Drugs List

Therapeutic Indications

Uses

Local anaesthetic for dental infiltration anaesthesia

Administration

For dental injection only.

Solution for injection containing 88 mg of articaine hydrochloride and 11 micrograms (1:200,000) of adrenaline per 2.2 ml cartridge administered by infiltration or nerve block injection provides pulpal analgesia that lasts 60 minutes.

Solution for injection containing 88 mg of articaine hydrochloride and 22 micrograms (1:100,000) of adrenaline per 2.2 ml cartridge administered by infiltration or nerve block injection provides pulpal analgesia that lasts 75 minutes and bleeding during the operation is significantly reduced.

Contraindications

Children under 4 years
General anaesthesia
Plasma cholinesterase deficiency
Breastfeeding

Precautions and Warnings

Administration site infection
Inflammation of injection site
Asthma
Cardiac conduction defects
Cardiogenic shock
Cardiovascular disorder
Diabetes mellitus
Epileptic disorder
Hepatic impairment
Hypovolaemia
Myasthenia gravis
Peripheral vascular disease
Pregnancy
Respiratory impairment
Thyrotoxicosis

Advise ability to drive/operate machinery may be affected by side effects
Contains sodium metabisulfite. Caution,may cause allergic reactions
Avoid accidental intravascular injection
Effect may be reduced if injected into an inflamed or infected area
Resuscitation facilities must be immediately available
Anaesthetic effect may impair swallowing
In obese patients dosing should be based on ideal weight

Intravascular injection is strictly contraindicated because of the risk of systemic adverse effects due to circulating adrenaline and/or articaine.

Patients with severe hepatic impairment have an increased risk of developing toxic plasma concentrations.

Patients with peripheral vascular disease or hypertensive vascular disease may have an exaggerated vasoconstrictor response which may result in ischaemic injury or necrosis.

Allergic type reactions may occur in patients with bronchial asthma due to hypersensitivity to the sulfite component.

Pregnancy and Lactation

Pregnancy

Articaine with adrenaline anaesthesia should be used with caution in pregnancy.

There is no clinical experience in the use of articaine with adrenaline in pregnant women. The safety of local anaesthetics during pregnancy has not been established with respect to adverse effects on the development of the foetus. The manufacturer recommends that articaine with adrenaline anaesthesia should only be used during pregnancy when the benefits are considered to outweigh the risks.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Articaine with adrenaline anaesthesia is contraindicated in breastfeeding.

There is no clinical experience in the use of articaine with adrenaline in breastfeeding women. It is not known whether articaine or its metabolites are excreted into human milk. The manufacturer recommends that nursing mothers should not breastfeed for 48 hours following anaesthesia with articaine and adrenaline.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Anaphylaxis
Apnoea
Apprehension
Bradypnoea
Decrease in blood pressure
Decrease in heart rate
Dysaesthesia
Facial oedema
Gingivitis
Headache
Hearing disturbances
Hypersensitivity reactions
Hypoaesthesia
Ischaemia
Logorrhoea
Methaemoglobinaemia
Nausea
Necrosis (injection site)
Nervousness
Nystagmus
Paraesthesia
Pruritus
Rash
Shaking
Tachypnoea
Trembling
Urticaria
Yawning

Presentation

Solution for injection containing articaine hydrochloride and adrenaline

Drugs List

Therapeutic Indications

Uses

Local anaesthetic for dental infiltration anaesthesia

Dosage

Adults

Children

Additional Dosage Information

Administration

For dental injection only.

Solution for injection containing 88 mg of articaine hydrochloride and 11 micrograms (1:200,000) of adrenaline per 2.2 ml cartridge administered by infiltration or nerve block injection provides pulpal analgesia that lasts 60 minutes.

Solution for injection containing 88 mg of articaine hydrochloride and 22 micrograms (1:100,000) of adrenaline per 2.2 ml cartridge administered by infiltration or nerve block injection provides pulpal analgesia that lasts 75 minutes and bleeding during the operation is significantly reduced.

Contraindications

Children under 4 years
General anaesthesia
Plasma cholinesterase deficiency
Breastfeeding

Precautions and Warnings

Administration site infection
Inflammation of injection site
Asthma
Cardiac conduction defects
Cardiogenic shock
Cardiovascular disorder
Diabetes mellitus
Epileptic disorder
Hepatic impairment
Hypovolaemia
Myasthenia gravis
Peripheral vascular disease
Pregnancy
Respiratory impairment
Thyrotoxicosis

Advise ability to drive/operate machinery may be affected by side effects
Contains sodium metabisulfite. Caution,may cause allergic reactions
Avoid accidental intravascular injection
Effect may be reduced if injected into an inflamed or infected area
Resuscitation facilities must be immediately available
Anaesthetic effect may impair swallowing
In obese patients dosing should be based on ideal weight

Intravascular injection is strictly contraindicated because of the risk of systemic adverse effects due to circulating adrenaline and/or articaine.

Patients with severe hepatic impairment have an increased risk of developing toxic plasma concentrations.

Patients with peripheral vascular disease or hypertensive vascular disease may have an exaggerated vasoconstrictor response which may result in ischaemic injury or necrosis.

Allergic type reactions may occur in patients with bronchial asthma due to hypersensitivity to the sulfite component.

Pregnancy and Lactation

Pregnancy

Articaine with adrenaline anaesthesia should be used with caution in pregnancy.

There is no clinical experience in the use of articaine with adrenaline in pregnant women. The safety of local anaesthetics during pregnancy has not been established with respect to adverse effects on the development of the foetus. The manufacturer recommends that articaine with adrenaline anaesthesia should only be used during pregnancy when the benefits are considered to outweigh the risks.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Articaine with adrenaline anaesthesia is contraindicated in breastfeeding.

There is no clinical experience in the use of articaine with adrenaline in breastfeeding women. It is not known whether articaine or its metabolites are excreted into human milk. The manufacturer recommends that nursing mothers should not breastfeed for 48 hours following anaesthesia with articaine and adrenaline.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Anaphylaxis
Apnoea
Apprehension
Bradypnoea
Decrease in blood pressure
Decrease in heart rate
Dysaesthesia
Facial oedema
Gingivitis
Headache
Hearing disturbances
Hypersensitivity reactions
Hypoaesthesia
Ischaemia
Logorrhoea
Methaemoglobinaemia
Nausea
Necrosis (injection site)
Nervousness
Nystagmus
Paraesthesia
Pruritus
Rash
Shaking
Tachypnoea
Trembling
Urticaria
Yawning

Overdosage

It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

The following number will direct the caller to the relevant local centre (0844) 892 0111

Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Further Information

Last Full Review Date: May 2016

Reference Sources

Joint Formulary Committee. British National Formulary. 71st ed. London: BMJ Group and Pharmaceutical Press; 2016.

Paediatric Formulary Committee. BNF for Children 2015-2016. London: BMJ Group, Pharmaceutical Press, and RCPCH Publications; 2015.

Summary of Product Characteristics: Septanest 1:100,000. Septodont Ltd. Revised June 2012.

Summary of Product Characteristics: Septanest 1:200,00. Septodont Ltd. Revised June 2012.

UK Drugs in Lactation Advisory Service.
Available at: https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1
Last accessed: 18 May 2016