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Cold sore: Topical: Children >2 years and Adolescents: Refer to adult dosing. Dosing: Renal Impairment No dosage adjustment provided in manufacturer's labeling(has not been studied). Dosing: Hepatic Impairment No dosage adjustment provided in manufacturer's labeling(has not been studied). Dosage Forms: U.S. Excipient information presented when available (limited, particularly for generics); consult specific product labeling. Solution, topical: Viroxyn®: Benzalkonium chloride 0.13% and benzocaine 7.5% (0.6 mL) [contains isopropyl alcohol 70% v/v] Generic Equivalent Available: U.S. No Prescribing and Access Restrictions Product only available to dental professionals. Administration Topical: Prior to administration, clean lotions, ointments, or cosmetics from the lip using only warm water and a washcloth. Saturate the applicator with solution and apply to the cold sore. Allow a few moments for the lip to numb, then massage the solution (using the applicator) into the cold sore by rubbing firmly without damaging the skin. Avoid brushing with toothpaste or drinking fruit juices or soft drinks for at least one hour after application. Use Topical treatment of cold sores Adverse Reactions Significant Frequency not defined: Local: Irritation, stinging (short-term) Contraindications Hypersensitivity to benzalkonium chloride, benzocaine, other ester-type local anesthetics, or any component of the formulation; ophthalmic use; use over a large area of body or >3 times daily; longer than 1 week unless directed by healthcare provider Warnings/Precautions

Other warnings/precautions: • Appropriate use: For topical use only. If symptoms persist for 7-10 days after treatment then reassess. Metabolism/Transport Effects None known. Drug Interactions (For additional information: Launch Lexi-Interact™ Drug Interactions Program ) Prilocaine: Methemoglobinemia Associated Agents may enhance the adverse/toxic effect of Prilocaine. Combinations of these agents may increase the likelihood of significant methemoglobinemia. Management: Monitor patients for signs of methemoglobinemia (e.g., hypoxia, cyanosis) when prilocaine is used in combination with other agents associated with development of methemoglobinemia. Avoid lidocaine/prilocaine in infants receiving such agents. Risk C: Monitor therapy Ethanol/Nutrition/Herb Interactions Food: Fruit juices and soft drinks may deactivate the active ingredient. Avoid drinking fruit juices and soft drinks for at least 1 hour after application. Mechanism of Action Benzalkonium chloride is an antiseptic and disinfectant; benzocaine is an ester local anesthetic that blocks both the initiation and conduction of nerve impulses by decreasing the neuronal membrane's permeability to sodium ions, which results in inhibition of depolarization with resultant blockade of conduction Use of UpToDate is subject to the Subscription and License Agreement . Topic 87454 Version 4.0 © 2013 UpToDate, Inc. All rights reserved. | Subscription and License Agreement | Release: 21.6- C21.56 Licensed to: AsanBook Dig. Med. Lib. | Support Tag: [0604-118.195.65.248-A392849A5D-S244013.14]