FormWeb • benzocaine/lidocaine/tetracaine topical

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Children's of Alabama

Approved Formulary

Alabama Medicaid Formulary Questions or Suggestions? CHS Homepage

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benzocaine/lidocaine/tetracaine topical

benzocaine/lidocaine/tetracaine topical

Drug Name	Form	Strength	Formulary Unrestricted	Formulary Restricted	Non-formulary	Interchange
BLT Cream	CREAM	7.5/7.5/5 gm (Rx cmpd)

VIEW MORE topical agents, topical anesthetics
CLASS

Comments:

Ingredient	Description	Quantity
Benzocaine USP (Ethyl Aminobenzoate)	Powder	7.5 g
Lidocaine USP	Powder	7.5 g
Tetracaine USP	Powder	5 g
Propylene Glycol USP	Liquid	6.25 g
Base (Jelene)	Plasticizer	q.s.126.25 gm

Last updated: Nov. 16, 2021

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Inpatient Pharmacy: 205-638-9641
IV Room: 205-638-9716
Pharmacy Offices: 205-638-9718

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