray the area once, up to four times per day.

Use in the treatment of Sore throat, sore mouth, and gag reflex suppression:

  • Oral lozenge:

    • Children ≥5 years and Adolescents:
      • Let one lozenge slowly dissolve in your tongue.
      • If necessary, it can be repeated every two hours.
  • Oral spray 5%:

    • Children ≥6 years and Adolescents:
      • Use 1 spray to the throat or afflicted area up to 4 times per day.
  • Oral spray 20%:

    • Children ≥2 years and Adolescents:
      • Up to four times each day, spray the throat or the afflicted area.

Benzocaine pregnancy risk category: C

  • Benzocaine can only be used for topical purposes. It is not recommended for use during pregnancy, as there is insufficient data.

Use during breastfeeding:

  • It can be used while you breastfeed. 

Benzocaine Dose in Renal Disease:

  • No dose adjustments have been advised by manufacturer in patient with kidney disease.

Benzocaine Dose in liver Disease:

  • No dose adjustments have been advised by manufacturer in patient with liver disease.

Side effects of Benzocaine:

  • Central nervous system:

    • Localized burning
    • Stinging sensation
  • Dermatologic:

    • Contact dermatitis
    • Localized erythema
    • Localized rash
    • Urticaria
  • Hematologic & oncologic:

    • Methemoglobinemia
  • Hypersensitivity:

    • Hypersensitivity
  • Local:

    • Local pruritus
    • Localized edema
    • Localized tenderness

Contraindication to Benzocaine include:

  • Allergy reactions to para-aminobenzoic (PABA) or any other part of the formulation
  • Self-medication should be avoided if you are allergic to any local anesthetics such as procaine, benzocaine and butacaine.
  • It shouldn't be used on lacerations, puncture wounds or deep wounds.

Warnings and precautions

  • Methemoglobinemia:
    • It was reported to be effective when applied topically to the mucous membranes or mouth, in a concentration of 14% to 20%.
    • It is not recommended to spray multiple times or for a longer duration than the indicated time.
    • Be careful in the following situations:
      • Coexisting breathing issues (emphysema and bronchitis in smokers)
      • Mucosa damaged or inflamed
      • Heart disease
      • Children under 6 months old
      • Anomalies in the enzyme or haemoglobin (glucose-6-phosphate dehydrogenase deficiency, hemoglobin-M disease,
      • NADH-methemoglobin reductase deficiency, pyruvate-kinase deficiency).
      • Those who are more vulnerable should think about alternatives to benzocaine sprays, like topical lidocaine.

Benzocaine: Drug Interaction

Note: Drug Interaction Categories:

  • Risk Factor C: Monitor When Using Combination
  • Risk Factor D: Consider Treatment Modification
  • Risk Factor X: Avoid Concomitant Use

Risk Factor C (Monitor therapy).

Dapsone (Topical) May increase the toxic/adverse effects of Methemoglobinemia Associated Agents.
Local Anesthesia Methemoglobinemia The negative/toxic effects of local anaesthetics may be exacerbated by accompanying substances. Risk of methemoglobinemia could rise.
Methemoglobinemia associative Agents Local anaesthetics could be more harmful or poisonous. Risk of methemoglobinemia could rise.
Nitric Oxide May intensify the toxic/unfavorable effects of agents associated with methemoglobinemia. Methemoglobinemia risk may rise when these drugs are combined. Monitoring patients for symptoms like hypoxia and cyanosis is crucial when nitric oxide is coupled with other substances that can lead to methemoglobinemia. Do not use lidocaine or prilocaine.
Prilocaine Methemoglobinemia Associated Agents can increase the toxic/adverse effects of Prilocaine. Combinations with these agents can increase the risk of methemoglobinemia. When prilocaine is combined with other agents that can cause methemoglobinemia, monitor patients for signs such as hypoxia and cyanosis. Lidocaine/prilocaine should not be given to infants who are receiving these agents.
Sodium Nitrite The toxic/unfavorable effect of sodium nitrite can be increased by methemoglobinemia associated agents. The likelihood of substantial methemoglobinemia could rise when these medications are combined.

Monitor:

  • Examine patients for methemoglobinemia symptoms and signs, such as tachycardia, dyspnea, pallor, weariness, cyanosis, muscle weakness, disorientation, confusion, and agitation.
  • The main clinical symptom of methemoglobinemia is the presence of chocolate-brown arterial blood.
  • Co-oximetry should be used to confirm suspected instances since it provides a precise and direct measurement of methemoglobin levels.
  • Conventional arterial blood gas tests or pulse oximetry readings are frequently unreliable.
  • Methemoglobinemia that requires rapid treatment is clinically severe.

How to administer Benzocaine?

  • Avoid coming into contact with your eyes and other mucous membranes.
  • Do not use some spray products near heat, flame, or fire as they may contain flammable components.
  • Avoid coming into contact with clothing or furnishings as some products can stain particular fibres.

Topical, external:

  • The ointment should be applied evenly.

Spray:

  • It should be shaken well before using.
  • Hold the affected area between 6 and 12 inches away.
  • Spray onto the palm of your hand before touching your hand to your face to apply to your face.
  • Applying it to skin that is damaged, blistered, or abraded is not advised.

Topical, oral: Gel/liquid:

  • It should be applied with a cotton applicator or fingertip to the affected area.
  • For dental irritation, do not reinsert dentures till irritation or pain is relieved
  • rinse mouth well before reinserting.

Lozenge:

  • It should be allowed to dissolve slowly in the mouth.

Ointment:

  • It should be applied evenly.

Spray:

  • Before using, it should be thoroughly mixed. Certain products can be applied more precisely directly using an extension tube.

Mechanism of action of Benzocaine:

  • It decreases the permeability of the neuronal membrane to sodium ions, which prevents the conduction and initiation of neuronal impulses.
  • Conduction blockage and depolarization inhibition are the results.

Onset:

  • Around 15 to 30 seconds, the anaesthetic impact of spray begins.

Absorption:

  • Through healthy skin, its absorption is inadequate.
  • It penetrates mucosal membranes thoroughly and traumatises skin.

Metabolism:

  • It is primarily metabolised via the plasma via hydrolysis and hepatic pathway (to a lesser extent).

Benzocaine international brands:

  • Aftertest Topical Pain Relief
  • Anacaine
  • Anbesol Cold Sore Therapy
  • Anbesol JR
  • Anbesol Maximum Strength
  • Anbesol
  • Baby Anbesol
  • Benz-O-Sthetic
  • Bi-Zets/Benzotroches
  • Blistex Medicated
  • Cepacol INSTAMAX
  • Chiggertox
  • Dent-O-Kain/20
  • Dentapaine
  • Dermoplast
  • Foille
  • HurriCaine One
  • Hurricaine
  • HurriPak Starter Kit
  • Ivy-Rid
  • Kank-A Mouth Pain
  • Ora-film
  • Pinnacaine Otic
  • Sore Throat Relief
  • Zilactin Baby
  • AAA Spray
  • Anaesthesin
  • Anesthetite
  • Auralyt
  • Baby Orajel
  • Babydent
  • Bumeze
  • Claudemor
  • Clovaine Gel
  • Dentispray
  • Dermopur
  • Dolodent
  • Etylu Aminobenzoesan
  • Foille
  • Freez-Eze Throat Anesthetic Gel
  • Gastobenz
  • Gengivarium
  • Graneodin-B
  • Happy-Dent
  • Hurricaine
  • Hurricaine Gel
  • Hurricane Spray
  • Lanacane
  • Lodoc
  • Mandelay
  • Nani Pre Dental
  • Neo-angin
  • Octicaina
  • Oracaine
  • Orajel
  • Oratics Oral Gel
  • Orogel
  • Orogel Dental Gel
  • Oticaina
  • Otisyn
  • Solarcaine
  • Tonjac Benzogel
  • Topex
  • Topicaine
  • Topispray
  • Trimplex

Benzocaine Brands in Pakistan:

Benzocaine [Ear Drops 1 %w/v]

Hitogen Highnoon Laboratories Ltd.

Benzocaine [Lozenges 5 mg]

Armada Scotmann Pharmaceuticals
Tyno Lozenges Lemon Reko Pharmacal (Pvt) Ltd.
Tyno Lozenges Orange Reko Pharmacal (Pvt) Ltd.