Drugs List

Contraindications

Arterial hypertension
Cardiovascular disease
Children under 3 years
Coronary disease
Valvular defects (usually following infectious rheumatism)

Precautions and Warnings

Pregnancy - see Pregnancy section.
Breastfeeding - see Lactation section.

Mepivacaine must be administered by a specialist who is aware of the diagnosis and management of emergencies arising from the use of anaesthesia. Resuscitative equipment and facilities should be immediately available when local anaesthetics are administered.

An exaggerated vasoconstrictor response may occur in patients with peripheral vascular disease.
After administration, cardiovascular and respiratory vital signs and the patient's state of consciousness should be monitored. Possible central nervous system toxicity may be indicated by restlessness, anxiety, tinnitus, dizziness, blurred vision, tremors, depression or drowsiness. Signs of cardiovascular depression may result from a vasovagal reaction, especially if the patient is in an upright position. If an adverse reaction is noted the patient should be placed in a recumbent position.

For dental injection only. To minimise the risk of intravascular injection, double aspiration should be performed before mepivacaine is injected slowly. Note that the absence of blood in the syringe does not assure that intravascular injection will be avoided.

Mepivacaine with adrenaline should not be injected repeatedly at the same site. This is because repeated injections at a single site may lead to tissue anoxia, delayed healing, oedema or necrosis due to reduced blood flow and increased oxygen consumption.

Mepivacaine should be used with caution if there is inflammation or infection at the site of the proposed injection. This may alter the pH at the site of injection and reduce the anaesthetic effect.

Debilitated patients, elderly and children should be given lower doses commensurate with their age and physical condition.

Patients with hepatic impairment should be treated with caution as mepivacaine is metabolised by the liver. Patients with severe hepatic disease are at a greater risk of developing toxic plasma concentrations.

Patients with renal impairment should be treated with caution as mepivacaine is excreted by the kidneys, and they consequently have a greater risk of developing toxic plasma concentrations.

Carefully consider the use of mepivacaine in patients with a history of severe disturbance of cardiac rhythm or heart block. In these patients, the depressant cardiac effects of mepivacaine may be detrimental to the patient.

Caution if using mepivacaine with adrenaline in patients with epilepsy and impaired respiratory function.

Pregnancy and Lactation

Pregnancy

Mepivacaine-type anaesthetics are considered safe for use during pregnancy based on their long usage. However caution should be exercised during early pregnancy as no controlled studies have been carried out in pregnant women.

Retrospective studies of pregnant women who were given local anaesthesia during the early stages of pregnancy have not shown any evidence of birth defects.

No animal reproduction studies have been performed with mepivacaine.

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 14-17 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

Caution should be exercised when mepivacaine is administered during lactation.

It is not known if mepivacaine is excreted in human milk.

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

CNS effects
Light-headedness
Nervousness
Apprehension
Euphoria
Confusion
Dizziness
Drowsiness
Tinnitus
Blurred vision
Double vision
Vomiting
Sensation of heat
Sensation of cold
Numbness
Twitching
Tremor
Convulsions
Unconsciousness
Respiratory depression
Respiratory arrest
Cardiovascular effects
Bradycardia
Hypotension
Cardiovascular collapse
Cardiac arrest
Sweating
Hypoxia
Changes in pulse
Allergic reaction
Cutaneous lesions
Urticaria
Oedema
Anaphylactoid reaction
Angina
Anxiety
Arrhythmia (including ventricular tachycardia and atrial fibrillation)
Faintness
Fear
Increased blood pressure
Pallor
Palpitations
Restlessness
Seizures
Changes in cognitive and sensorial capacity
Throbbing headache
Weakness
Peripheral vasoconstriction

Presentation

Each 2.2ml cartridge contains 44mg of mepivacaine hydrochloride and adrenaline base 1:100,000 solution for injection.

Drugs List

Dosage

Adults

Elderly

Children

Patients with Renal Impairment

Patients with Hepatic Impairment

Additional Dosage Information

Contraindications

Arterial hypertension
Cardiovascular disease
Children under 3 years
Coronary disease
Valvular defects (usually following infectious rheumatism)

Precautions and Warnings

Pregnancy - see Pregnancy section.
Breastfeeding - see Lactation section.

Mepivacaine must be administered by a specialist who is aware of the diagnosis and management of emergencies arising from the use of anaesthesia. Resuscitative equipment and facilities should be immediately available when local anaesthetics are administered.

An exaggerated vasoconstrictor response may occur in patients with peripheral vascular disease.
After administration, cardiovascular and respiratory vital signs and the patient's state of consciousness should be monitored. Possible central nervous system toxicity may be indicated by restlessness, anxiety, tinnitus, dizziness, blurred vision, tremors, depression or drowsiness. Signs of cardiovascular depression may result from a vasovagal reaction, especially if the patient is in an upright position. If an adverse reaction is noted the patient should be placed in a recumbent position.

For dental injection only. To minimise the risk of intravascular injection, double aspiration should be performed before mepivacaine is injected slowly. Note that the absence of blood in the syringe does not assure that intravascular injection will be avoided.

Mepivacaine with adrenaline should not be injected repeatedly at the same site. This is because repeated injections at a single site may lead to tissue anoxia, delayed healing, oedema or necrosis due to reduced blood flow and increased oxygen consumption.

Mepivacaine should be used with caution if there is inflammation or infection at the site of the proposed injection. This may alter the pH at the site of injection and reduce the anaesthetic effect.

Debilitated patients, elderly and children should be given lower doses commensurate with their age and physical condition.

Patients with hepatic impairment should be treated with caution as mepivacaine is metabolised by the liver. Patients with severe hepatic disease are at a greater risk of developing toxic plasma concentrations.

Patients with renal impairment should be treated with caution as mepivacaine is excreted by the kidneys, and they consequently have a greater risk of developing toxic plasma concentrations.

Carefully consider the use of mepivacaine in patients with a history of severe disturbance of cardiac rhythm or heart block. In these patients, the depressant cardiac effects of mepivacaine may be detrimental to the patient.

Caution if using mepivacaine with adrenaline in patients with epilepsy and impaired respiratory function.

Pregnancy and Lactation

Pregnancy

Mepivacaine-type anaesthetics are considered safe for use during pregnancy based on their long usage. However caution should be exercised during early pregnancy as no controlled studies have been carried out in pregnant women.

Retrospective studies of pregnant women who were given local anaesthesia during the early stages of pregnancy have not shown any evidence of birth defects.

No animal reproduction studies have been performed with mepivacaine.

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 14-17 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

Caution should be exercised when mepivacaine is administered during lactation.

It is not known if mepivacaine is excreted in human milk.

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

CNS effects
Light-headedness
Nervousness
Apprehension
Euphoria
Confusion
Dizziness
Drowsiness
Tinnitus
Blurred vision
Double vision
Vomiting
Sensation of heat
Sensation of cold
Numbness
Twitching
Tremor
Convulsions
Unconsciousness
Respiratory depression
Respiratory arrest
Cardiovascular effects
Bradycardia
Hypotension
Cardiovascular collapse
Cardiac arrest
Sweating
Hypoxia
Changes in pulse
Allergic reaction
Cutaneous lesions
Urticaria
Oedema
Anaphylactoid reaction
Angina
Anxiety
Arrhythmia (including ventricular tachycardia and atrial fibrillation)
Faintness
Fear
Increased blood pressure
Pallor
Palpitations
Restlessness
Seizures
Changes in cognitive and sensorial capacity
Throbbing headache
Weakness
Peripheral vasoconstriction

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 ).

Shelf Life and Storage

Store below 25 degrees C in a dry place.
Protect from light.
Keep the container in the outer carton.

If only part of the cartridge is used, the rest must be discarded.

Reference Sources

British National Formulary, 61st Edition (2011) Pharmaceutical Press, London.

Martindale: The Complete Drug Reference, 37th edition (2011) ed. Sweetman, S. Pharmaceutical Press, London.

Summary of Product Characteristics: Scandonest 2% Special. Septodont Ltd. Revised August 2003.