Comprehensive medication guide to Tetracaine including estimated pricing, availability information, side effects, and how to find it in stock at your local pharmacy.
Estimated Insurance Pricing
$0–$20 copay for generic ophthalmic tetracaine; typically Tier 1–2 on commercial formularies. Prior authorization rarely required. In-office procedure use is billed as part of the procedure code.
Estimated Cash Pricing
$31–$43 retail for tetracaine HCl 0.5% ophthalmic solution (5 mL); as low as $29 with GoodRx or SingleCare discount cards. Compounded formulations may vary. Hospital-administered spinal forms are billed as part of facility/procedure charges.
Medfinder Findability Score
65/100
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Tetracaine (also known as amethocaine) is an ester-class local anesthetic that has been used in medicine since 1941. It is listed on the World Health Organization's Essential Medicines List for its effectiveness, affordability, and wide clinical utility across ophthalmology, anesthesiology, and emergency medicine.
Tetracaine is available in three primary formulations: a 0.5% ophthalmic solution (eye drops) for in-office eye procedures, an injectable form for spinal anesthesia in surgical settings, and a 2% topical solution for minor skin anesthesia. The ophthalmic form is the most commonly dispensed outpatient formulation. Brand names have included Pontocaine (discontinued), Altacaine, and Tetcane.
As a non-controlled substance, tetracaine can be prescribed by ophthalmologists, optometrists, anesthesiologists, emergency physicians, ENT surgeons, and primary care providers. It is not typically taken at home — the ophthalmic and injectable forms are administered by healthcare providers during procedures.
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Tetracaine works by blocking voltage-gated sodium channels in nerve cells. Pain signals travel along nerves as electrical impulses called action potentials, which depend on sodium ions rushing through specialized protein channels (sodium channels) in the nerve cell membrane. Tetracaine prevents this sodium influx.
Specifically, tetracaine crosses the nerve cell membrane in its non-ionized (lipid-soluble) form, then converts to an ionized (charged) form inside the cell. The ionized form acts as an allosteric inhibitor, binding to the alpha subunit of open, activated sodium channels and blocking sodium influx. This prevents action potential generation and stops pain signal transmission.
For complete nerve conduction blockade, tetracaine must inhibit at least three successive nodes of Ranvier along a nerve axon. Once tetracaine is metabolized by plasma pseudocholinesterases in the tissues, sodium channel function is restored and sensation returns. The ophthalmic form produces anesthesia within 30 seconds and lasts 10–15 minutes; the spinal form provides 2–3 hours of anesthesia.
0.5% — ophthalmic solution
1 drop in affected eye(s) as needed; administered by provider; onset 30 seconds, duration 10–15 minutes
1% — injection (spinal)
Dose determined by anesthesiologist per patient weight, age, and procedure; hospital use only; duration 2–3 hours
2% — topical solution
Thin layer applied to affected skin area up to 4 times daily; use minimum amount needed
Tetracaine is not on the FDA's active drug shortage list as of 2026, but patients and providers do experience availability challenges at retail pharmacies. The core issue is distribution: the majority of tetracaine supply flows directly from manufacturers to hospitals, surgery centers, and ophthalmology clinics — bypassing retail pharmacy networks entirely. This means major chain pharmacies like CVS and Walgreens rarely stock it.
For patients who receive an outpatient prescription, compounding pharmacies and independent pharmacies are the most reliable sources. Hospital-affiliated outpatient pharmacies are also a solid option. The limited number of manufacturers for the ophthalmic formulation creates a supply chain with less redundancy than more common drugs, occasionally producing localized shortfalls.
Rather than calling pharmacy after pharmacy yourself, medfinder will contact pharmacies in your area to find which ones can fill your tetracaine prescription and text you the results.
Tetracaine is not a controlled substance, meaning it does not require a DEA registration or any special prescribing credentials beyond a standard state medical or prescribing license. A broad range of providers can prescribe it for appropriate clinical uses.
Ophthalmologists (MD/DO) — Primary prescribers for ophthalmic 0.5% solution; administer for tonometry, foreign body removal, and minor eye procedures
Optometrists (OD) — May administer ophthalmic tetracaine in-office for routine procedures, scope-dependent by state
Anesthesiologists and CRNAs — Administer injectable tetracaine for spinal anesthesia in hospital and surgical center settings
Emergency Medicine Physicians — Use tetracaine for ED procedures including eye irrigation, foreign body removal, and wound care
ENT Surgeons — Use for surface anesthesia in ear, nose, and throat procedures
Primary Care Physicians, NPs, PAs — May prescribe the 2% topical solution for minor skin conditions
Telehealth providers can technically prescribe tetracaine (it is not a controlled substance), but its primary uses require in-person clinical administration. A telehealth prescription is most realistic for the topical skin formulation. For ophthalmic and spinal use, an in-person visit with a specialist is required.
No. Tetracaine is not a DEA-scheduled controlled substance. It requires a valid prescription from a licensed healthcare provider, but it is not subject to DEA monitoring, special dispensing restrictions, or refill limits that apply to scheduled controlled substances.
Because tetracaine has no significant abuse potential or physical dependence liability, it was never placed on the DEA controlled substance schedule. Prescriptions can be filled without special pharmacy registration, electronic prescribing requirements, or quantity-per-fill limitations that apply to Schedule II–V drugs.
The following side effects are common and typically resolve within minutes:
Transient stinging or burning at the site of instillation
Conjunctival redness (eye redness)
Eye irritation, discomfort, or itching
Watering eyes (lacrimation)
Temporary numbness at the site of application (intended effect)
Methemoglobinemia — risk increases when combined with oxidizing agents; symptoms include blue lips/skin, headache, rapid heart rate
Allergic reactions — rare; more likely after repeated exposure; due to PABA metabolite
Systemic toxicity — dizziness, tremors, cardiac effects; occurs with excessive absorption (large areas, occlusion)
Corneal damage — risk with long-term/unsupervised ophthalmic use; can cause permanent vision loss
Hypotension — with spinal tetracaine due to sympathetic blockade and vasodilation
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Proparacaine
Most common ophthalmic alternative; 0.5% drops; similar onset, slightly longer duration (~15 min), less stinging on instillation; also ester class
Lidocaine
Amide anesthetic; available in ophthalmic gel (2%–4%), injectable, and topical forms; suitable when ester contraindications present; widely stocked
Bupivacaine
Long-acting amide anesthetic; used for spinal and regional nerve blocks; duration 2–3+ hours; alternative when extended anesthesia is needed
Benzocaine
Ester topical anesthetic available OTC; used for oral and minor skin pain; not a substitute for ophthalmic tetracaine
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Nitroglycerin (all forms)
moderateConcurrent use with tetracaine increases methemoglobinemia risk. Monitor for cyanosis, headache, rapid heart rate.
Dapsone
moderateSignificant methemoglobinemia risk when combined with tetracaine due to additive oxidizing effects.
Chloroquine
moderateMonitor for signs of methemoglobinemia when coadministered with tetracaine.
Bupivacaine implant (Exparel)
majorIncreased local anesthetic systemic toxicity risk; avoid additional local anesthetics within 96 hours of implantation.
Hyaluronidase
moderateHastens anesthetic onset but increases systemic tetracaine absorption, raising toxicity risk.
IV/Rectal Acetaminophen
minorMonitor for methemoglobinemia signs when parenteral acetaminophen is used concurrently with tetracaine.
Nitrofurantoin
minorMonitor for methemoglobinemia when coadministered with tetracaine.
Tetracaine is a well-established, affordable, and effective local anesthetic that has served patients and providers for over 80 years. As a WHO Essential Medicine, it remains a first-line option for ophthalmic procedures and continues to be used for spinal anesthesia worldwide. Its non-controlled status makes it straightforward to prescribe, and its generic availability keeps costs accessible.
The main challenge with tetracaine in 2026 is availability at retail pharmacies — not shortage. Because it's primarily a clinical drug, the retail pharmacy network does not reliably stock it. Patients prescribed tetracaine for outpatient use should expect to call compounding or independent pharmacies, and should anticipate cash prices of $29–$43 per 5 mL with or without discount cards.
If you're having difficulty locating tetracaine at a pharmacy near you, medfinder is a paid service that contacts pharmacies on your behalf and texts you the results — saving you time and frustration.
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Our medication guides are researched and written to help patients make informed decisions. All content is reviewed for accuracy and updated regularly. Learn more about our standards
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