Alternatives to Cocaine if you can't fill your prescription

Alternatives to Cocaine Hydrochloride for Nasal Procedures

If your doctor planned to use Cocaine Hydrochloride (brand names Goprelto or Numbrino) for your nasal procedure but can't find it in stock, you're not alone. Due to limited manufacturers and strict DEA regulations, this medication can be difficult to source.

The good news? There are several effective alternatives that can provide similar anesthesia and vasoconstriction for nasal procedures. This guide covers the most common options so you can have an informed conversation with your doctor.

Why Cocaine Hydrochloride Is Unique

Before looking at alternatives, it helps to understand what makes Cocaine Hydrochloride special. It's the only local anesthetic that provides both numbing and vasoconstriction (blood vessel shrinking) in a single product. During nasal procedures, this dual action:

• Numbs the nasal tissues so you don't feel pain
• Shrinks blood vessels to reduce bleeding and improve the surgeon's view

Most alternatives achieve the same result by combining two separate medications — one for anesthesia and one for vasoconstriction.

Alternative 1: Lidocaine with Oxymetazoline

Lidocaine is the most widely used local anesthetic in the world. When combined with Oxymetazoline (a nasal decongestant that shrinks blood vessels), it can replicate both of Cocaine Hydrochloride's effects.

• Pros: Widely available, well-studied, significantly less expensive, lower cardiovascular risk
• Cons: Requires two separate products; may not provide quite the same level of vasoconstriction as Cocaine
• Common use: Very popular in ENT and nasal procedures worldwide

Alternative 2: Tetracaine with Oxymetazoline

Tetracaine is another ester-type local anesthetic. Research published in Anesthesia & Analgesia found that Tetracaine mixed with Oxymetazoline may actually provide superior topical anesthesia compared to Cocaine for nasal procedures.

• Pros: Potentially better pain relief than Cocaine, good vasoconstriction when combined with Oxymetazoline
• Cons: Less commonly stocked than Lidocaine combinations; may require preparation
• Common use: ENT procedures, especially when strong anesthesia is needed

Alternative 3: Phenylephrine with Lidocaine (Co-Phenylcaine)

Co-Phenylcaine is a combination spray containing Lidocaine and Phenylephrine. It's widely used in ENT practice, particularly in the UK and internationally.

• Pros: Convenient spray formulation, provides both anesthesia and vasoconstriction
• Cons: May not be as readily available in the US as individual components
• Common use: ENT examinations and minor nasal procedures

Alternative 4: Xylometazoline with Lidocaine

Xylometazoline is a nasal decongestant similar to Oxymetazoline. When combined with Lidocaine, it creates another two-in-one approach to nasal anesthesia and vasoconstriction.

• Pros: Good clinical evidence supporting its use as a Cocaine alternative
• Cons: May need to be prepared by the clinical team; not available as a premixed product in the US
• Common use: Nasal surgeries in settings where Cocaine is not available

Alternative 5: Oxymetazoline Alone (for Vasoconstriction Only)

In some cases, your doctor may choose to use Oxymetazoline (such as Afrin nasal spray) for vasoconstriction and a completely separate method for anesthesia (such as an injected local anesthetic). This approach separates the two functions that Cocaine provides in one product.

• Pros: Oxymetazoline is inexpensive and widely available over the counter
• Cons: Doesn't provide anesthesia; requires a separate anesthetic
• Common use: Minor nasal procedures or as part of a multi-agent approach

How to Talk to Your Doctor About Alternatives

If Cocaine Hydrochloride isn't available for your procedure, here are some questions to ask your doctor:

• "Which alternative do you recommend for my specific procedure?"
• "Will the alternative work just as well for my situation?"
• "Are there any additional risks with the alternative?"
• "Will this change the cost of my procedure?"
• "Should we wait for Cocaine Hydrochloride to become available, or proceed with an alternative?"

Your doctor has likely dealt with Cocaine Hydrochloride shortages before and will have experience with alternatives that work well for your type of procedure.

Should You Wait for Cocaine Hydrochloride?

In most cases, the answer is no. The alternatives listed above are well-studied and effective. Delaying a medically necessary procedure to wait for a specific anesthetic usually isn't recommended, especially when good alternatives exist.

However, there may be rare cases where your surgeon strongly prefers Cocaine Hydrochloride for a specific reason. In that case, check our guide to finding Cocaine in stock and use MedFinder to search for availability near you.

Cost Considerations

One potential silver lining: many alternatives to Cocaine Hydrochloride are significantly less expensive. Goprelto starts at around $250 per treatment and Numbrino at around $565, while Lidocaine and Oxymetazoline are a fraction of that cost. For more on managing costs, see our guide on saving money on Cocaine in 2026.

The Bottom Line

While Cocaine Hydrochloride has unique properties that make it a valuable tool in nasal procedures, effective alternatives exist. Lidocaine with Oxymetazoline is the most widely used substitute, and Tetracaine with Oxymetazoline may actually provide better anesthesia in some cases. Work with your doctor to find the best option for your situation.

For the latest on supply, visit our Cocaine shortage update for 2026.