Antipyrine/benzocaine/phenylephrine otic Disease Interactions

The use of medications that are intended for the treatment of otitis externa or other conditions of the external ear canal should generally be avoided, or otherwise approached with caution, in patients with a perforated tympanic membrane due to the risk of toxicity from medication that may get into the middle ear. Caution is also advised in patients with longstanding, chronic otitis media because of the possibility of a perforated tympanic membrane in such patients.

Rarely, benzocaine has induced methemoglobinemia resulting in respiratory distress and cyanosis. Therapy with benzocaine should be administered cautiously to patients with or predisposed to methemoglobinemia. If life-threatening or severe methemoglobinemia develops, methylene blue infused at a dosage of 1 to 2 mg/kg body weight will rapidly reverse or improve the condition except in G-6-PD-deficient patients.

Topically applied sympathomimetic agents are systemically absorbed, with the potential for producing clinically significant systemic effects, particularly during prolonged or indiscriminate use. In cardiac tissues, these agents may produce positive chronotropic and inotropic effects via stimulation of beta-1 adrenergic receptors. Cardiac output, oxygen consumption, and the work of the heart may be increased. In the peripheral vasculature, vasoconstriction may occur via stimulation of alpha-1 adrenergic receptors. The use of topical sympathomimetic agents has rarely been associated with palpitations, tachycardia, arrhythmia, hypertension, reflex bradycardia, and coronary occlusion. Therapy with topical sympathomimetic agents should be administered cautiously in patients with sensitivity to sympathomimetic amines, hyperthyroidism, or underlying cardiovascular or cerebrovascular disorders, especially coronary insufficiency, cardiac arrhythmia, or hypertension.

Topically applied sympathomimetic agents are systemically absorbed, with the potential for producing clinically significant systemic effects, particularly during prolonged or indiscriminate use. In patients with prostate enlargement, urinary difficulty may develop or worsen due to smooth muscle contraction in the bladder neck via stimulation of alpha-1 adrenergic receptors. Therapy with topical sympathomimetic agents should be administered cautiously in patients with hypertrophy or neoplasm of the prostate. It is important that the recommended dosages of the individual products not be exceeded.

Topically applied sympathomimetic agents are systemically absorbed, particularly during prolonged or indiscriminate use. Slight increases in blood glucose concentrations may occur with the use of these drugs. Therapy with topical sympathomimetic agents should be administered cautiously in patients with diabetes mellitus. Closer monitoring of blood glucose concentrations may be appropriate. It is important that the recommended dosages of the individual products not be exceeded.