Is Benzocaine compatible with breastfeeding? Do we have alternatives for Benzocaine?

Benzocaine

June 18, 2018 (Very Low Risk)

Local anesthetic indicated for the relief of pain and cutaneous itching, vaginal, rectal, otic, dental and oral mucosa.
Topical application.

At latest update, relevant published data on excretion into breast milk were not found.

Topical anesthetics (intended for dermatological or oral use) when properly used, show limited systemic absorption which is practically nil, with nil or non-significant systemic levels in maternal plasma and breast milk and should pose no harm to the breastfed infant (Hale 2019 p, PDR 2018, AEMPS 2018, Briggs 2017, AEMPS 2008, Nice 2000).

Benzocaine may induce appearance of methemoglobinemia and systemic toxicity if absorbed (PCR 2018, Hoffman 2015, Lepe 2015, Bittmann 2011, Chung 2010, Bouziri 2010, Bong 2009).

Avoid use on the breast, otherwise, in case of use on the nipple, apply after a feed and wipe it out by thoroughly washing with water before the next feed.
Never apply on the nipple.

Alternatives

Very Low Risk

Compatible. Not risky for breastfeeding or infant.

Low Risk

Moderately safe. Mild risk possible. Follow up recommended. Read the Comment.

High Risk

Poorly safe. Evaluate carefully. Use a safer alternative. Read the Comment.

Very High Risk

Not recommended. Cessation of breastfeeding or alternative.

Synonyms

  • Anaesthesinum
  • Ethoform
  • Ethyl Aminobenzoate

Writings

  • Βενζοκαΐνη (Greek)
  • بانزوكائين (Arabic)
  • Бензокаин (Cyrillic)
  • 苯佐卡因 (Chinese)
  • アミノ安息香酸エチル (Japanese)
  • Benzocaïne (French)
  • C9 H11 NO2 (Molecular formula)
  • Ethyl 4-aminobenzoate (Chemical name)
  • C05AD03; D04AB04; N01BA05; R02AD01 (ATC Code/s)

Drug trade names

References

  1. Hale TW. Hale's Medications & Mothers' Milk. Springer Publishing Company. 2019
  2. AEMPS. Benzocaína. Ficha técnica. 2018 Full text (in our servers)
  3. PDR.net. Benzocaine (Anbesol). Drug Summary. 2018 Full text (link to original source) Full text (in our servers)
  4. Briggs GG, Freeman RK, Towers CV, Forinash AB. Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk. Wolters Kluwer Health. 11th edition (acces on line) 2017
  5. Lepe-Zúñiga JL, Aguilar-Gómez LE, Godínez-Téllez NC. [Association of benzocaine and paracetamol with neonatal-acquired methemoglobinemia]. Bol Med Hosp Infant Mex. 2015Abstract
  6. Hoffman C, Abubakar H, Kalikiri P, Green M. Nosocomial Methemoglobinemia Resulting from Self-Administration of Benzocaine Spray. Case Rep Anesthesiol. 2015Abstract
  7. Bittmann S, Krüger C. Benzocaine-induced methaemoglobinaemia: a case study. Br J Nurs. 2011Abstract
  8. Chung NY, Batra R, Itzkevitch M, Boruchov D, Baldauf M. Severe methemoglobinemia linked to gel-type topical benzocaine use: a case report. J Emerg Med. 2010Abstract
  9. Bouziri A, Khaldi A, Menif K, Ben Jaballah N. Unusual cause of severe toxic methemoglobinemia in an infant: a case report. Int J Emerg Med. 2010Abstract Full text (link to original source) Full text (in our servers)
  10. Bong CL, Hilliard J, Seefelder C. Severe methemoglobinemia from topical benzocaine 7.5% (baby orajel) use for teething pain in a toddler. Clin Pediatr (Phila). 2009Abstract
  11. AEMPS Hemoal (Benzocaína + Efedrina). Ficha técnica. 2008 Full text (in our servers)
  12. Nice FJ, Snyder JL, Kotansky BC. Breastfeeding and over-the-counter medications. J Hum Lact. 2000Abstract