Alternative to Antipyrine/Benzocaine Otic

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
pharmerjohn

pharmerjohn

Working on a Dream
10+ Year Member
Joined
May 29, 2012
Messages
487
Reaction score
98
Antipyrine/benzocaine is being D/Ced according to the FDA. Can someone recommend an alternative for hospital use? Thanks!
Members don't see this ad.
 
Thanks for your response, Old Timer. I found Carbamide Peroxide (Debrox otic), but I'm not sure if that's an effective alternative.
 
Members don't see this ad :)
WVUPharm2007 said:
Are we talking for pain or ear wax removal....?
Click to expand...

Ear wax removal, anti-inflammatory and analgesic. If 2 different agents can be used, then that'd be fine as well. Single product is preferred though, due to ease of administration.
 
pharmerjohn said:
Ear wax removal, anti-inflammatory and analgesic. If 2 different agents can be used, then that'd be fine as well. Single product is preferred though, due to ease of administration.
Click to expand...

A/B otic is only for pain. You can use Carbamide Peroxide (Debrox) or Olive Oil to loosen ear wax.
 
Is dexamethasone a possibly good alternative for pain/inflammation?
 
Amy evidence for topical benzocaine/Lidocaine being more effective than oral ibuprofen or acetaminophen. Probably not. It's a relic from the 1960's stop using it, it doesn't really work anyway.
 
Members don't see this ad :)
Old Timer said:
Amy evidence for topical benzocaine/Lidocaine being more effective than oral ibuprofen or acetaminophen. Probably not. It's a relic from the 1960's stop using it, it doesn't really work anyway.
Click to expand...

When you have a kid screaming and crying about ear pain, I'm sure as a parent you'll try anything, even if it doesn't work.
 
So we go from marginally effective to doesn't really work anyway...
 
To say something is marginally effective and to say it is a relic from the 60's are two completely different things. Old doesn't mean it doesn't work - right "old timer"? 🙂

you know what is also a relic from the 60's (actually a hell of a lot older) - aspirin - now we all know it is only marginally effective
 
Dred Pirate said:
To say something is marginally effective and to say it is a relic from the 60's are two completely different things. Old doesn't mean it doesn't work - right "old timer"? 🙂

you know what is also a relic from the 60's (actually a hell of a lot older) - aspirin - now we all know it is only marginally effective
Click to expand...

Aspirin is proven safe and effective and guess what it's the only NSAID that does have a heart risk. It's safe and effective as a blood thinner for secondary prevention in patient's who are S/P M.I..
 
Wheresmyaricept said:
When you have a kid screaming and crying about ear pain, I'm sure as a parent you'll try anything, even if it doesn't work.
Click to expand...

Stay pre-pharmacy. You don't give medication or any other treatment to a patient when other treatments that are proven safe and effective are available.
 
Because of all the literature saying to let mild ear infections run their coarse and not use antibiotics, and because parents don't like to hear that they want something, so doctors given AB drops & ibuprofen.....I agree with OT, I haven't read anything that AB actually works, and I haven't even heard anything anecdotally that it works. But an RX for AB is a way for the doctor to show s/he cares, because people expect an RX for something (anything) when they see a doctor.
 
Old Timer said:
Aspirin is proven safe and effective and guess what it's the only NSAID that does have a heart risk. It's safe and effective as a blood thinner for secondary prevention in patient's who are S/P M.I..
Click to expand...
I think you missed the sarcasm in my post
 
Old Timer said:
Stay pre-pharmacy. You don't give medication or any other treatment to a patient when other treatments that are proven safe and effective are available.
Click to expand...


Because 100% of the things I say are 100% serious 100% of the time, especially on the Internet. At least someone else got the reference I was trying to make about the Hyland's garbage. I can't tell you how many times I've try to dissuade people from wasting money on that stuff.


What safe and effective treatments have you offered in lieu of Ab otic? You offer solutions for ear wax. But let's be real, if they're prescribing Ab Otic for earwax, they're doing something wrong. So what are these "safe and effective alternatives" you've been harping about? As a pharmacist, you should know that you need to have your recommendation at the ready and not just generalize "alternatives available".


Ps I don't update my tag from pre-pharm because a) I don't really care that much and it doesn't bother me and b) to see how elitist people can be about something so petty. You're probably one of those pharmacists that refuses to help techs because they do "tech jobs". I already have an opinion on what to substitute, but I would like to see what the mighty Oldtimer would recommend.
 
Wheresmyaricept said:
Because 100% of the things I say are 100% serious 100% of the time, especially on the Internet. At least someone else got the reference I was trying to make about the Hyland's garbage. I can't tell you how many times I've try to dissuade people from wasting money on that stuff.


What safe and effective treatments have you offered in lieu of Ab otic? You offer solutions for ear wax. But let's be real, if they're prescribing Ab Otic for earwax, they're doing something wrong. So what are these "safe and effective alternatives" you've been harping about? As a pharmacist, you should know that you need to have your recommendation at the ready and not just generalize "alternatives available".


Ps I don't update my tag from pre-pharm because a) I don't really care that much and it doesn't bother me and b) to see how elitist people can be about something so petty. You're probably one of those pharmacists that refuses to help techs because they do "tech jobs". I already have an opinion on what to substitute, but I would like to see what the mighty Oldtimer would recommend.
Click to expand...

Trust me... Old Timer knows how to train a tech and he also knows an alternative to some ear drop.

He's a good pharmacist just don't talk about social/political issues with him
 
Dred Pirate said:
why would you give debrox to someone who has ear pain? that is not an alternative to AB OTIC - that is like suggesting pepcid to some one because miralax is backordered
Click to expand...

Well, earwax causes pain. So that could be a justification for using Debrox. Get the earwax out = get relief from ear pain.
 
Dred Pirate said:
ah - same thing - docusate is used to get rid of ear wax, not treat pain (due to infection or other reason)
Click to expand...

I think this thread has sucked the ability to see sarcasm in posts.

Maybe this is a much more serious topic than I gave it credit.
 
Corpseman said:
I think this thread has sucked the ability to see sarcasm in posts.

Maybe this is a much more serious topic than I gave it credit.
Click to expand...
everything is a serious topic, without AB we will have tons of people having to actually know what a little pain is like - god forbid we teach kids to be tough 🙂
 
Wheresmyaricept said:
What safe and effective treatments have you offered in lieu of Ab otic? You offer solutions for ear wax. But let's be real, if they're prescribing Ab Otic for earwax, they're doing something wrong. So what are these "safe and effective alternatives" you've been harping about? As a pharmacist, you should know that you need to have your recommendation at the ready and not just generalize "alternatives available".
Click to expand...

Oral Ibuprofen and Floxin otic. They work just as well for Otitis Media...... There is data for that and there is no evidence for A/B otic.
 
Old Timer said:
Oral Ibuprofen and Floxin otic. They work just as well for Otitis Media...... There is data for that and there is no evidence for A/B otic.
Click to expand...
I think the real question is "Why are we treating ear pain?" If it's impacted wax, then you've got Debrox. If it's otitis media, antibiotics aren't usually recommended because they're largely viral anyway. Swimmers ear you can use the abx/steroid drops. Just about any ear pain I can think of there is an underlying cause that you would treat that leads to relief, rather than using a topical pain reliever. Plus most patients can tolerate a few days of acetaminophen or ibuprofen.


Now for a random thought with zero evidence: topical Voltaren gel?
 
Fire also cures every disease. Why isn't it more common?
 
zelman said:
Why not Pennsaid? Gel seems like a worse idea.
Click to expand...
Didn't think of that. Only thought of the gel because somebody above mentioned viscous lidocaine. Although doesn't Pennsaid have some "penetration enhancing" formulation? That's doesn't sound good for the ear either. Either way it's probably not a good idea.
 
Dred Pirate said:
why would you give debrox to someone who has ear pain? that is not an alternative to AB OTIC - that is like suggesting pepcid to some one because miralax is backordered
Click to expand...
The OP clearly stated that he wants something for "Ear wax removal, anti-inflammatory and analgesic."

How would Debrox not be appropriate when one of his listed goals is ear wax removal? Or are you just illiterate?

Debrox + Advil would cover all 3 things that were listed.
 
SClENCE said:
The OP clearly stated that he wants something for "Ear wax removal, anti-inflammatory and analgesic."

How would Debrox not be appropriate when one of his listed goals is ear wax removal? Or are you just illiterate?

Debrox + Advil would cover all 3 things that were listed.
Click to expand...

There are three patients in the entire universe that have pain from ear wax that requires benzocaine. It's the glycerin that softens the ear wax. Patients in the ER who need pain relief most likely have otitis media and not ear wax.....
 
Old Timer said:
There are three patients in the entire universe that have pain from ear wax that requires benzocaine. It's the glycerin that softens the ear wax. Patients in the ER who need pain relief most likely have otitis media and not ear wax.....
Click to expand...

I agree. Doesn't change the fact that the OP specifically said ear wax removal. Maybe you should tell him what he's trying to treat before anyone gives any more suggestions.
 
SClENCE said:
I agree. Doesn't change the fact that the OP specifically said ear wax removal. Maybe you should tell him what he's trying to treat before anyone gives any more suggestions.
Click to expand...

Read the whole thread. I suggested things for ear wax removal. I stand by everything I said.

Old Timer said:
A/B otic is only for pain. You can use Carbamide Peroxide (Debrox) or Olive Oil to loosen ear wax.
Click to expand...

Old Timer said:
Oral Ibuprofen and Floxin otic. They work just as well for Otitis Media...... There is data for that and there is no evidence for A/B otic.
Click to expand...

Stop reading with one eye. There is no clinical reason on this earth to use Auralgan for ear wax and in the 35 years I have been doing this I have never seen it. I know you have vast experience in the practice of pharmacy working as a tech for 15 minutes and everything
 
Doctors are not writing prescriptions for people for A/B because they have wax buildup. If someone goes to the doctor and gets a diagnosis of wax buildup, then the doctor will either 1) give them an ear rinse and clean the wax out or 2) give them a prescription for debrox (which I do occasionally see.) I have never seen a prescription for A/B that wasn't accompanied by some sort of antibiotic (either otic or oral.)

So no, suggesting debrox for someone in lieu of A/B does NOT make any sense. As DP said, you might as well suggest Pepcid (hey, maybe they had an allergic reaction causing histamine to be released in their ear, which caused an inflammation? obviously this makes no sense, but neither does suggesting Debrox.)

I'd be more likely to suggest Hyland's (and I probably still wouldn't), not because I believe it has any efficacy whatsoever, but because the placebo effect might give them some relief until the antibiotic kicked in.
 
"pharmerjohn, post: 16724188, member: 472733"]Antipyrine/benzocaine is being D/Ced according to the FDa.
Can someone recommend an alternative for hospital use? Thanks![/QUOTE]
I am not a doctor. I am not a pharmacist. I am a mother of two children who are now grown. Both of my children grew up suffering from ear infections from the time they were weeks old until they were teenagers. I would take them to the doctor, usually in the middle of the night when they woke up screaming , they would confirm ear infections - typically in both ears and we would be sent home with oral antibiotics and a b drops for inner ear pain. yes at 51 years old I now realize both of them probably had antibiotics way too often as children but at the time antibiotic resistance was not yet understood and that is what we, the parents, were prescribed from pediatricians, emergency rooms, and Urgent Care Centers and we, as parents, could only trust the doctors and the pharmacist to confirm that treatment because there was no Internet available it didn't exist yet . My children began getting ear infections as young infants and didn't know the word medicine or you'll feel better soon or anything like that; as their mother I administered what was necessary. In every instance in both of my kids throughout every one of their ear infections they would go from screaming crying and being unconsolable to completely calm within 5 minutes of administering the a b drops into their ears. They didn't know the difference between oral pain relievers or ear drops as a matter of fact as fussing babies it would have been easier to get drops in their mouth than their ears but no amount of oral pain relief safe enough for an infant ever relieved the pain the way the a b drops did. It was nearly instant. I probably used it 30 times on my son and probably 50 times on my daughter and regardless of their age, it took away the pain immediately or at least within 5 minutes. I am 51 years old now and have begun to get ear infections. the a b drops are no longer available but amazingly I have some left from when my kids were young. Yes they are expired I'm sure I'm going to get crap about how I should have thrown them away but when I administer one or two drops into my own ear, it's like getting a shot of novacaine, the pain is gone. Yes the ear infection is still there and still needs treated, although I don't use antibiotics and take a natural remedy to treat it, The old and expired drops kick in faster and last longer than any amount of oral pain medication. I have an 8 month old grandson who now gets ear infections and the a b drops are no longer available for him to use. his father was one of my children who remembered being dragged to the ER at 3 a.m. then waiting at a 24-hour pharmacy for a prescription to be filled on the floor clinging to my shoe screaming in pain with me feeling completely hopeless while the pharmacist fill the prescription and moments after putting in the pain drops, the a b drops, he would thank me and tell me what a good mommy I was. now as a father with a child who gets ear infections, the a b drops are not available to him. For all of you who say there is no proof that they were effective you need to talk to my son and or my daughter who got relief from it and I can also kontest that 10 year old drops still provide instant relief for me an adult. you can do a placebo study on adults and say that the idea of the drops entering the air is the reason they thought the pain was better but that doesn't work on a 5 month old screaming infant who stops crying within 5 minutes of having the drops put in and having that same effect when they are 5 years old and 10 years old and 25 years old . Infants React to what they feel they aren't smart enough to know what is being put in their ear is for pain relief they are helpless but yeah it worked amazing each and every time. As a mother I am so thankful those drops were available when my kids were young because I couldn't imagine the crying and screaming of the pain they were in having to last one more moment, not because I was intolerant of the crying but because I knew my children were suffering and I was oh so thankful to have a remedy that would stop that suffering so very fast versus any OTC or prescription pain reliever given orally available at the time
Maybe they weren't proven to be effective in some laboratory standards, but how about asking the people who stop suffering almost immediately after using these if they were effective or not? I am not alone both of my kids grew up going to daycare, and as a single mother I had no choice but to work. An awful lot of kids at their age range got ear infections and all of us mothers raved how immediate the response was to the a b drops versus the amount of time it took for Children's Tylenol to kick in and I personally would much rather put drops in a child's ear than load their body up with NSAIDs. I get the concept that our world has gone insane Lee scientific and everything has to be proven 20,000 times in a laboratory versus just seeing the response of how it works and I understand that is necessary from a safety standpoint on most things but I would encourage you to do a study of as few as one two as many as a billion infants who have an active ear infection, put the drops in their ear, and watch how quickly they stop crying and allow that to guide you to how effective these drops are. I am glad I have the expired drops, that old Relic that you call it, but I am sad that the pain relief is not available for my grandson and that unfortunately he will have to wait for NSAIDs to kick in and enter his kidneys and liver while his immune system should be getting a boost. Sometimes science sucks.
 
boerboellover said:
I am not a doctor. I am not a pharmacist. I am a mother of two children who are now grown. Both of my children grew up suffering from ear infections from the time they were weeks old until they were teenagers. I would take them to the doctor, usually in the middle of the night when they woke up screaming , they would confirm ear infections - typically in both ears and we would be sent home with oral antibiotics and a b drops for inner ear pain. yes at 51 years old I now realize both of them probably had antibiotics way too often as children but at the time antibiotic resistance was not yet understood and that is what we, the parents, were prescribed from pediatricians, emergency rooms, and Urgent Care Centers and we, as parents, could only trust the doctors and the pharmacist to confirm that treatment because there was no Internet available it didn't exist yet . My children began getting ear infections as young infants and didn't know the word medicine or you'll feel better soon or anything like that; as their mother I administered what was necessary. In every instance in both of my kids throughout every one of their ear infections they would go from screaming crying and being unconsolable to completely calm within 5 minutes of administering the a b drops into their ears. They didn't know the difference between oral pain relievers or ear drops as a matter of fact as fussing babies it would have been easier to get drops in their mouth than their ears but no amount of oral pain relief safe enough for an infant ever relieved the pain the way the a b drops did. It was nearly instant. I probably used it 30 times on my son and probably 50 times on my daughter and regardless of their age, it took away the pain immediately or at least within 5 minutes. I am 51 years old now and have begun to get ear infections. the a b drops are no longer available but amazingly I have some left from when my kids were young. Yes they are expired I'm sure I'm going to get crap about how I should have thrown them away but when I administer one or two drops into my own ear, it's like getting a shot of novacaine, the pain is gone. Yes the ear infection is still there and still needs treated, although I don't use antibiotics and take a natural remedy to treat it, The old and expired drops kick in faster and last longer than any amount of oral pain medication. I have an 8 month old grandson who now gets ear infections and the a b drops are no longer available for him to use. his father was one of my children who remembered being dragged to the ER at 3 a.m. then waiting at a 24-hour pharmacy for a prescription to be filled on the floor clinging to my shoe screaming in pain with me feeling completely hopeless while the pharmacist fill the prescription and moments after putting in the pain drops, the a b drops, he would thank me and tell me what a good mommy I was. now as a father with a child who gets ear infections, the a b drops are not available to him. For all of you who say there is no proof that they were effective you need to talk to my son and or my daughter who got relief from it and I can also kontest that 10 year old drops still provide instant relief for me an adult. you can do a placebo study on adults and say that the idea of the drops entering the air is the reason they thought the pain was better but that doesn't work on a 5 month old screaming infant who stops crying within 5 minutes of having the drops put in and having that same effect when they are 5 years old and 10 years old and 25 years old . Infants React to what they feel they aren't smart enough to know what is being put in their ear is for pain relief they are helpless but yeah it worked amazing each and every time. As a mother I am so thankful those drops were available when my kids were young because I couldn't imagine the crying and screaming of the pain they were in having to last one more moment, not because I was intolerant of the crying but because I knew my children were suffering and I was oh so thankful to have a remedy that would stop that suffering so very fast versus any OTC or prescription pain reliever given orally available at the time
Maybe they weren't proven to be effective in some laboratory standards, but how about asking the people who stop suffering almost immediately after using these if they were effective or not? I am not alone both of my kids grew up going to daycare, and as a single mother I had no choice but to work. An awful lot of kids at their age range got ear infections and all of us mothers raved how immediate the response was to the a b drops versus the amount of time it took for Children's Tylenol to kick in and I personally would much rather put drops in a child's ear than load their body up with NSAIDs. I get the concept that our world has gone insane Lee scientific and everything has to be proven 20,000 times in a laboratory versus just seeing the response of how it works and I understand that is necessary from a safety standpoint on most things but I would encourage you to do a study of as few as one two as many as a billion infants who have an active ear infection, put the drops in their ear, and watch how quickly they stop crying and allow that to guide you to how effective these drops are. I am glad I have the expired drops, that old Relic that you call it, but I am sad that the pain relief is not available for my grandson and that unfortunately he will have to wait for NSAIDs to kick in and enter his kidneys and liver while his immune system should be getting a boost. Sometimes science sucks.
Click to expand...
Nobody cares.
Sugar cubes work better in infants.
 
Wow TLDR. Some of you guys need to get new hobbies 😉
Anyway, from what I did read, it seems we agree that if wax is/may be the issue then use debrox or docusate to loosen it up (and/or scoop it out if you can).
Doing some digging, i came up with a couple of potential alternatives. These do appear to exist/available in USA per Uptodate. I haven't tried ordering either yet, so we'll have to see if it triggers pharmacy call backs. If so, I give up.

Drops, Otic, as lidocaine hydrochloride otic
Ear Pain MD: 4% (12.5 mL) [contains aloe, benzalkonium chloride, benzyl alcohol] Instill 2 drops to affected ear up to 4 times daily.
Ear Pain MD for Kids: EXACTLY THE SAME LOL
Benzocaine
Oral 10% or 20% liquid (12ml): Children ≥2 years and Adolescents: Instill 2 drops to affected ear up to 4 times daily.

While these otic anesthetics may not have good evidence they actually help, or are relics, and most of us who actually see patients I'll bet would agree...it sure does help to be able to offer a worried mom "something" that may help. They've usually already tried ibu/apap before they've come to me. I also do telemedicine so rarely get a look inside (they do sell cheap otoscope/"ear endoscopes" on amazon for <$20 that have a camera that can allow you to see what's going on in there on your smartphone, so that helps a lot).
 
You’d be surprised how often ibuprofen and acetaminophen are overlooked because they are not otic dose forms…
Reoccurring patient “logic” that only an otic dose form will work for ears. Similar with joint, muscle aches and topicals

If wasting money will make them feel better…🤣. Any jokers on these forums want to say something on homeopathics?
 
RxPreceptor said:
If wasting money will make them feel better…🤣. Any jokers on these forums want to say something on homeopathics?
Click to expand...

I'm not sure why this 6 year old thread was resurrected, but I did already comment on homeopathics in my 2015 reply. To quote my 2015 self:

"I'd be more likely to suggest Hyland's (and I probably still wouldn't), not because I believe it has any efficacy whatsoever, but because the placebo effect might give them some relief until the antibiotic kicked in."

I'll add on, there have been studies of various designs that basically show that yes, wasting money makes people feel better. When people ask me about homeopathic, I always tell them, "There is no evidence this works, and zero reason to think there could be any reason it works. But its unlikely to harm you if you try it." 80% of the time, people thank me and buy it. The placebo effect is strong.
 
You must log in or register to reply here.

Similar threads

C
Alternatives to pharmacy?
Replies
9
Views
2K
RXDOC1986
R
I
Career Change to Pharmacy
Replies
9
Views
1K
lord999
lord999
JustFillIt
Alternative to pharmacy - yes we are qualified
Replies
25
Views
4K
DH1987
D
P
Expanded Role of Team Members. Who are they hiring to do these things? Nurses or Pharmacist or Other? Everyone fighting to show VALUE to get paid.
Replies
0
Views
323
PrincessSnow
P
Blueberry Tea
New to Walmart pharmacy, how to get better at visual verification?
Replies
1
Views
1K
quickpic007
quickpic007
Top