Tetracaine

PONTOCAINE

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Tetracaine ballicule: receptor binding, kinetics and half-life diagram — Mechanism of action: Tetracaine ballicule

What it isPotent long-acting ester local anesthetic that blocks voltage-gated sodium channels; used topically and for spinal anesthesia.

Why this oneProvides dense, durable surface or neuraxial anesthesia in very small doses.

What limits itRapid absorption or excess dosing can cause seizures, respiratory arrest, and cardiac arrest; ester metabolism also permits PABA-related allergy.

Tetracaine molecular structure (skeletal formula) — Molecular structure: Tetracaine

FDA-approved for

topical/spinal anesthesia (1941)

FDA label

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FDA dosing	Population	Start	Target	Max
Topical ocular (corneal) anesthesia	Adults and pediatric (under HCP supervision)	1 drop in the eye(s) PRN	1 drop PRN	1 drop PRN

Renal Undefined

Hepatic Undefined

Instructions

For administration under direct supervision of a healthcare provider; not for patient self-administration
Not for injection or intraocular/intracameral use
Patients should not touch the eye for 10–20 minutes after use (insensitivity risk)

Available strengths

sol 0.5 %
drops 5 mg/mL
cream 2 g/100 mL
cream 20 mg/1000 mg
gel 20 mg/1000 mL
ointment 2 g/100 g
inj 10 mg/mL

Cautions

Corneal endothelial damage if used intracamerally — not for injection/intraocular use
Prolonged use or abuse may cause corneal epithelial toxicity and permanent corneal damage
Corneal injury from insensitivity — avoid touching the eye until sensation returns
For healthcare-provider administration only

Adverse reactions

Transient stinging
Burning
Conjunctival redness
Eye irritation
Eye pain
Ocular discomfort

Pregnancy No adequate and well-controlled studies in pregnant women

Lactation No data on presence in human milk

Cost

Tetracaine (PONTOCAINE)

Strength		#/mo	generic $/unit	CostPlus
0.5 %	sol	per unit		not offered

NADAC is a voluntary CMS survey of what retail community pharmacies pay for the drugs they stock. Tetracaine is dispensed outside retail pharmacies, so it rarely appears on surveyed invoices.

Generic entryBy 2023

NO BOXED WARNINGS

Principal risklocal-anesthetic systemic toxicity with seizures or cardiac arrest

Classes and tags

Clinical profile

Therapeutic safety burden2 / 4

Overdose danger3 / 4

Weight-gain liability0 / 4

Sedation liability0 / 4

QT / Torsades0 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk0 / 4

Legacy pregnancy categoryNot assigned — PLLR-era drug

Defining liabilityLocal tissue injury and inadvertent systemic exposure can cause seizures or cardiovascular toxicity.

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