General MedicationsSUBMUCOSALHigh Alert

Articaine Hydrochloride and Epinephrine

ARTICAINE HYDROCHLORIDE AND EPINEPHRINE

Standard Dose

2 DOSAGE AND ADMINISTRATION For dental procedures by intraoral submucosal infiltration or nerve block. ( 2.1 ) - For infiltration: 0.5-2.5 mL (20-100 mg articaine HCl) - For nerve block: 0.5-3.4 mL (20-136 mg articaine HCl) - For oral surgery: 1.0-5.1 mL (40-204 mg articaine HCl) For most routine dental procedures, Articaine HCl and Epinephrine containing 1:200,000 is preferred. However, when more pronounced hemostasis or improved visualization of the surgical field are required, Articaine HCl and Epinephrine containing epinephrine 1:100,000 may be used. ( 2.1 ) Maximum recommended dosages ( 2.2 ): - Healthy adults: 7 mg/kg of articaine HCl and 0.0017mg/kg of epinephrine (equivalent to 0.175 mL/kg for either product presentation, articaine HCl and epinephrine 1:100,000 or 1:200,000) - Pediatric patien ts 4-16 years: 7 mg/kg of articaine HCl and 0.0017mg/kg of epinephrine (equivalent to 0.175 mL/kg for either product presentation, articaine HCl and epinephrine 1:100,000 or 1:200,000) 2.1 Important Dosage Information Table 1 summarizes the recommended dosages of Articaine HCl and Epinephrine administered by intraoral submucosal infiltration or nerve block for various types of anesthetic dental procedures in healthy adults and pediatric patients. Table 1: Recommended Dosages for Both Strengths Articaine HCl and Epinephrine Injection Procedure Volume (mL) Total dose of articaine HCl (mg) Infiltration 0.5 mL to 2.5 mL 20 mg to 100 mg Nerve block 0.5 mL to 3.4 mL 20 mg to 136 mg Oral surgery 1 mL to 5.1 mL 40 mg to 204 mg The recommended dosages of Articaine HCl and Epinephrine in healthy adults serve only as a guide to the amount of anesthetic required for most routine dental procedures. The dosages to be used in adults depend on several factors such as type and extent of surgical procedure, depth of anesthesia, degree of muscular relaxation, and condition of the patient. In all cases, administer the lowest dosage that will produce the desired result. The dosages of Articaine HCl and Epinephrine to be used in pediatric patients aged 4 to 16 years old are determined by the age and weight of the patient and the type of dental procedure. For most routine dental procedures, Articaine HCl and Epinephrine containing epinephrine 1:200,000 is preferred. However, when more pronounced hemostasis or improved visualization of the surgical field are required, Articaine HCl and Epinephrine containing epinephrine 1:100,000 may be used. 2.2 Maximum Recommended Dosages Healthy Adults: The maximum recommended dosage of Articaine HCl and Epinephrine is 7 mg/kg of articaine and 0.0017mg/kg of epinephrine (equivalent to 0.175 mL/kg for either product presentation, articaine HCl and 1:100,000 or 1:200,000 epinephrine). Pediatric Patients Ages 4 to 16 Years: The maximum recommended dosage of Articaine HCl and Epinephrine is 7 mg/kg of articaine and 0.0017mg/kg of epinephrine (equivalent to 0.175 mL/kg for either product presentation, articaine HCl and 1:100,000 or 1:200,000 epinephrine) [see Use in Specific Populations (8.4) ] . 2.3 Dosage in Specific Populations Lower dosages or dosage reduction may be required in debilitated patients, acutely ill patients, elderly patients, and pediatric patients commensurate with their age and physical condition. No studies have been performed in patients with renal or liver impairment. Exercise caution when using Articaine HCl and Epinephrine in patients with severe liver disease. [ see Warnings and Precautions (5.2) , Use in Specific Populations (8.4 , 8.5 , and 8.6) ] 2.4 Important Administration Instructions Visually inspect Articaine HCl and Epinephrine for particulate matter and discoloration prior to administration. Prior to using the glass cartridges, disinfect by wiping the cap thoroughly with USP grade isopropyl alcohol (70%). Avoid use of isopropyl alcohol, as well as solutions of ethyl alcohol that are not of USP grade because they may contain denaturants that are injurious to rubber. Immersion is not recommended. Discard unused portion.

Max Dose

See official label

Primary Use

1 INDICATIONS AND USAGE Articaine HCl and Epinephrine is indicated for local, infiltrative, or conductive anesthesia in both simple and complex dental procedures in adults and pediatric patients 4 years of age or older.

Summary

Articaine HCl and Epinephrine is a combination of articaine HCl, an amide local anesthetic, and epinephrine, a vasoconstrictor, is indicated for local, infiltrative, or conductive anesthesia in both simple and complex dental procedures. in adults and pediatric patients 4 years of age or older.

Structured Monograph

Clinical summary

Indications and usage 1 INDICATIONS AND USAGE Articaine HCl and Epinephrine is indicated for local, infiltrative, or conductive anesthesia in both simple and complex dental procedures in adults and pediatric patients 4 years of age or older. Articaine HCl and Epinephrine is a combination of articaine HCl, an amide local anesthetic, and epinephrine, a vasoconstrictor, is indicated for local, infiltrative, or conductive anesthesia in both simple and complex dental procedures. in adults and pediatric patients 4 years of age or older. Dosage and administration 2 DOSAGE AND ADMINISTRATION For dental procedures by intraoral submucosal infiltration or nerve block. ( 2.1 ) - For infiltration: 0.5-2.5 mL (20-100 mg articaine HCl) - For nerve block: 0.5-3.4 mL (20-136 mg articaine HCl) - For oral surgery: 1.0-5.1 mL (40-204 mg articaine HCl) For most routine dental procedures, Articaine HCl and Epinephrine containing 1:200,000 is preferred. However, when more pronounced hemostasis or improved visualization of the surgical field are required, Articaine HCl and Epinephrine containing epinephrine 1:100,000 may be used. ( 2.1 ) Maximum recommended dosages ( 2.2 ): - Healthy adults: 7 mg/kg of articaine HCl and 0.0017mg/kg of epinephrine (equivalent to 0.175 mL/kg for either product presentation, articaine HCl and epinephrine 1:100,000 or 1:200,000) - Pediatric patien ts 4-16 years: 7 mg/kg of articaine HCl and 0.0017mg/kg of epinephrine (equivalent to 0.175 mL/kg for either product presentation, articaine HCl and epinephrine 1:100,000 or 1:200,000) 2.1 Important Dosage Information Table 1 summarizes the recommended dosages of Articaine HCl and Epinephrine administered by intraoral submucosal infiltration or nerve block for various types of anesthetic dental procedures in healthy adults and pediatric patients. Table 1: Recommended Dosages for Both Strengths Articaine HCl and Epinephrine Injection Procedure Volume (mL) Total dose of articaine HCl (mg) Infiltration 0.5 mL to 2.5 mL 20 mg to 100 mg Nerve block 0.5 mL to 3.4 mL 20 mg to 136 mg Oral surgery 1 mL to 5.1 mL 40 mg to 204 mg The recommended dosages of Articaine HCl and Epinephrine in healthy adults serve only as a guide to the amount of anesthetic required for most routine dental procedures. The dosages to be used in adults depend on several factors such as type and extent of surgical procedure, depth of anesthesia, degree of muscular relaxation, and condition of the patient. In all cases, administer the lowest dosage that will produce the desired result. The dosages of Articaine HCl and Epinephrine to be used in pediatric patients aged 4 to 16 years old are determined by the age and weight of the patient and the type of dental procedure. For most routine dental procedures, Articaine HCl and Epinephrine containing epinephrine 1:200,000 is preferred. However, when more pronounced hemostasis or improved visualization of the surgical field are required, Articaine HCl and Epinephrine containing epinephrine 1:100,000 may be used. 2.2 Maximum Recommended Dosages Healthy Adults: The maximum recommended dosage of Articaine HCl and Epinephrine is 7 mg/kg of articaine and 0.0017mg/kg of epinephrine (equivalent to 0.175 mL/kg for either product presentation, articaine HCl and 1:100,000 or 1:200,000 epinephrine). Pediatric Patients Ages 4 to 16 Years: The maximum recommended dosage of Articaine HCl and Epinephrine is 7 mg/kg of articaine and 0.0017mg/kg of epinephrine (equivalent to 0.175 mL/kg for either product presentation, articaine HCl and 1:100,000 or 1:200,000 epinephrine) [see Use in Specific Populations (8.4) ] . 2.3 Dosage in Specific Populations Lower dosages or dosage reduction may be required in debilitated patients, acutely ill patients, elderly patients, and pediatric patients commensurate with their age and physical condition. No studies have been performed in patients with renal or liver impairment. Exercise caution when using Articaine HCl and Epinephrine in patients with severe liver disease. [ see Warnings and Precautions (5.2) , Use in Specific Populations (8.4 , 8.5 , and 8.6) ] 2.4 Important Administration Instructions Visually inspect Articaine HCl and Epinephrine for particulate matter and discoloration prior to administration. Prior to using the glass cartridges, disinfect by wiping the cap thoroughly with USP grade isopropyl alcohol (70%). Avoid use of isopropyl alcohol, as well as solutions of ethyl alcohol that are not of USP grade because they may contain denaturants that are injurious to rubber. Immersion is not recommended. Discard unused portion. Warnings and cautions 5 WARNINGS AND PRECAUTIONS Accidental Intravascular Injection: May be associated with convulsions followed by coma and respiratory arrest. Resuscitative equipment, oxygen and other resuscitative drugs should be available. ( 5.1 ) Systemic Toxicity: Systemic absorption of Articaine HCl and Epinephrine can produce effects on the central nervous and cardiovascular systems. ( 5.2 )

Monitoring

• 5 WARNINGS AND PRECAUTIONS Accidental Intravascular Injection: May be associated with convulsions followed by coma and respiratory arrest.
• Resuscitative equipment, oxygen and other resuscitative drugs should be available.
• ( 5.1 ) Systemic Toxicity: Systemic absorption of Articaine HCl and Epinephrine can produce effects on the central nervous and cardiovascular systems.
• ( 5.2 ) Vasoconstrictor Toxicity: Local anesthetic solutions like Articaine HCl and Epinephrine that contain a vasoconstrictor should be used cautiously, especially in patients with impaired cardiovascular function or vascular disease.

Interaction Notes

• 7 DRUG 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 [see Warnings and Precautions (5.2) ].
• Patients who are administered local anesthetics are at increased risk of developing methemoglobinemia when concurrently exposed to the following drugs, which could include other local anesthetics: Table 5.