Tetracaine and Oxymetazoline (Nasal)

Tetracaine and Oxymetazoline delivered via a nasal spray numbs the tooth that will be worked on in a dental procedure. It can be used on children and adults who weight at least 40 kilograms.


Brand Names and Aliases

  • Kovanaze
  • Tetracaine Hydrochloride and Oxymetazoline Hydrochloride
  • Oxymetazoline and Tetracaine

Tetracaine is a local anesthetic that interrupts nerve impulses before they begin and prevents further transmission. It reduces the permeability of sodium ions in the neuronal membrane in order to interfere with depolarization, which results in blocking pain.

Oxymetazoline is a imidazoline derivative that, when delivered via the nasal mucosa, stirs up the alpha-adrenergic receptors, resulting in the constriction of blood vessels and increase of blood pressure.

Tetracaine and oxymetazoline are combined in a nasal spray that can numb your tooth via the attributes of the combined impacts of these drugs. It is effective for adults and children, but should not be used on anyone who weighs less than 40 kilograms.

This medicine should only be given to you or your child under the supervision of a dental health care professional, preferably a dentist.

Your dentist will provide this medicine in a dental clinic. It is delivered via a spray up your nose and is sprayed up the same side as the location of the maxillary tooth on which you are receiving dental work.

Approximately 10 minutes after you get the medicine, the dentist uses a test drill to verify whether the affected tooth is numb (anesthetized). If so, she will begin the dental procedure.

Condition(s) treated?

  • Numbing agent (dental procedures)

Type of medicine?

  • Adrenergic Agonist Agent
  • Imidazoline Derivative
  • Local Anesthetic

Side Effects

As with other medications, you may experience unwanted side effects while using this drug. It isn't clear why some people experience one or more side effects, while others experience none at all. Luckily, with this drug, you will already be in the dentist office and will receive care right away if any of the following occurs:

Less common

  • dizziness
  • nervousness
  • chest pain or discomfort
  • irregular heartbeat
  • blurred vision
  • shortness of breath
  • Bloody nose
  • unusual tiredness
  • difficulty swallowing
  • ulcers in the nose
  • fainting
  • pounding in the ears
  • headache

Incidence not known

  • difficulty breathing
  • rapid heart rate
  • tightness in the chest
  • Blue lips, palms or fingernails
  • redness of the skin
  • puffiness or swelling around the eyelids or eyes
  • swelling in your face, lips, or tongue
  • dark urine
  • fever
  • unusual bleeding or bruising
  • dizziness or lightheadedness
  • pale skin
  • cough
  • sore throat
  • hives or swelling of the throats, hands, legs, feet, or sex organs
  • welts, itching, or skin rash
  • noisy breathing

The following are symptomatic of an overdose and indicate emergency treatment is needed.

Symptoms of overdose

  • headache
  • no blood pressure or pulse
  • nervousness
  • Blurred or loss of vision
  • double vision
  • sweating
  • inability to speak
  • stuffy nose
  • dizziness, faintness, or lightheadedness when you stand or sit up quickly
  • unusual tiredness or weakness
  • confusion
  • stopping of heart
  • lightheadedness
  • night blindness
  • pounding in the ears
  • tunnel vision
  • irregular heartbeat
  • slow speech
  • difficulty in speaking
  • immobility in arms, legs or face
  • vomiting
  • halos around lights
  • pain in jaw, back, arms or neck
  • disturbed color perception
  • dizziness
  • fainting
  • lights appear too bright
  • chest pain or discomfort
  • unconsciousness
  • nausea

Other side effects don't require medical attention, as they aren't a threat to your health. Most of the time, these symptoms with go away as your body acclimates to the drug. In this case, since it's a one-time dosage, you may notice side effects before or after you leave the clinic.

Your dentist should be able to tell you if there is any way to alleviate or prevent any of these side effects. You can also ask your doctor or health care professional.

If any of the following symptoms do not get better in a reasonable period of time, seek medical aid. If you need temporary relief from the side effects themselves, ask your dentist for an over-the-counter recommendation that will alleviate the symptoms.

More common

  • Burning, itching
  • watery eyes
  • loss of or change in taste
  • pins and needles, or tingling feelings in the nose
  • sore throat
  • numbness
  • stuffy or runny nose

Not all possible side effects are listed, and you may experience something that hasn't yet been reported. Seek medical advice for what is going on in your body. To report side effects, call the FDA at 1-800-FDA-1088.


Tetracaine And Oxymetazoline can be obtained in the following dosage form:

  • solution

This product should only be used in your nose. It is delivered in ipsilaterally (same side) as the upper tooth that the dentist needs to fix. It takes about 10 minutes before the dentist can do a drill test.

Don't use this medication with other nose sprays, even if they are based on oxymetazoline. If you are using any nasal sprays, avoid doing so for at least 24 hours before the procedure.


Drug Interactions

Some medicines are not recommended to be used together due to known adverse effects. However, sometimes you may not have any choice. In such cases, your doctor should consider whether to change your dose leading up to the dental procedure. Be sure to tell your dental health professional about all the medications you are taking or plan to take prior to the procedure. It's probably a good idea to check with your doctor on potential risks as well.

This list covers interactions based on the significance and likelihood of occurrence. Using any of these medicines with Tetracaine and Oxymetazoline (Nasal Route) is specifically warned against in the literature.

  • Amineptine
  • Pindolol
  • Tianeptine
  • Tranylcypromine
  • Clomipramine
  • Penbutolol
  • Sotalol
  • Lofepramine
  • Amitriptyline
  • St John's Wort
  • Rasagiline
  • Procarbazine
  • Methylene Blue
  • Imipramine
  • Amitriptylinoxide
  • Moclobemide
  • Furazolidone
  • Isocarboxazid
  • Fentanyl Citrate
  • Levobunolol
  • Dibenzepin
  • Oxprenolol
  • Carteolol
  • Nortriptyline
  • Nadolol
  • Desipramine
  • Safinamide
  • Nialamide
  • Labetalol
  • Melitracen
  • Selegiline
  • Hyaluronidase
  • Opipramol
  • Doxepin
  • Phenelzine
  • Carvedilol
  • Amoxapine
  • Propranolol
  • Metipranolol
  • Timolol
  • Protriptyline
  • Iproniazid
  • Practolol
  • Linezolid
  • Trimipramine

Other Interactions

Some medicines are not recommended to be used while consuming specific foods or drink, due to the interactions that can occur. For best results, refrain from using tobacco or alcohol products to avoid negative outcomes. Talk to your doctor or dentist regarding the risk of smoking or drinking before or after the medicine is administered.


Before using this medicine, consider all the possible risks against the benefit of the procedure with a different medication. Don't just rely on your dentist's opinion since this impacts your health, not hers. Consider the following:


Let your dentist know if you have had allergic reactions to any medicines in the past. Disclose any known allergies to animals, dyes, preservatives and foods. Ask for the labeling that comes with the medicine prior to the day of the procedure.


The studies needed to understand the specific impact of tetracaine and oxymetazoline nasal spray on different age groups have not been performed. This medicine shouldn't be used in anyone under 3 years or who weighs less than 40 kg, since no safety and efficacy data is available.


Studies on different age groups have not been performed. In general, elderly people taking this drug may experience increased blood pressure, heart, kidney or liver problems. Extra care should be taken for this age group.


The studies needed to understand the specific impact of tetracaine and oxymetazoline nasal spray on breastfeeding mothers haven't been conducted. Ask your dentist if it's safe or whether you should hold off on breast feeding after the procedure, for a specified period.

Other Medical Problems

Other medical problems can complicate the use of these medicines. Tell your dentist if you have any of the following conditions.

  • Methemoglobinemia (blood disorder)
  • Frequent nosebleeds
  • High blood pressure (uncontrolled)
  • Thyroid disease that is not under control (Use of these medicines is strongly discouraged if you have this condition)
  • Liver disease
  • Deficiency of glucose-6-phosphate dehydrogenase (G6PD)

Note that you should proceed with caution if you have any of the following conditions. Using these medications can cause serious side effects.

  • Pseudocholinesterase deficiency

Other considerations, including use in children.

  • Your dentist will monitor your progress on this medication. They will determine whether to continue with the procedure and stop if you are having adverse effects. You can also raise concerns at any time, especially if your child is using the medicine.
  • Following the procedure, you should call your doctor or dentist if you or your child experience: stuffy or runny nose, dizziness, nose bleeds, or trouble swallowing.

Tetracaine has been known to cause methemoglobinemia. If you experience this during or after the procedure, seek immediate medical help. The symptoms include:

  • Blue-tinted lips, palms, fingernails
  • headache or fever
  • dark urine
  • dizziness or lightheadedness
  • unusual bleeding or bruising
  • pale skin
  • difficulty breathing
  • rapid heart rate
  • sore throat
  • unusual tiredness or weakness

This medicine may cause anaphylaxis, a life-threatening condition that requires emergency medical care. If you or your child develop severe forms of these symptoms, call your doctor right away:

  • Itching or rash
  • difficulty breathing or swallowing
  • any swelling of your hands

Avoid products with oxymetazoline, such as AfrinĀ® within 24 hours of the procedure. Do not use any inhaled medication while using Tetracaine and Oxymetazoline. You should also avoid any prescription or over-the-counter medications or supplements just before your dental procedure.


You shouldn't have to worry about storing this product at home, since it's only used for dental procedures. However, it needs to be kept between 36 and 46 degrees Fahrenheit. It can briefly be transported between 32 and 59 degrees Fahrenheit. All unused product must be thrown out and if the medicine has been left at room temperature for more than five days, it needs to be thrown out.


Tetracaine and oxymetazoline is a nasal spray used to numb areas of the mouth in preparation for dental procedures. There are possible side effects and negative drug interactions associated with this medicine that should be reviewed with your doctor or dentist.

It can be used for both adults and children safely, in most cases. This drug provides an alternative to administering anesthetic with a needle, which causes undue distress for some dental patients.

Carefully review all possible outcomes before finally agreeing to receive these drugs.

Last Reviewed:
December 23, 2017
Last Updated:
April 05, 2018
Content Source: