BONJELA TEETHING GEL
Active substance(s): CETALKONIUM CHLORIDE / LIDOCAINE HYDROCHLORIDE
NAME OF THE MEDICINAL PRODUCT
Bonjela Teething Gel.
QUALITATIVE AND QUANTITATIVE COMPOSITION
Equivalent to 0.27% w/w of Lidocaine base.
Also contains Ethanol (33.45%w/w)
For a full list of excipients, see section 6.1.
Water soluble viscous gel.
For the relief of pain and discomfort associated with infant teething.
Posology and Method of Administration
Topical application to the gums.
young Apply a small amount of Bonjela Teething Gel with a
clean little finger to the affected area and rub in
gently. Repeat every three hours if necessary.
Not recommended for infants under two months.
Adults and elderly:
Not intended for adult use.
Known hypersensitivity to anaesthetics of the amide type.
Hypersensitivity to any of the active ingredients or to any of the excipients.
Special warnings and precautions for use
To be used with caution in patients with hepatic or cardiac dysfunction.
Label warnings: Do not use more than every 3 hours. Do not exceed the stated dose.
Not recommended for infants under two months. Keep out of reach and sight of
children. If symptoms persist consult your doctor.
Interaction with other Medicinal Products and other Forms of Interaction
Concurrent use of either cimetidine or propranolol increases the risk of
Lidocaine toxicity. Lidocaine is antagonised by those diuretics which cause
Pregnancy and Lactation
Effects on Ability to Drive and Use Machines
There have been a few cases of contact dermatitis and methaemoglobinaemia.
The toxic effects of Lidocaine are directly related to blood concentrations.
Symptoms are dizziness, cyanosis due to methaemoglobinaemia, fall of blood
pressure, muscular tremors, convulsions, coma, irregular and weak breathing,
cardiac standstill and bronchial spasm. Removal of the ingested drug by
induced emesis followed by activated charcoal is only useful if the patient is
seen within 30 minutes of ingestion. The airway must be maintained and
artificial respiration with oxygen given until convulsions or depression are
controlled and blood pressure and pulse return to normal.
Convulsions can be controlled with diazepam (0.1mg/kg
succinylcholine chloride (10-50mg i.v. slowly). Perform artificial respiration
with oxygen until convulsions are controlled and continue giving oxygen until
blood pressure and pulse return to normal. Adequate arterial oxygen
saturation must be maintained. If convulsions are not continuous the
administration of oxygen may be sufficient to maintain the patient until the
blood level of Lidocaine falls.
Do not give stimulants.
methaemoglobinaemia can be treated by methylene blue (1%, 0.1 ml/kg, i.v.
over ten minutes). Treat fall in blood pressure by postural means (head down,
feet raised, supine position) or with i.v. saline or blood transfusion if shock
threatens. The critical period does not exceed one hour.
Suppression of pharyngeal sensation with concomitant effects on swallowing
may theoretically result from excessive topical oral use of Bonjela Teething
Gel. Such an effect has been reported in an adult who gargled and swallowed
5 ml of a 2% Lidocaine hydrochloride solution (equivalent to 100mg of
Lidocaine).However, assuming proportionality of body surface area and
pharyngeal surface area, this dose would be equivalent to a single dose of 5.4
g of Bonjela Teething Gel for a three month old child.
It is most unlikely, even with misuse or excessive application of Bonjela
Teething Gel, that the large amounts of Lidocaine hydrochloride or
cetalkonium chloride required to produce clinically-relevant toxic effects
would be reached. In the event of overdose, use should be discontinued and a
ATC Code: A01AB
Lidocaine hydrochloride is an established local anaesthetic agent which produces
tissue insensitivity by virtue of its ability to impede the inward flux of sodium ions,
thus preventing transmission of the nerve impulse.
Cetalkonium chloride is a quatemary ammonium antimicrobial agent, being
bactericidal towards both gram positive and gram negative organisms but with
preference for the former.
Lidocaine is highly lipophilic resulting in rapid passage through mucous
membranes, which is confirmed by human studies showing a Tmax of
approximately 50 minutes following application of a 2% solution to the intact
Metabolism is virtually complete by the hepatic route, undergoing three
transformations, oxidative-n-dealkylation, hydrolysis and hydroxylation.
In neonates a T½ of 3-5 hours has been reported following intrathecal
administration of Lidocaine to the mother; the elimination following topical
application to the oral mucosa is likely to be of the same order.
Pre-clinical Safety Data
No preclinical findings of relevance have been reported.
List of excipients
Ethanol 96%, glycerol, hypromellose 4500, sodium cyclamate 1969, banana flavour
and purified water.
Special Precautions for Storage
Store below 25°C.
Nature and contents of container
Internally lacquered collapsible aluminium tube with membrane seal fitted with a
polyethylene wadless cap. Pack sizes: 10g, 15g and 15 g plus teether.
Special precautions for disposal
No special requirements.
MARKETING AUTHORISATION HOLDER
Reckitt Benckiser Healthcare (UK) Limited,
MARKETING AUTHORISATION NUMBER(S)
DATE OF FIRST AUTHORISATION / RENEWAL OF
24 April 1995.
DATE OF REVISION OF THE TEXT