Topical Local Anaesthetic / Vasoconstrictor Topical
Cophenylcaine
Lidocaine (lignocaine) hydrochloride monohydrate 5% + Phenylephrine hydrochloride 0.5%
CPG Reference
Authorised Medications — Cophenylcaine (Cophenylcaine)
Indications
- ✓ Local pain: abrasions, small cuts and wounds
- ✓ Relief of mild and moderate epistaxis
- ✓ Post tonsillectomy haemorrhage
- ✓ Intra-oral haemorrhage
Contraindications
- ✕ Hypersensitivity to phenylephrine, lidocaine or other anaesthetics
- ✕ Children under 2 years of age
- ✕ Pregnancy
Precautions
- ⚠ Use with caution in patients with cardiovascular, hepatic and/or renal disease
- ⚠ Pause between subsequent doses
- ⚠ Maximum dosages should not be administered more than once in 24 hours
- ⚠ For oral use, nozzle inserted within the anterior 1/3 of mouth to avoid gag stimulation
Dosing
Adult — Local pain (abrasions, small cuts and wounds)
Amount Maximum 5 sprays (5 mg lidocaine per spray; 500 microg phenylephrine per spray)
Route Topical
Repeat Single application; maximum dosage not to be repeated within 24 hours
Max dose 5 sprays per 24 hours
Oral administration may cause a transient bitter taste
Paediatric (≥2 years) — Local pain (abrasions, small cuts and wounds)
Amount Maximum 5 sprays
Route Topical
Repeat Single application; maximum dosage not to be repeated within 24 hours
Max dose 5 sprays per 24 hours
Contraindicated in children under 2 years of age
Adult — Epistaxis
Amount Maximum 10 sprays (5 sprays per nostril)
Route Topical — intranasal (applied to nasal mucosa, NOT intranasal atomisation)
Repeat Single application; maximum dosage not to be repeated within 24 hours
Max dose 10 sprays per 24 hours
Intranasal route is topical application to nasal mucosa only — not intranasal atomisation
Paediatric (2–4 years) — Epistaxis
Amount 1 spray per nostril (maximum 2 sprays total)
Route Topical — intranasal (applied to nasal mucosa, NOT intranasal atomisation)
Repeat Single application; maximum dosage not to be repeated within 24 hours
Max dose 2 sprays per 24 hours
Contraindicated in children under 2 years of age
Paediatric (4–8 years) — Epistaxis
Amount 2 sprays per nostril (maximum 4 sprays total)
Route Topical — intranasal (applied to nasal mucosa, NOT intranasal atomisation)
Repeat Single application; maximum dosage not to be repeated within 24 hours
Max dose 4 sprays per 24 hours
Contraindicated in children under 2 years of age
Paediatric (8–12 years) — Epistaxis
Amount 3 sprays per nostril (maximum 6 sprays total)
Route Topical — intranasal (applied to nasal mucosa, NOT intranasal atomisation)
Repeat Single application; maximum dosage not to be repeated within 24 hours
Max dose 6 sprays per 24 hours
Contraindicated in children under 2 years of age
Adult — Post tonsillectomy haemorrhage / Intra-oral haemorrhage
Amount 1 spray, then pause; repeat if required up to a maximum of 5 sprays
Route Topical — oral use
Repeat 1 spray at a time with pause between doses; maximum dosage not to be repeated within 24 hours
Max dose 5 sprays per 24 hours
Nozzle inserted within the anterior 1/3 of mouth to avoid gag stimulation. Oral administration may cause a transient bitter taste
Paediatric (≥2 years) — Post tonsillectomy haemorrhage / Intra-oral haemorrhage
Amount 1 spray, then pause; repeat if required up to a maximum of 5 sprays
Route Topical — oral use
Repeat 1 spray at a time with pause between doses; maximum dosage not to be repeated within 24 hours
Max dose 5 sprays per 24 hours
Nozzle inserted within the anterior 1/3 of mouth to avoid gag stimulation. Contraindicated in children under 2 years of age
Side Effects & Notes
Side Effects
- • Transient bitter taste with oral administration
Clinical Notes
- → Each spray delivers: Lidocaine (lignocaine) hydrochloride monohydrate 5% — 5 mg per spray; Phenylephrine hydrochloride 0.5% — 500 microg per spray
- → Pause between subsequent doses — do not administer sprays continuously without pausing
- → Maximum dosages should not be administered more than once in 24 hours — this applies across all indications and routes
- → Intranasal route is topical application to nasal mucosa only — NOT intranasal atomisation
- → For oral/intra-oral use: insert nozzle within the anterior 1/3 of mouth to avoid triggering gag reflex
- → For epistaxis, if bleeding does not stop with direct pressure after 10 minutes, consider Cophenylcaine as per Minor Injury and Epistaxis clinical skill
- → Contraindicated in all patients under 2 years of age and in pregnancy
- → Use with caution in patients with cardiovascular, hepatic, or renal disease due to systemic absorption of lidocaine and phenylephrine