Mepivacaine hydrochloride
lINDICATIONS AND DOSE
Infiltration anaesthesia and nerve block in dentistry
▶Child 3–17 years:Consult expert dental sources
DOSESATEXTREMESOFBODY-WEIGHT
▶To avoid excessive dosage in obese patients, dose
should be calculated on the basis of ideal body-weight.IMPORTANT SAFETY INFORMATION
Should only be administered by, or under the direct
supervision of, personnel experienced in their use, with
adequate training in anaesthesia and airway
management, and should not be administered
parenterally unless adequate resuscitation equipment is
available.lCONTRA-INDICATIONSApplication to the middle ear (can
cause ototoxicity).avoid injection into infected tissues.
avoid injection into inflamed tissues.complete heart block
.preparations containing preservatives should not be used
for caudal, epidural, or spinal block, or for intravenous
regional anaesthesia (Bier’s block).should not be applied
to damaged skin
CONTRA-INDICATIONS, FURTHER INFORMATION
▶Injection siteLocal anaesthetics should not be injected into
inflamed or infected tissues nor should they be applied to
damaged skin. Increased absorption into the blood
increases the possibility of systemic side-effects, and the
local anaesthetic effect may also be reduced by altered
local pH.
lCAUTIONSCardiovascular disease.children (consider dose
reduction).debilitated patients (consider dose reduction).
epilepsy.hypovolaemia.impaired cardiac conduction.
impaired respiratory function.myasthenia gravis.shock
lINTERACTIONS→Appendix 1 : anaesthetics, local
lSIDE-EFFECTS
▶Common or very commonArrhythmias.dizziness.
hypertension.hypotension.nausea.paraesthesia.
vomiting
▶UncommonNeurotoxicity
▶Rare or very rareArachnoiditis.cardiac arrest.diplopia.
nerve disorders.respiratory depression
SIDE-EFFECTS, FURTHER INFORMATIONToxic effects after
administration of local anaesthetics are a result of
excessively high plasma concentrations; severe toxicity
usually results from inadvertent intravascular injection or
too rapid injection. The systemic toxicity of local
anaesthetics mainly involves the central nervous and
cardiovascular systems. The onset of toxicity can be
unpredictable and delayed. Monitor as per local protocol
for at least 30 minutes after administration.
lALLERGY AND CROSS-SENSITIVITY
▶Hypersensitivity and cross-sensitivityHypersensitivity
reactions occur mainly with the ester-type local
anaesthetics, such as tetracaine; reactions are less
frequent with the amide types, such as articaine,
bupivacaine, levobupivacaine, lidocaine, mepivacaine,
prilocaine, and ropivacaine. Cross-sensitivity reactions
may be avoided by using the alternative chemical type.
lPREGNANCYUse with caution in early pregnancy.
lBREAST FEEDINGUse with caution.
lHEPATIC IMPAIRMENTUse with caution; increased risk of
side-effects in severe impairment.
lRENAL IMPAIRMENTUse with caution; increased risk of
side-effects.
lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Solution for injection
▶Scandonest plain(Septodont Ltd)
Mepivacaine hydrochloride 30 mg per 1 mlScandonest plain 3 %
solution for injection 2. 2 ml cartridges| 50 cartridgeP£ 21. 95Mepivacaine with adrenaline
The properties listed below are those particular to the
combination only. For the properties of the components
please consider, mepivacaine hydrochloride above,
adrenaline/epinephrine p. 136.lINDICATIONS AND DOSE
Infiltration anaesthesia and nerve block in dentistry
▶BY LOCAL INFILTRATION
▶Child:(consult product literature)IMPORTANT SAFETY INFORMATION
Adrenaline/epinephrine must be used in a low
concentration when administered with a local
anaesthetic. The total dose of adrenaline should not
exceed 5 micrograms/kg ( 1 mL/kg of a 1 in200 000
solution) and it is essential not to exceed a
concentration of 1 in200 000( 5 micrograms/mL) if more
than 50 mL of the mixture is to be injected.lINTERACTIONS→Appendix 1 : anaesthetics, local.
sympathomimetics, vasoconstrictorlMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Solution for injection
EXCIPIENTS:May contain Sulfites
▶Scandonest special(Septodont Ltd)
Adrenaline 10 microgram per 1 ml, Mepivacaine hydrochloride
20 mg per 1 mlScandonest special 2 % solution for injection 2. 2 ml
cartridges| 50 cartridgeP£ 21. 95Prilocaine hydrochloride
lINDICATIONS AND DOSE
CITANEST 1%®
Infiltration anaesthesia|Nerve block
▶BY REGIONAL ADMINISTRATION
▶Child 6 months–11 years:Up to 5 mg/kg, dose adjusted
according to site of administration and response;
maximum 400 mg per course
▶Child 12–17 years: 100 – 200 mg/minute, alternatively,
may be given in incremental doses; dose adjusted
according to site of administration and response;
maximum 400 mg per course
DOSESATEXTREMESOFBODY-WEIGHT
▶To avoid excessive dosage in obese patients, dose
should be calculated on the basis of ideal body-weight.IMPORTANT SAFETY INFORMATION
Should only be administered by, or under the direct
supervision of, personnel experienced in their use, with
adequate training in anaesthesia and airway
management, and should not be administered
parenterally unless adequate resuscitation equipment is
available.lCONTRA-INDICATIONSAcquired methaemoglobinaemia.
anaemia.application to the middle ear (can cause
ototoxicity).avoid injection into infected tissues.avoidBNFC 2018 – 2019 Local anaesthesia 829
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