SJ3- lidocaine hcl, tetracaine hcl, benzocaine spray 
Dermal Source, Inc.

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Drug Facts - For use by licensed professionals only


Active Ingredients  Purpose
Lidocaine Hydrochloride   5% Topical Anesthetic
Tetracaine Hydrochloride   1% Topical Anesthetic
Benzocaine 12% Topical Anesthetic

Uses: External Use Only. Do Not Swallow. Temporarily supplies pain relief to either intact or open skin due to pain sensitive procedures.

WARNINGS -  Keep out reach of children

Do not use if you have

Avoid contact with eyes, in case of accidental contact with eyes, rinse immediately with copious amounts of eyewash and seek treatment by an eye care specialist. If accidentally swallowed, get medical help immediately.

When using this product you may notice temporary blanching or redness of the skin where liquid is applied.

Directions:  Sensitivity test advised prior to use.

Apply to intact skin to clean prior to application of predeadener. Use to wipe off predeadener. During procedure, swipe across skin and wait for numbness to develop (90 seconds). Not appropriate for eyeliner. You may reapply as necessary to continue anesthesia. Discontinue use if sensitivity occurs. Remove product before continuing with procedure.

Inactive Ingredients: Propylene Glycol, Ethoxydiglycol, Tetrasodium EDTA.

Other information: Store in a cool dark place or refrigerate. Discard after expiration date.

Questions? Contact distributor on product label.

PRINCIPAL DISPLAY PANEL

SUPERIOR

SJ3

SuperJuice 3

anesthetic for use during a pain sensitive procedure

4 oz.

Distributed by: DERMAL SOURCE
Portland, OR 97232

www.dermalsource.com
1-866-568-3223

label
SJ3 
lidocaine hcl, tetracaine hcl, benzocaine spray
Product Information
Product TypeHUMAN OTC DRUGItem Code (Source)NDC:80069-011
Route of AdministrationTOPICAL
Active Ingredient/Active Moiety
Ingredient NameBasis of StrengthStrength
Lidocaine Hydrochloride (UNII: V13007Z41A) (Lidocaine - UNII:98PI200987) Lidocaine Hydrochloride Anhydrous50 mg  in 1 mL
Tetracaine Hydrochloride (UNII: 5NF5D4OPCI) (Tetracaine - UNII:0619F35CGV) Tetracaine Hydrochloride10 mg  in 1 mL
Benzocaine (UNII: U3RSY48JW5) (Benzocaine - UNII:U3RSY48JW5) Benzocaine120 mg  in 1 mL
Inactive Ingredients
Ingredient NameStrength
Propylene Glycol (UNII: 6DC9Q167V3)  
Diethylene Glycol Monoethyl Ether (UNII: A1A1I8X02B)  
Edetate Sodium (UNII: MP1J8420LU)  
Packaging
#Item CodePackage DescriptionMarketing Start DateMarketing End Date
1NDC:80069-011-01118.294 mL in 1 BOTTLE, PUMP; Type 0: Not a Combination Product08/15/2021
Marketing Information
Marketing CategoryApplication Number or Monograph CitationMarketing Start DateMarketing End Date
OTC Monograph DrugM01708/15/2021
Labeler - Dermal Source, Inc. (183535629)
Establishment
NameAddressID/FEIBusiness Operations
HTO Nevada, Inc. (dba Kirkman)117115846manufacture(80069-011)

Revised: 10/2023
Document Id: effc8758-819d-4c83-8931-929b203e56f9
Set id: f26ffe2e-7bb0-4280-8b54-a5d8c086f04c
Version: 3
Effective Time: 20231013
 
Dermal Source, Inc.