Prilocaine 2% injection
- Drugs List
- Therapeutic Indications
- Precautions and Warnings
- Pregnancy and Lactation
- Side Effects
Parenteral formulations of prilocaine 2%, used for intrathecal injection.
Anaesthesia - spinal
Due to the complexity and specialist nature of dosage regimens for anaesthetics, specific dosing information on this agent is not included.
The duration of action for prilocaine 2% injection is dose dependant.
For intrathecal injection only, into the intervertebral space L2/L3, L3/L4 and L4/L5.
Children under 18 years
Decompensated cardiac failure
Severe cardiac conduction defects
Precautions and Warnings
Diabetic autonomic neuropathy
Glucose-galactose malabsorption syndrome
Obstetric paracervical anaesthesia
Occlusive peripheral vascular disorder
Reduce dose in patients with hepatic impairment
Reduce dose in patients with renal impairment
Advise ability to drive/operate machinery may be affected by side effects
Advise patient not to drive or operate machinery until assessed
Treatment to be initiated and supervised by a specialist
Administer injection slowly
Aspirate prior to injection to avoid intravascular administration
Avoid local anaesthetics if inflammation in region of proposed injection
Do not inject near site of skin infection
Resuscitation facilities must be immediately available
Treatment to be administered by or under supervision of specialist
Monitor closely patient with previous or current arrhythmic disorder
Monitor vital signs, respiration & cardiac function
Discontinue immediately on the first signs of toxicity
In obese patients dosing should be based on ideal weight
Reduce dose in elderly
Breastfeeding: Do not breastfeed & discard milk for 24 hours after therapy
In high risk patients, the general condition of the patient should be improved prior to administration.
The manufacturer advises reducing the dose in patients with established concomitant disorders (e.g. vascular occlusion, arteriosclerosis, diabetic polyneuropathy), in debilitated patients or in late pregnancy.
High or total spinal block, with consequent cardiovascular and respiratory depression, can rarely be experienced with prilocaine. Severe hypotension and bradycardia may also be induced by prolonged block of the sympathetic nervous system, even to the point of cardiac arrest. A drop in arterial pressure and cardiac frequency may also occur. Elderly patients and patients in the final period of pregnancy are more at risk.
Neurological damage may rarely be seen after spinal anaesthesia, marked by paraesthesia, loss of sensitivity, motor weakness and paralysis. There is no evidence that spinal anaesthesia is negatively influenced by neurological disorders such as multiple sclerosis, hemiplegia, paraplegia or neuromuscular disorders, but appropriate care should be taken when administering prilocaine to these patients, with thorough consideration of the benefits and risks of prilocaine administration.
Pregnancy and Lactation
Use prilocaine with caution in pregnancy.
Prilocaine is contraindicated for paracervical block or pudendal block.
There is no published information on the use of prilocaine in pregnant women. The manufacturer states that prilocaine should only be given in pregnancy if the expected benefits clearly outweigh the potential risks, and a dose reduction should be considered in late pregnancy.
Prilocaine is known to cross the placenta.
Animal studies have shown reproductive toxicity.
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 ).
Use prilocaine with caution in breastfeeding.
It is not known if prilocaine is present in human breast milk. The effect on the nursing infant is also unknown. The manufacturer states that if administration is clinically necessary, breastfeeding can be resumed approximately 24 hours after use of prilocaine 2% injection.
LactMed suggests that alternative anaesthetics may be preferable when breastfeeding.
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
Changes in pulse
Sensation of cold
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 ).
Last Full Review Date: May 2018
Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 3rd edition (2015) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.
NICE Evidence Services Available at: www.nice.org.uk Last accessed: 09 May 2018
Summary of Product Characteristics: Prilotekal 20mg/ml solution for injection. Sintetica Limited. Revised February 2017.
US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
Available at: https://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT
Prilocaine Last revised: 08 September 2013
Last accessed: 10 May 2018
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