Version May 2024
Dermal pain/itching: Topical: Apply to affected area up to 3 or 4 times daily. Maximum daily dose: 30 g/day.
Hemorrhoids, anorectal pain/itch:
Note: Combine with dietary modifications, bowel hygiene, and warm sitz baths for best results (Ref). General dosing guidelines provided; refer to specific product labeling for dosing instructions.
Topical (external): Apply to anal area, as needed, up to 4 times daily.
There are no dosage adjustments provided in the manufacturer's labeling.
There are no dosage adjustments provided in the manufacturer's labeling.
Refer to adult dosing.
(For additional information see "Dibucaine: Pediatric drug information")
Dermal pain/itching: Children ≥2 years weighing ≥16 kg and Adolescents: Topical: Apply to affected area up to 3 or 4 times daily. Maximum daily dose: 7.5 g/day for children and 30 g/day for adults
Hemorrhoids/anorectal disorders; rectal pain/itching: Children ≥12 years and Adolescents: Topical: Apply to affected external anal area up to 3 or 4 times daily
There are no dosage adjustments provided in the manufacturer’s labeling.
There are no dosage adjustments provided in the manufacturer’s labeling.
There are no adverse reactions listed in the manufacturer's labeling.
Postmarketing: Dermatologic: Acute generalized exanthematous pustulosis (Cubero 2010), allergic dermatitis (including contact dermatitis, maculopapular rash, and symmetrical drug-related intertriginous and flexural exanthema [SDRIFE]) (de Groot 2022)
OTC labeling: When used for self-medication, do not use in or near the eyes or in children <2 years or weight <16 kg.
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 glucose-6-phosphate dehydrogenase 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).
Other warnings/precautions:
• Self-medication (OTC use): For external use only. When used for self-medication, notify health care provider and discontinue use if condition worsens, does not improve within 7 days, or if redness, irritation, swelling, bleeding, or other symptoms develop or increase. Do not put this product into the rectum using fingers or any mechanical device or applicator; do not exceed recommended dose unless directed by a health care provider. Do not use in large quantities, particularly over raw surfaces or blistered areas.
• Topical application: When topical anesthetics are used prior to cosmetic or medical procedures, the lowest amount of anesthetic necessary for pain relief should be applied. High systemic levels and toxic effects (eg, methemoglobinemia, irregular heart beats, respiratory depression, seizures, death) have been reported in patients who (without supervision of a trained professional) have applied topical anesthetics in large amounts (or to large areas of the skin), left these products on for prolonged periods of time, or have used wraps/dressings to cover the skin following application.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Ointment, External:
Nupercainal: 1% (28.4 g, 60 g)
Nupercainal (Topical): 1% (56.7 g [DSC])
Generic: 1% (28 g, 28.35 g, 56 g)
Yes
Ointment (Dibucaine (Perianal) External)
1% (per gram): $0.14
Ointment (Dibucaine External)
1% (per gram): $0.21 - $0.24
Ointment (Nupercainal External)
1% (per gram): $0.18
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.
Topical: For external use only; do not use in or around eyes. Prior to rectal use, clean the affected area with mild soap and warm water and rinse thoroughly; gently dry by patting or blotting with toilet tissue or a soft cloth. Do not put this product into the rectum using fingers or any mechanical device or applicator.
For external use only.
Rectal use: Clean the affected area with mild soap and warm water and rinse thoroughly; gently dry by patting or blotting with toilet tissue or a soft cloth. Do not put this product into the rectum using fingers or any mechanical device or applicator.
Topical dermal use: Do not use in or around eyes. Do not use in large quantities, particularly over raw surfaces or blistered areas.
Dermal pain/itching: Temporary relief of pain and itching caused by sunburn, minor burns, minor cuts, scrapes, insect bites or minor skin irritation.
Hemorrhoids, anorectal pain/itch: Temporary relief of pain and itching due to hemorrhoids and other anorectal disorders.
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.
Methemoglobinemia Associated Agents: May enhance the adverse/toxic effect of Local Anesthetics. Specifically, the risk for methemoglobinemia may be increased. Risk C: Monitor therapy
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.
Onset of action: Within 15 minutes.
Duration: 2 to 4 hours.
Absorption: Poor through intact skin, but well absorbed through mucous membranes and excoriated skin.
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