Articaine Hydrochloride + Epinephrine

Articaine and Epinephrine is an amide local anesthetic containing a vasoconstrictor indicated for local, infiltrative, or conductive anesthesia in both simple and complex dental procedures.

Articaine is an amide local anesthetic. Local anesthetics block the generation and conduction of nerve impulses, presumably by increasing the threshold for electrical excitation in the nerve, by slowing the propagation of the nerve impulse and by reducing the rate of rise of the action potential. In general, the progression of anesthesia is related to the diameter, myelination, and conduction velocity of the affected nerve fibers. Epinephrine is a vasoconstrictor added to articaine to slow absorption into the general circulation and thus prolong maintenance of an active tissue concentration.

Below are the recommended volumes and concentrations of articaine-epinephrine for various types of anesthetic procedures. The dosages suggested below are for normal healthy adults, administered by submucosal infiltration and/or nerve block.

Infiltration: 0.5 mL to 2.5 mL or 20 mg to 100 mg of articaine
Nerve block: 0.5 mL to 3.4 mL or 20 mg to 136 mg of articaine
Oral surgery: 1.0 mL to 5.1 mL or 40 mg to 204 mg of articaine.

For normal healthy adults, the maximum dose of articaine administered by submucosal infiltration and/or nerve block should not exceed 7 mg/kg of body weight.

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 generally be avoided. In situations when concurrent therapy is necessary, careful patient monitoring is essential

Articaine HCl and Epinephrine is contraindicated in patients who are hypersensitive to products containing sulfites. Products containing sulfites may cause allergic-type reactions including anaphylactic symptoms and life-threatening or less severe asthmatic episodes in certain susceptible people. Sulfite sensitivity is seen more frequently in asthmatic than in non-asthmatic people

Common side effects include Pain, headache, facial edema, gingivitis, paresthesia, infection. Other side effects include pain, headache, positive blood aspiration into syringe, swelling, face edema, infection, neck pain, abdominal pain, ear pain, taste perversion, and accidental injury have been reported

Gastrointestinal side effects including nausea and emesis, gingivitis, constipation, diarrhea, dyspepsia, glossitis, gum hemorrhage, mouth ulceration, nausea, stomatitis, tongue edema, tooth disorder, and vomiting have been reported.

Musculoskeletal side effects including trismus, arthralgia, myalgia, back pain, and osteomyelitis have been reported.

General side effects including sleepiness, malaise, and asthenia have been reported.

Nervous system side effects including paresthesia, numbness and tingling, dizziness, dry mouth, facial paralysis, hyperesthesia, increased salivation, nervousness, neuropathy, paresthesia, somnolence, and exacerbation of Kearns-Sayre syndrome have been reported.

Cardiovascular side effects including palpitation, hemorrhage, migraine, syncope, tachycardia, and elevated blood pressure have been reported.

Respiratory side effects including pharyngitis, rhinitis, sinus pain, and sinus congestion have been reported.

Pregnancy Category C. There are no adequate and well-controlled studies in pregnant women with articaine with epinephrine. This should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

Nursing Mothers: It is not known whether Articaine and Epinephrine is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when this combination is administered to a nursing woman.

Local & Surface anesthesia

Pediatric Use: Safety of doses greater than 7 mg/kg of articaine in pediatric patients has not been established. Dosages in pediatric patients should be reduced, commensurate with age, body weight, and physical condition.

Renal or Hepatic Insufficiency: No studies have been performed with articaine and epinephrine in renal and hepatic impaired patient.