Articaine
Brand names: Septocaine
Drug class:
Antineoplastic Agents
Usage of Articaine
Dental Anesthesia
Local, infiltrative, or regional (i.e., nerve block) anesthesia in simple and complex dental and periodontal procedures.
Anesthetic activity comparable to that of lidocaine, mepivacaine, and prilocaine.
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How to use Articaine
General
Administration
Submucosal Injection
For solution and drug compatibility information, see Compatibility under Stability.
Administer by submucosal infiltration or by nerve block.
Aspirate prior to administration to guard against intravascular injection.
For chemical disinfection of the cartridge unit, use isopropyl (rubbing) alcohol (91%) or ethyl alcohol (70%). Do not use brands that are not of USP grade, since these preparations may contain denaturants that may be injurious to rubber.
Dosage
Available as fixed combination containing articaine hydrochloride and epinephrine bitartrate; dosage expressed in terms of articaine hydrochloride.
Pediatric Patients
Dental Anesthesia Submucosal InjectionChildren ≥4 years of age: Use lower dosages than those suggested for healthy adults (see Adults under Dosage and Administration).
Simple procedures: 0.76–5.65 mg/kg used in clinical trials.
Complex procedures: 0.37–7.48 mg/kg used in clinical trials.
Approximately 13% of pediatric patients in clinical trials required additional injections for complete anesthesia.
Adults
Dental Anesthesia Submucosal InjectionUsual dosage range: 20–204 mg.
Recommended Dosages (as articaine hydrochloride 4% with epinephrine 1:100,000) for Dental Anesthesia in Healthy Adults1Procedure
Volume of Injection (mL)
Total Dose of Articaine Hydrochloride (mg)
Infiltration
0.5–2.5
20–100
Nerve block
0.5–3.4
20–136
Oral surgery
1–5.1
40–204
Prescribing Limits
Pediatric Patients
Dental Anesthesia Submucosal InjectionMaximum 7 mg/kg (0.175 mL/kg).
Adults
Dental Anesthesia Submucosal InjectionMaximum 7 mg/kg (0.175 mL/kg).
Special Populations
Hepatic Impairment
Reduce dosage in patients with hepatic disease.
Geriatric Patients
Reduce dosage in patients ≥65 years of age.
Patients 65–74 Years of AgeSimple procedures: 0.43–4.76 mg/kg used in clinical trials.
Complex procedures: 1.05–4.27 mg/kg used in clinical trials.
Approximately 6% of patients in clinical trials required additional injections for complete anesthesia.
Patients ≥75 Years of AgeSimple procedures: 0.78–4.76 mg/kg used in clinical trials.
Complex procedures: 1.12–2.17 mg/kg used in clinical trials.
None of the patients in clinical trials required additional injections for complete anesthesia.
Other Populations
Reduce dosage in patients with cardiac disease, debilitated patients, and patients with acute illnesses.
Warnings
Contraindications
Warnings/Precautions
Warnings
Epinephrine AdministrationInjection contains epinephrine, which may cause tissue necrosis or systemic toxicity. Consider usual precautions associated with epinephrine administration.
Accidental Intravascular InjectionAccidental intravascular injection may result in confusion, seizures, CNS or cardiorespiratory depression, coma, and/or respiratory arrest.
Aspirate prior to administration to guard against intravascular injection.
Should be used only by clinicians who are sufficiently knowledgeable in the diagnosis and management of dose-related toxicity and other acute emergencies that might arise. Resuscitative equipment and drugs must be available for immediate use.
Sensitivity Reactions
Sulfite SensitivityArticaine injection contains sodium metabisulfite, which may cause allergic-type reactions (including anaphylaxis and life-threatening or less severe asthmatic episodes) in certain susceptible individuals.
General Precautions
CNS EffectsToxic plasma concentrations of local anesthetics (resulting from systemic absorption) associated with adverse CNS effects (e.g., restlessness, anxiety, tinnitus, lightheadedness, dizziness, disorientation, excitement, blurred vision, tremors, depression, drowsiness).
Carefully monitor level of consciousness after each local anesthetic injection.
Cardiovascular EffectsToxic plasma concentrations of local anesthetics (resulting from systemic absorption) associated with adverse cardiovascular effects (e.g., reduced myocardial contractility, peripheral vasodilation, depressed cardiac conduction and excitability). Possible atrioventricular block, ventricular arrhythmia, cardiac arrest, and, rarely, death. Carefully monitor cardiovascular and respiratory vital signs after each local anesthetic injection.
Cardiac arrhythmias may occur in patients receiving potent general anesthetics; use with caution in such patients.
Articaine hydrochloride injection contains epinephrine; risk of exaggerated vasoconstrictor response in patients with hypertension or peripheral vascular disease. Risk of ischemic injury or necrosis.
Use with caution in patients with heart block or other cardiovascular disease.
Specific Populations
PregnancyCategory C.
LactationNot known whether articaine or its metabolites are distributed into milk. Caution advised if used in nursing women.
Pediatric UseSafety and efficacy not established in children <4 years of age.
Geriatric UseNo substantial differences in safety and efficacy relative to younger adults, but increased sensitivity cannot be ruled out.
Hepatic ImpairmentNot studied in patients with hepatic impairment. Use with caution in patients with severe hepatic impairment.
Common Adverse Effects
Pain, headache, facial edema, gingivitis, paresthesia, infection.
What other drugs will affect Articaine
Approximately 5–10% of available articaine is metabolized by CYP enzymes.
Specific Drugs
Drug
Interaction
Comments
Anesthetics, general
Possible cardiac arrhythmias when articaine is administered during or following administration of potent general anesthetics
Use with caution
Antidepressants, tricyclics
Possible severe, prolonged hypertension due to epinephrine component
Avoid concomitant use; if must be used concomitantly, careful monitoring is required
Butyrophenones
Possible reduction or reversal of pressor effect of epinephrine
Avoid concomitant use; if must be used concomitantly, careful monitoring is required
MAO inhibitors
Possible severe, prolonged hypertension due to epinephrine component
Avoid concomitant use; if must be used concomitantly, careful monitoring is required
Phenothiazines
Possible reduction or reversal of pressor effect of epinephrine
Avoid concomitant use; if must be used concomitantly, careful monitoring is required
Disclaimer
Every effort has been made to ensure that the information provided by Drugslib.com is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Drugslib.com information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Drugslib.com does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Drugslib.com's drug information does not endorse drugs, diagnose patients or recommend therapy. Drugslib.com's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners.
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