Is it safe to use Orajel (benzocaine) in the nose to numb the area?

Using Benzocaine (Orajel) in the Nose is Not Recommended

Using Orajel (benzocaine) in the nose for numbing is not recommended due to significant safety concerns, including the risk of methemoglobinemia, which can be life-threatening even with topical application.

Safety Concerns with Nasal Benzocaine Use

Methemoglobinemia Risk

• Benzocaine products carry an FDA warning about methemoglobinemia, a serious condition that reduces oxygen carried in the blood 1
• This dangerous condition can occur even in patients who have safely used the product before
• A case report documented a 6-year-old developing a potentially lethal methemoglobin level of 69.9% after using Baby Orajel (7.5% benzocaine) 2
• Signs of methemoglobinemia include:
  • Pale, gray, or blue colored skin
  • Headache and dizziness
  • Rapid heart rate
  • Shortness of breath
  • Fatigue or lack of energy

Other Safety Concerns

• Benzocaine products are not FDA-approved for nasal use
• The FDA label specifically warns against using benzocaine for purposes other than directed 1
• Risk of allergic reactions, especially in patients with history of allergies to local anesthetics 1

Appropriate Alternatives for Nasal Numbing

If nasal numbing is required for medical procedures, the following evidence-based alternatives are recommended:

For Medical Procedures (Under Professional Supervision)

• Lidocaine is the preferred topical anesthetic for nasal procedures due to its favorable cardiovascular and systemic toxicity profile 3
• When administered by healthcare professionals, the total dose of lidocaine should not exceed 9 mg/kg lean body weight 3
• For nasotracheal intubation, phenylephrine in combination with lidocaine is recommended over cocaine 3

For Nasal Congestion/Epistaxis Management

• For nasal congestion, over-the-counter vasoconstrictors like oxymetazoline or phenylephrine can be used short-term (no more than 3-5 days) 4
• For epistaxis (nosebleed):
  • Apply firm sustained compression to the lower third of the nose for 10-15 minutes 4
  • Topical vasoconstrictors like oxymetazoline have a 65-75% success rate for controlling bleeding 4
  • Nasal moisturization with saline gel or spray 1-3 times daily can help prevent recurrence 4

Important Cautions

• Prolonged use of nasal vasoconstrictors (>3-5 days) can lead to rebound congestion and rhinitis medicamentosa 4, 5
• Benzalkonium chloride, a preservative in many nasal sprays, can cause toxic reactions and exacerbate allergic rhinitis symptoms 6
• Self-administration of topical anesthetics in the nose carries significant risks and should be avoided without medical supervision

Bottom Line

For nasal discomfort or congestion, safer alternatives like saline sprays or short-term use of decongestants are recommended. If numbing is needed for a medical procedure, it should be performed by a healthcare professional using appropriate medications at safe doses. Never use Orajel or other benzocaine products in the nose due to the risk of potentially fatal methemoglobinemia.