Articaine Hydrochloride + Epinephrine

Indications

Articaine Hydrochloride + Epinephrine is used for: Local anesthesia

Adult Dose

Dosage depends on several factors such as route, type and extent of surgical procedure, duration of anaesthesia and patient's condition and age. Local Infiltration: 0.5-2.5 mL injection of 4% solution; 20-100 mg total dose Nerve block: 0.5-3.4 mL injection of 4% solution; 20-136 mg total dose Oral surgery: 1-5.1 mL injection of 4% solution; 40-204 mg total dose No more than 7 mg/kg (0.175 mL/kg)

Child Dose

Local, Infiltrative, or Conductive Anesthesia in Dental Procedures <4 years old: Safey and efficacy not established 4-16 years old: Use lower end of dose range No more than 7 mg/kg (0.175 mL/kg)

Renal Dose

Administration

Contra Indications

Tachycardia, hypertension, cerebral arteriosclerosis, ischaemic heart disease, IV admin, anaesthetise digits or appendages, myasthenia gravis.

Precautions

Epilepsy, impaired cardiac conduction, CHF, DM, closed angle glaucoma, impaired liver function (if site of admin is likely to result in high blood levels), severe renal dysfunction. Local anaesthetic effect may be reduced if injected into an inflamed or infected area. Cerebrovascular insufficiency, hyperthyroidism. Neonates, elderly, patients in poor general condition (optimise patient's condition before major block), pregnancy. Lactation: excretion in milk unknown; use with caution

Pregnancy-Lactation

Pregnancy Category: C Lactation: excretion in milk unknown; use with caution

Interactions

The administration of local anesthetic solutions containing epinephrine to patients receiving monoamine oxidase inhibitors, nonselective beta-adrenergic antagonists, or tricyclic antidepressants may produce severe, prolonged hypertension. Phenothiazines and butyrophenones may reduce or reverse the pressor effect of epinephrine. Concurrent use of these agents should be avoided; however, in situations when concurrent therapy is necessary, careful patient monitoring is essential.

Adverse Effects

Side effects of Articaine Hydrochloride + Epinephrine : 1-10% Facial edema, Headache, Pain, Paresthesia, Sleepiness, Gingivitis, Nausea, Vomiting, Infection Frequency Not Defined Systemic absorption of significant concentrations of local anesthetic can produce myocardial depression, cardiac conduction changes, CNS excitation, convulsions, and cardiorespiratory arrest Potentially Fatal: CNS toxicity (due to inadvertent IV admin), medullary depression with tonic & clonic convulsions; ventricular fibrillation; severe hypertension with cerebral haemorrhage and pulmonary oedema; unconsciousness; possibly respiratory arrest. Allergic reactions including anaphylactic symptoms and possibly life threatening asthmatic episodes in susceptible patients may occur due to sodium metabisulphate constituent. Central nerve blocks may cause CV depression (especially in hypovolaemia). Retrobulbar inj may reach subarachnoid space causing CV collapse, apnoea, convulsions, temporary blindness. Paracervical block may cause foetal bradycardia/tachycardia (careful monitoring of foetal heart rate is necessary).

Mechanism of Action

Local anesthetics prevent generation/conduction of nerve impulses by reducing sodium permeability and increasing action potential threshold.