Local anaesthesia of the nasal mucous membranes for diagnostic procedures and surgery
Applied intranasally per the label for the specific procedure
Its eye-care role, testing for Horner syndrome, is off-label and absent from this label
OFF-LABELNot in the FDA label for this product
Horner syndrome, confirming an oculosympathetic palsy
One drop of 4% to 10% solution in each eye, read at 40 to 60 minutes; compounded, as no ophthalmic product is marketed
n=169 · 0.8 mm confirms
Cocaine blocks noradrenaline reuptake at the iris dilator, so a pupil with any oculosympathetic lesion dilates less than its fellow and the anisocoria widens. Tested in 119 patients with Horner syndrome against 50 normal subjects, the odds of Horner syndrome rose with the size of the post-cocaine anisocoria: at 0.8 mm the odds ratio was about 1050 to 1, with a lower 95% confidence limit of 37 to 1. The authors also found that simply measuring the anisocoria AFTER cocaine predicted better than calculating the change from baseline. It confirms the diagnosis and says nothing about where the lesion sits.
Hypersensitivity to cocaine hydrochloride or other ester-based local anesthetics.
Available Forms
Cocaine hydrochloride nasal solution 4%, a clear blue-green solution.
Mechanism of Action
Blocks reuptake of norepinephrine, causes vasoconstriction, and provides corneal anesthesia
Warnings & Precautions
For intranasal use only; do not apply to damaged nasal mucosa.
Cocaine is a Schedule II controlled substance with a risk of abuse and dependence.
Cardiovascular events, including myocardial ischaemia, arrhythmia and hypertensive crisis, have been reported; avoid in uncontrolled hypertension or known cardiovascular disease.
Seizures and other central nervous system effects can follow systemic absorption.
Do not use with a monoamine oxidase inhibitor.
Common Side Effects
Hypertension, tachycardia, and sinus tachycardia.
Pregnancy & Lactation
Pregnancy: Cocaine crosses the placenta and is associated with placental abruption, preterm birth and fetal growth restriction; avoid.
Lactation: Cocaine is present in human milk and can cause serious adverse reactions in the infant; advise against breastfeeding for at least 48 hours after a dose.
GoodRx
Available Forms
Mechanism of Action
Pregnancy & Lactation
Pediatric Use